Valuing consumer safety

Snowboarding is quickly becoming a popular sport at alpine resorts. In contrast to alpine skiing, where injuries to the knee and thumb are most common, the wrist (and forearm) and ankle are the most frequently injured body regions for snowboarders. Unfortunately, the rapid international growth of the sport has not been matched by detailed epidemiological evaluation of the injuries specific to snowboarding or the countermeasures to prevent them. The aim of this paper is to critically review the literature describing injury prevention measures, or countermeasures, for snowboarding. In doing so, it provides an evaluation of the extent to which these countermeasures have been demonstrated to be effective or associated with the occurrence of new types of injuries. Few countermeasures specific for snowboarding were found to have been formally evaluated. The countermeasures to which some attention has been paid are boots, bindings, wrist guards, skill level and methods of falling. Skill level and the other injury countermeasures apply more generally across the sport. Recommendations for countermeasure implementation include: education for snowboarders, adherence to snow conduct and safety codes, preparing snowboarders for their activity and maintenance of parks and runs. Recommendations for improved data collections include: standardising and maintaining existing data collections, collecting information about equipment used by snowboarders and monitoring injury trends. Further biomechanical and epidemiological research needs to be undertaken on knee/ankle and wrist/forearm injuries. Evaluation of countermeasures needs to keep pace with the rapid developments in this field. Particular attention should be directed towards evaluations of the role of wristguards, boots/bindings, fall technique and lessons in preventing injuries. Given the rapidly increasing popularity of the sport, the need for the safety equipment to be evaluated would seem to be a priority, along with identification of the mechanisms of injury.     

Skiing and snowboarding injuries and their impact on the emergency care system in South Tyrol: a restrospective analysis for the winter season 2001–2002

Objectives. To evaluate the incidence and the pattern of skiing and snowboarding injuries in South Tyrol and their impact on the emergency medical system in the winter season 2001–2002 in an attempt to rationalize and improve the emergency care and assist in prevention strategies.

Methods. All medical records of patients referred to our emergency department (ED) that sustained a skiing or snowboarding injury during the study period were retrospectively reviewed. Age, sex, local or non-local residency, type of injury, data and time of accident, type of transport to the hospital, hospital admission or ED discharge, Injury Severity Score, outcome (including mortality) were evaluated. On site mortality data were obtained from the emergency call-center registry. Ski resorts utilization was estimated from the data published by the Regional Office of Cable Transport.

Results. For the period analyzed approximately 2,500,000 skier and snowboarder days were recorded in the whole region of which about 500,000 were attributed to the four nearby ski resorts that refer to our hospital. Of the 1087 patients, 794 were skiers and 294 were snowboarders. Snowboarders were younger than skiers (mean age 20 and 36 respectively, p = 0.001). Females were equally represented in the two groups. Male patients, children, senior skiers and non-local residents suffered from more severe injuries than their corresponding classes (p < 0.01, p = 0.002, p = 0.02, p = 0.000 respectively). Critical injuries (ISS ≥ 25) were homogeneously spread in the groups, with the exception of the non-local resident patients that showed a higher incidence (p < 0.02). No difference in severity was found between skiers and snowboarders. The incidence was 2.05 per 1,000 skier-days. Mortality rate was 1.6 per 1,000,000 skier-days. The pattern of injury was different: snowboarders showed more forearm and wrist trauma and skiers more lower extremity injuries. 208 patients were hospitalized and the mean length of stay was 4.5 days. Head trauma and fractures were the most common diagnosis of admission. The lack of field triage led to 12% of unjustified helicopter transfer and 9.6% of avoidable ambulance transport.

Conclusions. Incidence, pattern of injuries and mortality from skiing and snowboarding accidents in South Tyrol resemble those reported in other part of the world. Nevertheless, strategies for prevention are needed. The routine use of helmets should be enforced by law. Dangerous behaviors should be prosecuted. Skiers and snowboarders should be made aware that skiing beyond their technical ability can be life-threatening.     

