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.     

How much would low- and middle-income countries benefit from addressing the key risk factors of road traffic injuries?

Abstract

Despite strong advocacy, the UN Decade of Action for Road Safety (2011–2020) is ending with most low- and middle-income countries (LMICs) no closer to the Sustainable Development Goals target of reducing traffic mortality by half. In contrast, most high-income countries (HICs) have seen large benefits in recent decades from large-scale safety interventions. We aimed to assess how much LMICs would benefit from interventions that address six key risk factors related to helmet use, seatbelt use, speed control, drink driving, and vehicle design for safety of occupants and pedestrians. We use a comparative risk assessment framework to estimate mortality and health loss (disability adjusted life years lost, DALYs) that would be averted if these risks were reduced through intervention. We estimate effects for six countries that span all developing regions: China, Colombia, Ethiopia, India, Iran, and Russia. We find relatively large benefits (27% reductions in road traffic deaths and DALYs) from speed control in all countries, and about 5%-20% reductions due to other interventions depending on who is at risk in each country. To achieve larger gains, LMICs would need to move beyond simply learning from HICs and undertake new research to address risk factors particularly relevant to their context.     

Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala,Uganda

ABSTRACT

Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22–15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01–1.96). Older children (12–18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26–4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03–12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21–3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11–0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.     

Injuries in preschool children: the hypothetical protector effect of minor injuries and risk factors for minor and medically attended injuries

This study aimed to investigate the relationship between minor and medically attended injuries and to analyse the influence of child-related factors and family-related factors in injuries of preschool children. Individual interviews were conducted with 335 parents of 1- to 5-year-old children. Parents informed about the child and the family variables and reported the child's history of injuries in the last year. The frequencies of minor injuries and medically attended injuries were not correlated. The risk factors for both kinds of injuries include the number of siblings and the size of the family. Minor injuries were more frequent in older than in younger children. Medically attended injuries were more frequent in boys than in girls. The risk factors that influence minor and medically attended injuries are different, suggesting that the strategies to prevent and reduce injuries need to take that difference into consideration.     

Bicycle-related injuries: Injury,hazard, and risk patterns

Abstract

This paper provides the results of a U.S. Consumer Product Safety Commission (CPSC) study to determine the circumstances involved in bicycle-related injuries treated in U.S. hospital emergency rooms. It also includes information from a CPSC exposure survey of the U.S. population of bicycle users and their patterns of bicycle and helmet use. Together, these data were used to identify and evaluate risk factors currently associated with bicycle use in the United States

Risk models identified factors specifically associated with injuries to children and to adults. Children were at particular risk of injury, and appeared to be especially vulnerable to head injury. In addition, the risk of injury for children was significantly increased when riding in non-daylight conditions. For both adults and children, there was a higher risk of injury on streets than in such areas as bike paths or unpaved surfaces. While some problems associated with bicycle assembly, operation, and maintenance were observed, the data did not suggest that any mechanical remedy is likely to reduce injuries substantially.     

Accidental injuries among the elderly within the Vienna community: Epidemiology,risk factors and preventive measures

Abstract

Unintentional injuries ('accidents’) among elderly people are a significant burden in public health because such accidents happen frequently and because the proportion of older age groups in the population will continue to rise during the coming decades. One aim of this study, which was done in Vienna, the capital of Austria, was to broaden the preventive concept, adding lifestyle and living conditions to already well-known risk factors following the health promotion approach. Furthermore, characteristics that predispose older residents to accidents should be identified in order to design preventive measures for reducing injuries in this age group.

809 interviews with people 60 years of age and over were conducted, concerning accidents, outcomes of accidents, physical fitness, drug intake, type of house or dwelling, equipment in the household incorporating safety features, psychological well-being and social relations. The information collected was used to draw cross-sectional comparisons between participants who reported having experienced at least one accident in the previous 12 months and those who did not. Furthermore, the accident incidents were classified into 2 groups: incidents without injuries and injurious accidents. The latter served as a base for the epidemiology of injuries for people 60 years of age and over within the Vienna community.

20% of all senior citizens suffer at least one unintentional injury every year, in addition to which 8% experience critical incidents (mostly falls) without injury. Most accidents occur at home or involve pedestrians in public traffic areas. Over 90% of all accidents are falls, and 20% result in fractures. The most important risk factors for accidents in the elderly are gender, increasing age, poor physical fitness and low physical activity, the type of household and household equipment, poor psychological well-being, low income and loneliness.

