Search

BackgroundWorldwide, injuries represent one of the leading causes of mortality, and nearly one-quarter of all injuries are road traffic related. In many high-income countries, the burden of road traffic injuries (RTIs) has shifted from premature death to injury and disability with long-term consequences; therefore, it is important to assess the full burden of an RTI on individual lives.ObjectiveTo describe how men and women with minor and moderate injuries reported the consequences of an RTI on their health and lives.MethodsThe study was designed as an explorative qualitative study, in which the answers to an open-ended question concerning the life and health consequences following injury were analysed using systematic text condensation.ParticipantsA total of 692 respondents with a minor or a moderate injury were included.ResultsThe respondents reported the consequences of the crash on their health and lives according to four categories: physical consequences, psychological consequences, everyday life consequences and financial consequences. The results show that medically classified minor and moderate injuries have detrimental long-term health and life consequences. Although men and women report some similar consequences, there are substantial differences in their reported psychological and everyday life consequences following an injury. Women report travel anxiety and PTSD-like symptoms, being life altering for them compared with men, for whom these types of reports were missing.ConclusionThese differences emphasise the importance of considering gender-specific physical and psychological consequences following an RTI.

This study investigates the degree to which a previous hospitalisation for injury of any intent is a risk of subsequent youth suicide and whether this association is influenced by family socioeconomic status or economic stress.A nationwide register-based cohort study was conducted covering all Swedish subjects born between January 1977 and December 1991 (N=1,616,342, male/female ratio=1.05). The cohort subjects were followed-up from January 1998 to December 2003, when aged 7-26 years. Poisson regression and the likelihood ratio test (95% CI) were used to assess the age-adjusted effect of hospitalisation for injuries of various intent on youth suicide and its effect once adjusted for family sociodemographic and social circumstances.Each set of exposures was associated independently and significantly with suicide mortality. Being hospitalised for self-inflicted injuries or injuries of undetermined intent was associated with a risk of suicide 36 to 47 times, respectively, that of subjects never hospitalised in the period under study (95% CI 28.36 to 45.58 and 26.67 to 83.87 for self-inflicted injuries and for events of undetermined intent, respectively; overall p0.01). Similarly, previous events of unintentional injury markedly increased the risk of suicide (RR 3.08; 95% CI 2.26 to 4.19). These effects were solid and not substantially altered after adjustment for family demographic and socioeconomic circumstances.A strong association exists between previous hospitalisation for injury of any intent and youth suicide. The association is robust and unaltered by family socioeconomic circumstances.

Background Burn injuries are a leading cause of premature death worldwide and are largely attributable to poor living conditions. Timely care is a prerequisite to reduce morbidity and mortality and it can be significantly improved by smartphone-based consultation systems. The overall aim of this project is to assess how an mHealth system for acute burn injury care can impact on the delivery of emergency care for burns victims in terms of clinical management. Methods The clinical quality includes assessments of diagnostic accuracy and patient management. Bedside diagnosis or image based diagnosis by burns experts will be used as gold standard. Technology Usability Evaluation Model will be used to assess how the users experience the system. Results A tele-consultation system for acute burn care is currently under implementation in the Western Cape, South Africa. An application (app) is installed on a smartphone located in each of the emergency services of 8 hospitals to transmit visual and textual information between emergency staff at point of care and a network of burns specialists. A stepwise implementation of the system will start in Tanzania in the beginning of 2016. The burn specialists already involved in South Africa will act as experts for Tanzania. The evaluation will build on an evaluation already started in South Africa. The first part of the evaluation will include the hospitals currently using the mHealth system in the Western Cape, South Africa and 2–3 hospitals in Tanzania. The mHealth system and results of the evaluation will be presented at the conference. Conclusions Low cost and timely alternatives to burn injury control are a pressing need in many low- and middle-income settings and countries. This project is a determinant step in that direction and can lead to the implementation of a viable, inclusive, and environment friendly mHealth system.