滑雪场经济效益分析

滑雪场是新兴的企业组织,在我国处于起步阶段。如何提高滑雪场的经营效益,成为我国滑雪产业发展的"瓶颈问题"。我国各种规模的滑雪场有350家,但全国整个滑雪产业的经营额尚不及美国科罗拉多州的一个滑雪场的销售额度。近几年来,特别是一些中大型的滑雪场在经营方面遇到了"寒潮"。应借鉴西方的厂商理论对滑雪场的经营效益进行定量分析,采取更有效的措施提高我国滑雪场经营效益。     

Home-related injuries among under-five-year children and mothers' care regarding injury prevention in rural areas

This cross-sectional study was conducted in rural areas of Twiserkan (Toyserkan) County, in Iran, to assess factors associated with home-related injuries among under-five-year children and their mothers’ care regarding injury prevention. Mothers who had their under-five-year-old children injured within a 12-month period were identified from recorded information in Twiserkan Health Center. Then, data were gathered using pre-tested questionnaire and through interview with injured children's mothers. The questions were about characteristics of the children's injuries and their mothers’ care regarding injury prevention, using PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation) model with focus on knowledge and attitude; enabling and reinforcing factors; and mothers' preventive behaviours. The study results showed that 197 out of 210 total identified mothers took part in the study. The reported injuries were 11.68%, 39.09%, and 49.24%, respectively, for severe, moderate, and mild cases. Fall was the most frequent injury with 35%. Among PRECEDE model constructs, there was a statistically significant correlation between mothers' knowledge and injury severity among children. Home-related injuries are an important health problem among study population and their prediction and prevention are necessary. Enhancement of mothers’ knowledge can be helpful to improve child injury prevention.     

Developing the evidence-base for Safe Communities: a multi-level, partly randomised, controlled trial

Safe Communities, representing a global activation of the public health logic, may be strengthened through theoretical, methodological and empirical support. In the spirit of this Special Issue that aims to analyse the achievements and challenges inherent to Safe Communities, we offer our contribution in the form of a methodology of a multi-country child safety, peace and health promotion study. The study, situated within an African-centred initiative called Ukuphepha - an isiZulu word meaning demonstrating African safety - is underpinned by four theoretical claims that frame injury and violence prevention as a multi-disciplinary issue to be addressed through a suite of interventions to family and extended social systems. The interventions, sensitive to the priorities of each participating country, have been informed by the literature on effective interventions and the authors' joint experiences of community development. The study is designed as a population-based, multi-level, multi-intervention partly randomised controlled trial, and there are potentially 24 participant communities representing South Africa, Mozambique, Egypt, Zambia, Uganda, Bangladesh, Malaysia and Australia - over three commencement phases. Whereas process evaluation will focus on community engagement, impact evaluation will consider risk and protective factors, and outcome evaluation will examine the overall effectiveness of the interventions. Notwithstanding the many challenges, the study will provide insights into the methodology and mechanisms of ecologically-oriented interventions that locate injury and violence prevention as an activity arising from safety, peace and health promotion.     

Drunk, drowsy, doped: skiers' and snowboarders' injury risk perceptions regarding alcohol, fatigue and recreational drug use

The objective was to investigate perceptions of snowfield resort visitors about injury risk regarding alcohol, fatigue and recreational drug use. Visitors to a resort village in a large Australian snowfield region completed a brief survey about fatigue, alcohol and recreational drug use and injury risk perception. Participants stated their ability to ski or snowboard and drive safely following a lack of sleep, alcohol and recreational drug use. Intoxicated snowfield resort visitors were compared with non-intoxicated visitors. Safety beliefs across snow sport and transport were compared. Participants reported that they generally slept less than usual and 30% reported both drinking alcohol and using drugs more than usual while visiting the snowfields. Participants perceived driving as a greater injury risk than skiing/snowboarding (p < 0.001). Fatigue was perceived as a relatively weak injury risk factor, particularly whilst skiing and snowboarding. Awareness needs to be raised among snowfield resort visitors about the contribution of alcohol, fatigue and recreational drug use to snow sport and transport-related injury risk.     