The findings regarding falls suggest some possible opportunities for reducing the risk of falls by improving buildings and dwellings of the elderly. A promising attempt at practical implementation of these findings is being conducted by the Vienna-based Austrian Institute for Home and Leisure Safety in cooperation with the Vienna City Council. These two organizations are implementing a long-term program that aims at mobilizing institutions and organizations involved in working with the elderly.     

Dealing with existing theory: national fatality rates,vehicle standards and personal safety

Abstract

In this paper we discuss some of the weaknesses in exiting theories and understandings behind road safety interventions and policy making. The paper deals with four main issues: road traffic fatality rates and per capita income of countries, vehicle crashworthiness standards, role of pedestrian and powered two-wheeler share in traffic on fatalities, and safety standards for vehicles other than cars. Recent data indicate that there may not be a strong relationship between income and road safety performance and it is possible for low and middle-income countries (LMIC) to decrease death rates at present income levels. Safer cars have had a major role in reducing fatality rates, but, gains in traffic safety in high income countries may be partly due to reducing exposure of vulnerable road users. Small lightweight vehicles (like tuk-tuks, three-wheeled scooter taxis) operating in many LMIC appear to have low fatality rates though they do not follow any crashworthiness standards. Very different crashworthiness standards need to be developed for low mass vehicles incapable of operating speeds greater than 50?km/h. LMIC may not be able to reduce fatality rates below about 7 per 100,000 population unless there are innovative developments in road design and all vehicle safety standards.     

Childhood and adolescent injuries in elementary schools in north-western Uganda: extent,risk and associated factors

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural–urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.     

Perceptions of risk among children with and without attention deficit/hyperactivity disorder

Traditionally, health professionals have positioned injury prevention strategies from their own perspective with little acknowledgement or understanding of the perspective of those who experience risk taking: specific populations of children with differing approaches to risk perception and problem-solving. The present study addresses this oversight by engaging children with and without attention deficit/hyperactivity disorder (ADHD) to explore the meaning of risk from their perspective. Although both groups of children reported similar processes of assessing risk, unique to children with ADHD was the overestimation of their physical abilities, intentional risk taking and anticipation of positive or no consequences of their risk taking. These findings also advance our knowledge of potentially appropriate strategies to effect change in risk taking that could influence risk of injury. Specifically, findings suggest that prevention efforts that incorporate both cognitive and social interventions are the most promising approaches. Integrating this understanding of children's perception of risk builds our knowledge about the contribution of risk perception to injury events and may help to inform future injury prevention initiatives with children with ADHD.     

Victims of road accidents with serious injuries and dependence on some individual,climatic and infrastructure factors on federal highways in Brazil

Abstract

Road or urban traffic accidents in Brazil have a large presence in external causes of mortality. The main goal of this study is to discover significant factors in the incidence of accidents on Brazilian highways based on a database with information on each person injured on federal highways in Brazil reported by the Federal Highway Police. Some factors are considered in the study as cause of the accident, type of accident, stage of the day, weather condition, highway type, highway facility, age of the victim, gender of the victim and type of vehicle. From the obtained results of chi-square tests and logistic regression models, it was observed statistical dependence (p?<?0.05) of the occurrence of injured people with serious injuries and the factors cause of the accident, type of accident, day, highway type and vehicle type. Considering the dead victims, the covariates age, time of day, highway type, highway facility, gender and type of vehicle showed significance (p?<?0.05). These results are of great interest for authorities to increase road enforcement, improve highway facilities and target the production of vehicles with better safety standards.     

Pillion riders' cloth related injuries and helmet wearing patterns: a study of Lahore,Pakistan

This study aims at investigating the burden and pattern of clothing related pillion riders' injuries and their helmet wearing pattern in Lahore, Pakistan. Data were collected for nine months (July 2013 to March 2014), reporting 13,248 motorcycle related injuries, out of which 8751 (66%) cases were related to the clothing related pillion riders' injuries. Out of these injuries 10.30% were severe injuries which can be prevented or reduced by proper safety measure, e.g. wearing helmet. It was also found that most of the fatalities were not wearing helmet. Injuries due to wearing of loose fitting clothes and absence of helmet are not uncommon in Pakistan and other underdeveloped parts of the world. Such accidents may be reduced by creating awareness and safety sense in the riders, where use of safe dress and helmet should be encouraged in order to avoid such fatal damages.     