Background Every year, 1.3 million people are killed and up to 50 million are injured in road traffic accidents worldwide. The burden of road traffic injury has shifted from the premature death to a reduced quality of life (QoL) for those injured, therefore it is important to understand the effect of road traffic injury (RTI) on QoL. We aimed to assess and conclude the current knowledge about the relationship between RTI and QoL. Methods A systematic review of the literature on QoL after an RTI, in both adults and paediatric populations, from 3 databases (Pubmed, PsychInfo and SafetyLit) over the last fourteen years was undertaken. The methodological quality of the studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale. Results Nineteen articles were included and assessed for quality. In general, the QoL scores of those injured were similar to population norms at the first assessment, followed by a drop from the first assessment to the second assessment. The majority of the participants reported an increase of QoL from the second assessment to the third assessment but they never reached the population norms at the last follow-up (range 6 weeks to 2 years). Age, gender, socioeconomic status, injury severity, injury type, and PTSD were associated with poorer QoL. Conclusions The available literature regarding the QoL of persons injured in road traffic accidents is heterogeneous in regards to aims and tools used for assessment. Our review confirmed that independent of how QoL was measured, the overall QoL is significantly reduced after an RTI compared to the general population norms. Persons who are older, of female gender, lower socioeconomic status, diagnosed with PTSD, with more severe injuries or injuries to the lower limbs are more vulnerable to loss of QoL following an RTI compared to other patient groups injured in road traffic accidents.

Background Children are more likely to be accompanied by the age 10 after which their independent mobility increases initially as pedestrian and bicyclists, and later as drivers of motorcycles and four-wheelers. The mobility patterns of children were mostly surveyed in high or upper middle income countries. The aim of this study was to understand the mobility in children to and from school in urban dense lower middle income country. Methods This survey of school children was conducted from September to December 2014 in Karachi, Pakistan. Children in grades 6–10 approximately age 10–14 years from a random sample of 58 schools were interviewed face to face and their parents were interviewed on telephones. Mobility pattern was compared across gender. Results There were 1288 children and 732 parents interviewed. On the day of survey, majority of children reported walking (72%) to schools (58.6% girls’ vs 41.4% boys). Majority of parents (71%) also reported walking as the travel model of children to and from school. There were 22% boys who came to school on their own compared to 16% girls however more girls (30%) were accompanied with someone compared to boys (5.4%). While according to parents 49% of boy children and 29% of girl children were allowed to go school on their own. Less than half (43%) of children were allowed to cross main roads (same ratio of boys and girls). There were three-fourth girls who thought their parents never trust them when they were in road traffic on their own. Conclusions Although walking is the common travel mode of both boys and girls for their schools but parents’ license for mobility varies by sex of the children with more restrictions for girls.

Background All around the world, injuries in childhood have an important impact on individual and population health. Childhood unintentional injuries are a leading cause of death globally among children and young people aged 0–17 years. The latest updates on the Global Burden of Diseases shows that injury is the fourth leading cause of deaths among children below 15 years of age. Child mortality due to injury is a public health problem internationally and in Europe. Socioeconomic position inequalities in childhood injuries are well known, but there is less information on how child mortality by injuries is socially patterned by parental education. There is a need to evaluate published evidence. Methods Using Arksey and O’Malley’s and Levac et al methodological frameworks for scoping review methodology as a guide, our scoping review of published literature begins by searching several databases: PubMed, Scopus, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and the Educational Resources Information Centre (ERIC) and web of science. A possible research question will be: What is known from the existing literature about the effect of parental education on childhood injuries? The scoping review will consider all study designs including qualitative and quantitative methodologies. Bibliographic data and abstract content will be collected and analysed using a tool developed iteratively by the research team. Results This study will provide a broad overview of the research literature specific to differences in socioeconomic inequalities in childhood injuries, measured by parental educational attainment. Potential gaps in the research on the possible effect of parental education on childhood injuries will be identified, and thus, the results will inform future research directions. Conclusions The findings of this scoping review protocol will be used to determine the evidence coming from the research literature about the relationship and influence of parental education (mother and/or father education) in the frequency of childhood injuries. We will disseminate our findings through the presentation in the 12th World Safety Conference, as well as through articles published to generate key messages most relevant.