Motala Municipality - a sustainable Safe Community in Sweden

An extensive research project concerning injury prevention was planned and initiated in Motala Municipality in the early 1980s. This article summarises 25 years of work for injury prevention and safety promotion in Motala. Evaluation of both process and effect were conducted based on a quasi-experimental study design, as well as cost-effectiveness and cost-benefit analyses of interventions. Initial evaluations results showed an annual incidence of injuries of 118.9/1000 citizens in 1983/1984 consisting of injuries at home (35%), sports injuries (18.9%), injuries at work (13.7%), traffic-related injuries (12.8%) and other injuries (19.5%). The annual social economic costs of injuries were estimated at 116 million Swedish crowns (SEK). By 1989, after two years of preventive work, the incidence of injuries was reduced by 13%. The greatest decrease was among the moderate severity category of injuries (41%). The social economic costs were thereby reduced by 21 million SEK per year. Since then, work with injury prevention has continued and annual evaluations have shown that the incidence of injuries, with some fluctuation, has continued to decrease up to the latest evaluation in 2008. The total decrease during the study period was 37%. This study shows that community-based injury prevention work according to the Safe Community model is a successful and cost-effective way of reducing injuries in the local community.     

论滑雪场及周边城镇建设与房地产开发的互动关系

滑雪场建设是滑雪旅游产业发展的基础,它依托房地产开发建设,又拓宽了房地产开发市场;它对雪场周边城镇的经济发展也是有力的促动。为此,雪场及其周边城镇的房地产开发建设要围绕滑雪旅游这个中心,突出冰雪文化特色和生态特色,推动雪场及周边城镇的经济发展。     

Strategies and goals of community-based injury prevention programmes--a mixed-methods study of 25 Scandinavian WHO Safe Communities

Documentation and analysis of prevention goals and interventions employed by community-based injury prevention programmes is vital to advance the knowledge and understanding of synergistic multi-strategy injury prevention programmes. This study examined the goals and interventions of 25 Scandinavian community-based injury prevention programmes in WHO-designated Safe Communities. Collection and analysis of quantitative data from survey questionnaires to the programme coordinators was followed by collection and analysis of qualitative data from structured interviews with programme coordinators from eight of the programmes. The results demonstrated that the programmes under study predominantly relied on "intuitive" and subjective methods for selecting interventions. The programmes largely failed to transform injury surveillance data into information and knowledge that could prioritize community safety strategies and measures, due to insufficient time and personnel resources. The results demonstrated the importance of combining passive approaches with active interventions. Educational efforts were considered essential to the programmes. The programmes preferred to rely on broadly stated goals rather than specific objectives.     

Strategies and goals of community-based injury prevention programmes – a mixed-methods study of 25 Scandinavian WHO Safe Communities

Documentation and analysis of prevention goals and interventions employed by community-based injury prevention programmes is vital to advance the knowledge and understanding of synergistic multi-strategy injury prevention programmes. This study examined the goals and interventions of 25 Scandinavian community-based injury prevention programmes in WHO-designated Safe Communities. Collection and analysis of quantitative data from survey questionnaires to the programme coordinators was followed by collection and analysis of qualitative data from structured interviews with programme coordinators from eight of the programmes. The results demonstrated that the programmes under study predominantly relied on ‘intuitive’ and subjective methods for selecting interventions. The programmes largely failed to transform injury surveillance data into information and knowledge that could prioritize community safety strategies and measures, due to insufficient time and personnel resources. The results demonstrated the importance of combining passive approaches with active interventions. Educational efforts were considered essential to the programmes. The programmes preferred to rely on broadly stated goals rather than specific objectives.     

Injury incidence,risk perception and product-related safety behavior among 18- and 45-year-olds

Abstract

Adolescents generally have twice the injury incidence of adults. This increased risk of injury may partly be a consequence of the types of activities performed, the level of exposure to products and the safety behavior. The purpose of this paper was to identify possible predictors for the increased injury risk of adolescents compared to adults. To this end, all 18- and 45-year-olds in a major city in Norway received a questionnaire asking for information on injury experience, level of use and risk perceptions concerning 14 specific products, and the adoption of safety measures; 686 18-year-olds and 81 o 45-year-olds answered the questionnaire. The adolescents reported a higher injury incidence as compared to adults for all the listed products. The difference was significant even after controlling for level of use. Adolescents also had higher levels of risk perception and decreased adoption of safety measures as compared to adults. Females reported less injuries but higher levels of risk perception than males. Females also adopted more safety measures. An important finding from this study was that adolescents, as compared to adults, also expose themselves to increased risk levels when ‘ordinary’ products are concerned, and not only in terms of well-known high-risk activities (driving fast, skiing downhill, etc.). This tends to support the idea that more general factors or dimensions of risk-related behaviors may exist which should be accounted for in the planning of injury prevention activities.     