Costs of unintentional injuries among children in an urban slum community in Kampala city,Uganda

Abstract

Unintentional injuries cause deaths, disabilities, productivity and financial losses and disproportionately affect children in low-income settings yet their cost remains under studied. This study determined the household out-of-pocket expenditure and missed school attendance due to unintentional childhood injuries in a Ugandan slum. We used a cross-sectional household survey design. Data were collected on occurrence and associated costs of unintentional injuries during a one-year period from July 2014 to June 2015. A total of 706 (44.7%) children who had suffered from injuries were reported in the one year period. More male children (N?=?415, 58.7%) suffered injuries than females (N?=?291, 41.2%). The average out-of-pocket expenditure on treating an injury was US $24.1 [standard deviation (SD)?=?±$62.8] and mean school days lost were 25 days (SD?=?±51.8). Road traffic injuries (RTIs) resulted in higher costs [mean difference was US $51.1 (95% CI: $11.4–$90.8)] compared to injuries that, for example, occurred at school. In a Ugandan slum community, unintentional childhood injuries resulted in high out-of-pocket expenditures and missed school attendance. The costs varied widely depending on external causes of the injury. These findings highlight the need to invest in population level injury prevention interventions to reduce injury costs by households.     

Comparison of attitudes towards school lunch by elementary school children in Japan,Korea and Thailand

The attitudes of elementary school children towards school lunch among three Asian countries, namely Japan, Korea and Thailand, were compared. More school children in Japan felt that their teachers gave them advice during the school lunch programme. Japanese and Korean teachers advised their children to eat as much as possible of the lunch. Korean children may be a little more obedient with regard to heeding the advice. However, few teachers in Thailand gave the children advice over eating lunch, and the Thai children looked forward to and enjoyed the school lunch. The different responses between Thailand and other two countries may be attributed in part to the differences in the teachers' instruction in the programme. Elementary school teachers, especially in Thailand and Korea, have to take more classes in food and nutrition in universities or colleges, and positively take part in the school lunch programme.     

The specific factors continuum model, with implications for globalization and income risk

This paper embeds the specific factors model in the goods continuum approach of Dornbusch et al. (1977, 1980) and applies it to analyze the effect of globalization on income risk. Globalization amplifies sector specific income risk induced by idiosyncratic sectoral technology shocks, but tends to reduce income risk to both mobile and immobile factors induced by aggregate technology shocks that differ by country. Aggregate risk bears most heavily on the poorest specific factors.     

Partner violence as a risk factor for mental health among women from communities in the Philippines,Egypt, Chile,and India

Although studies have documented the association between Intimate Partner Violence (IPV) and mental health, few have been done in developing countries. In this study, the association between IPV and mental health in women from different developing countries was established.

Women, 15 to 49 years old with at least one child 18 years old or younger, were randomly selected from communities in Chile, Egypt, India, and the Philippines (N = 3974). The Self Report questionnaire (SRQ) was used to assess mental health. Women with a score on the SRQ of 8 or more, or who reported ever attempting suicide, were classified as having poor mental health. Physical IPV was defined as being slapped, hit, kicked, beaten or threatened by a male partner during the past year. Psychological violence included being insulted or belittled, threatened or abandoned.

Between 22.5% (in Egypt) to 41% (in Chile) of participating women reported a score of eight or more on the SRQ. High scores on the SRQ were significantly associated with current physical and psychological IPV in the samples from all participating countries except Chile. Twelve percent of women in Chile, 2.6%, in Egypt, 7.5% in India and 1.6% in the Philippines reported attempting suicide. Suicide attempts were also associated with current physical IPV in the Philippines, Egypt, and India, and with psychological violence in Egypt and India.

IPV is a significant risk factor for poor mental health in these developing countries. Efforts to reduce IPV should be considered as part of a mental health program.     

中朝韩经贸关系纵深发展的战略进路

随着东北亚地区经济联系的日益紧密,域内国家间的相互依存度明显提高.东北亚经济合作划时代的契机是域内国家签订自由贸易协定,从而平行地促进产业分工.中朝韩三国经贸合作规模的提升和发展速度的提高,可以推动一度因日本态度消极而搁浅的中日韩自由贸易区建设,并将成为东北亚经济合作发展的催化剂.中朝经贸发展的能动力在于中国建设性的参与朝鲜的经济革新发展,而中韩经贸发展的增长点则在于加速建立自由贸易区.