Background Gender differences have been reported both in exposure to and outcome of burn injuries. Whereas the general gender distribution of burns is relatively well known, few studies have examined gender differences in incidence and management of burns for different burn mechanisms in sub-Saharan Africa. Methods The study is cross sectional and based on case reports of patients seeking care for a burn injury at Emergency Centres in eight health care facilities in the Western Cape Province, South Africa between June 2012 and May 2013 (n = 1915). Gender specific incidence rates were compiled for age groups 0–4, 5–9, 10–14, 15–19, 20–54 and 55+. Differences in proportions in men and women were examined for AIS, length of stay and disposition. All analyses were stratified by burn mechanism. Results Children 0–4 years have the highest incidence of burns with boys and girls relatively equally affected. Gender differences in burn incidence are found in ages 20 years and older. Men 55 years and older have a higher risk compared to women for hot liquid burns whereas men aged 20–54 have a higher risk of fire burns. While no gender differences in children are observed in injury management, adult men are significantly more transferred than women (all burn mechanisms aggregated) while women with both hot liquid and fire burns are treated as outpatients to a higher extent. No gender difference in AIS or length of stay are found among adults. Conclusions Even though burn incidence is highest among children, gender differences in burn incidence and management are mainly visible in adults. Results about men being transferred and women treated as outpatients to a higher extent in spite of similar AIS raise the question of hidden gender biases in the healthcare.

Background In 2010 more than half of road traffic injury (RTI) deaths occurred to pedestrians, bicyclists and motorcyclists defined as vulnerable road users (VRUs). Lower middle income countries account for the highest proportion of VRU deaths. The distribution of RTI burden by road user type in children globally, regionally and by income levels is unclear. To investigate country-level changes over time in global child RTI deaths among VRUs and non-VRUs with respect to region, economy between 1990 and 2013 Methods Country-level data were extracted from the Global Burden of Disease study, split into seven geographical regions and four income levels (low-income [LICs], lower-middle [LMICs], upper-middle [UMICs] and high-income [HICs]). Death rates and percent change in rates between 1990 and 2013 were calculated for road users aggregated, and independently for VRUs and non-VRUs. Results Child RTI death rates decreased globally, by region and across all country economic categories between 1990 and 2013 (a global average of 32% reduction in RTI death rates from 1990 to 2013 and a range of 28% (LICs)−54%(HICs). Reductions were also found for both VRUs (35%) and non-VRUs (25%) except in LICs where a 16% increase arose among non–VRUs. This applies particularly to those LICs from South Asia (26%). Death rates of VRUs (35%) in the LMICs of Sub –Saharan Africa also reported increments. For VRUs, the decrease was more than twice higher in HICs (58%) and LICs (44%) compared to UMICs (20%) or LMICs (23%). Conclusions The distribution of RTI death varies across different economic categories and regions of the world by road user type.