Impact of the Safe Community program in Harstad on the incidence of injuries

Objectives Since 1987, the Harstad community in Norway has run an injury prevention program according to the Safe Community approach. The effectiveness of this approach in reducing injury rates is poorly documented. The aim of this study was to evaluate the impact of the Harstad program on the incidence of injuries. Methods We used data from the National Injury register of Norway and compared age-adjusted incidence rates and standardized rate ratios of injuries in Harstad and three control communities for the period 1992-1997. Results Harstad had the second highest rates for both all injuries and fractures. No reduction in the incidence of injuries in Harstad was observed from 1992-1997. The injury rates in 1992-1997 were similar to the rates recorded in 1985/86. Conclusions The injury prevention program in Harstad has not reduced overall injury rates. The Safe Community concept is an organizational strategy, but implementation of proven and targeted risk reduction measures will be needed if community-based programs are to result in risk reductions.     

Unintentional child home injury incidence and patterns in six countries in Europe

This study investigates the incidence and patterns of child home injuries in six European Union countries. Emergency department and inpatient injury data on injuries to children aged 0-18 years in the home (n = 88,567) for the years 2003-2004 were extracted from the European Injury Database in Austria, Denmark, France, Netherlands, Portugal and Sweden. The incidence of child home injuries was 44.9/1000 inhabitants Six age-dependent injury patterns were identified using cluster analysis: 1) open wound head injuries; 2) hospital admissions for bruises, contusions, abrasions; 3) falls on stairs indoors; 4) fractures and sprains of the upper extremities; 5) crush/cut/piercing of the fingers; 6) miscellaneous injuries. Child home injuries are a considerable public health problem, particularly in the ages 0 to 4 years. The findings are useful for injury surveillance at the European level yet do not allow for designing testable countermeasures for prevention within home safety initiatives.     

Height, fun and safety in the design of children's playground equipment

The study reported in this paper adopted a holistic design approach to investigate issues associated with height related playground injuries from a users' perspective. The main objective was to gain an understanding of the relationship between height and fun so as to establish practical guidelines for addressing the causes of height related injuries whilst maintaining the attributes of playground equipment that children find fun and challenging. Results show that, on the one hand, the risk of injury increases when height is coupled with the use of upper body strength and, on the other hand, that coordination is a greater source of fun and challenge than height for children. Accordingly, it is suggested that the level of risk of injury attached to children's playground equipment can be reduced when the use of lower body strength and coordination are combined with lower free fall heights.     

Evaluation of a home injury prevention program in a WHO Safe Community

The objective of this study was to evaluate the effect of a community-based injury prevention program on home injuries. Unintentional injuries occurring in private homes and during leisure time account for 70-80% of injuries treated in public health care. A quasiexperimental design was used for the study, with cross-sectional preand post-implementation measurements in the program area and in a neighboring control community. Children and the elderly were two main target groups of the intervention program, which was based on a participative strategy for community involvement. The study was based on defined total populations. The total relative risk for home injury occurrence decreased in the study area, whereas it increased in the control area. Regarding age and gender, there was a decrease for females and males in the study area and a slight increase in the control area. For males, the youngest and oldest age groups showed no decrease, whereas females showed a decrease among the youngest and those aged 60-79. No decrease was observed in the control area. The study showed that the Safe Community approach had a general effect on the incidence of home injuries.     

Product involvement in do-it-yourself maintenance injury

Abstract

PROBLEM Numerous activities to promote bicycle safety have been implemented in Norway. The overall effect of these activities has not been evaluated.

method Information about cases of bicycle-related injuries occurring in 1990-1993 was obtained from prospective registration of all injuries treated by hospitals and emergency clinics in four urban centers in NORWAY. Incidence was calculated per number of cyclists, based on data obtained from the 1992 National Bicycle Survey. Temporal changes in injury severity and in age-specific incidence (per bicycle riders) of all injuries, upper-head injuries, other injuries, injuries due to bicycle-motor vehicle collision, and injuries leading to inpatient treatment were analyzed by logistic regression analysis.

RESULTS 3,893 injuries occurred in the study population in 1990-1993. The average annual incidence was 33.1 per 10,000 population aged 4 years and higher, or 47.9 per 10,000 bicyclists. No significant secular trends were found for any of the analyzed parameters.

CONCLUSIONS Bicycle safety promotion measures implemented during 1990-1993 did not significantly reduce the risk of bicycle-related injury in Norway. Effective bicycle safety programs should be implemented, based on the positive experiences from other countries. Injury surveillance systems appear to be a useful tool for evaluating injury prevention programs.     

Comparing the characteristics of snowboarders injured in a terrain park who present to the ski patrol,the emergency department or both

Ski patrol report forms are a common data source in ski/snowboard research, but it is unclear if those who only present to the emergency department (ED) are systematically different from those who see the ski patrol. To determine the proportion and characteristics of injured snowboarders who bypass the ski patrol before presenting to the ED, three groups of injured snowboarders were compared: presented to the ED only, ski patrol only and ski patrol and ED. Data were collected from ski patrol Accident Report Forms (ARFs), ED medical records and telephone interviews. There were 333 injured snowboarders (ED only: 34, ski patrol only: 107, both: 192). Ability, time of day, snow conditions or drugs/alcohol predicted ED only presentation. Concussions (RRR: 4.66; 95% CI: 1.83, 11.90), sprains/strains (RRR: 4.22; 95% CI: 1.87, 9.49), head/neck (RRR: 2.90; 95% CI: 1.48, 5.78), trunk (RRR: 4.17; 95% CI: 1.92, 9.09) or lower extremity (RRR: 3.65; 95% CI: 1.32, 10.07) injuries were significantly more likely to present to ski patrol only versus ski patrol and ED. In conclusion, snowboarders who presented to the ED only had similar injuries as those who presented to both.     

A survey of inventions aimed at preventing drowning

To identify, describe and compare injuries among three water sport activities: kite surfing (KS), personal watercraft (PWC) and towed water sports (TWS). The study was a cross sectional, online survey. The setting was on Perth, Western Australia's popular beaches and riverbanks. Main outcome measures were number of injuries and level of severity; level of exposure and protection measures. Overall, 43% reported at least one injury in the past 12 months, a rate of 22.3 injuries per 100 h. Kite surfers were more likely to report an injury than PWC or TWS. One-half of injuries occurred while on the water. Most injuries were caused by landing awkwardly (56%) and/or trying new tricks (41%). Despite 90% of respondents having used at least one personal protective equipment (PPE) item, half (49%) reported always using a personal floatation device. This study provided information on KS, PWC and TWS injuries as well as a range of safety behaviours. It is recommended that these results form the basis of further research to reduce injury rates and encourage the use of PPE items.     

Addressing the worst cases

Child injury, regardless of intent, is a major public health issue in Australia and elsewhere. Child protection and injury prevention policies and practices are implemented in most countries in an attempt to manage and reduce the incidence of both intentional and unintentional injuries. While these systems are thought to assist in improving protection from violence, injury and neglect, one of the major limitations in understanding the effectiveness of child protection policy in Australia is a lack of reliable national data on child abuse and neglect. As a result there is a lack of an appropriate evidence base on which to guide the development of effective policies. A particular area where official figures may under-represent the true prevalence of child deaths is those which result from homicide. This article provides a review of the recent literature on child homicide, abuse and neglect, with the overall aim of understanding more fully the reasons for the possible under-representation of child homicides and provides recommendations to address this problem in Australia. Improvements in methods of identifying at risk children in addition to systematic investigations of child deaths to understand the risk factors and underlying contributing factors are required.     

Knowledge,attitudes, and practices of family physicians and nurses regarding unintentional injuries among children under 15 years in Cairo,Egypt

Unintentional injuries are a leading cause of death among children, especially in developing countries. Lack of reliable data regarding primary health care professionals' role in childhood unintentional injury prevention hinders the development of effective prevention strategies. A survey of 99 family physicians and nurses from 10 family health centres sought to develop insight into their knowledge, attitudes, and practices regarding unintentional injury prevention for children <15 in Cairo, Egypt. Approximately, 60% were familiar with the terms unintentional injuries and injury prevention. Falls and road traffic crashes were identified as primary causes of childhood injuries by 54.5%. While >90% agreed injury prevention counselling (IPC) could be effective, only 50.5% provided IPC. Lack of time and educational materials were the leading barriers to provision of IPC (91.9% and 85.9%, respectively), while thinking counselling is not part of their clinical duties was the least perceived barrier (9.1%). There is a large disconnect between providers' knowledge, attitudes and practices regarding IPC, more training and provision of counselling tools are essential for improving IPC by Egyptian medical providers.