Background The relationship between lower economic level and high injury rates in children is well established, but less is known about how development measures shape child injury inequalities, especially in low- and middle-income countries. The aim of this study is to assess the strength of the relationship between child injury mortality rates and existing country level development measures in Sub-Saharan Africa and South Asia, the two regions with the highest child injury mortality rates globay. Methods This was an ecological, cross-sectional country level study in 54 countries comprising the Sub-Saharan Africa and South Asia region participating in the Global Burden of Disease (GBD) project. The outcome measure was injury mortality rates per 100,000 for the 1–14 age group calculated from the GBD 2013, 2000, 1990. Country level measures chosen to reflect the core domains of development relevant to child well-being (economy/socioeconomic status, governance and human rights) were extracted from the World Bank Open Database, the Institute for Economics and Peace and the Economist Intelligence Unit. Pearson’s correlation coefficient was used to examine the association between development measures and all injuries/unintentional/intentional child mortality rates for both regions combined in 2013. Injury mortality rates were then presented for each region in 1990, 2000 and 2013. Results Development variables that showed significant correlation with unintentional injury mortality included: Democracy Index, improved water source for the rural population, infant mortality rate, under-5 mortality rate, maternal mortality rate, life expectancy at birth and private prepaid plans. None correlated with intentional injuries. There was a decrease in all injury and unintentional mortality rates for both regions from 1990 to 2013; intentional rates increased 1990 to 2000 and are now (2013) decreasing again. Conclusion Injury mortality rates declined overall in both regions from 1990 to 2013 but within and between regional differences exist and must be addressed in order to reduce child injury inequality on a global scale; further research is needed to improve our understanding of how development affects these rates.

Introduction Severe burn injuries require timely medical attention at an appropriate level of care. Correct referral of patients with burns depends on accurate estimation of injury severity. This study aims to determine how often patients at a trauma unit in a large referral hospital in South Africa are referred to the Burn Unit according the guidelines for burn referrals. Methods Patients presenting with a burn injury to the trauma unit at the Red Cross War Memorial Children’s Hospital (RXH) during a 7-months period were included in the study. Patient medical records were studied and compared to the Western Cape Guidelines for referral of patients with burns to determine the number of patients that met the criteria, as well as the number who did not meet the criteria. Result In total, 702 patients were included in the study. The most common reasons for referral were patients “under two years of age”, and “burns to special areas”. Out of the 702 patients that were seen at the trauma unit, 499 were transferred to the burns unit. Out of the 499 patients who were referred, 94% met the criteria for referral. Out of the patients who were not referred to the burns unit, 80% also met the criteria for referral. This group of patients differed in that they had significantly smaller burns compared to those who were referred. Conclusion The data suggests that most patients were referred according to the guidelines, with a potential over-triage in very few cases. However, a large numbers of patients met the criteria for referral but were not transferred to the burns unit. These burns were mostly minor burns that likely did not require specialist care. In conclusion, while referral guidelines do catch the patients that need referral, they also catch many that do not need referral.

Background Oman has one of the highest road traffic fatality rates in the world. Speeding behaviour has been recognised as one of the most important risk factor in fatal road traffic crashes (RTCs) in the Sultanate of Oman in the year 2011. The aim of this study was to identify factors that are associated with self-reported speeding behaviour based on the Theory of Planned Behaviour (TPB). Methods The study was cross sectional. A total of 1800 Omani male drivers in the age range of 17–45 years were recruited during March 2013 from directorate of vehicle registration using systematic random sampling technique based on their seat number. A questionnaire was developed and used to collect data concerning socio-demographic characteristics, driving behaviour, driving history and the subscales of TPB. The questionnaire was assessed for validity and reliability. Multivariate logistic regression was used to examine the association between the constructs of TPB and speeding behaviour. Results The response rate was 71.4%. The mean age was 29 ± 6.6 (mean ± standard deviation) years. Only 14% (n = 174) of the drivers reported that they never or very rarely exceeded the speed limit when given the chance. The drivers with younger age, having children, high monthly income, having motoring and speeding offences were more likely to speed compared to other drivers. The odds of speeding among those who said their speed was “much faster” compared to other drivers was 4.7 (Odds Ratio (OR) = 4.7, 95% CI: 1.6, 13.8). Around 46% of the sample had got speeding offences. Speeding behaviour is significantly predicted by attitude and subjective norms. Speeding behaviour is significantly predicted by intention to respect the speed limits (OR = 0.72, 95% CI: 0.72, 0.76) and by attitude, subjective norms and perceived behavioural control. Conclusions Speeding behaviour is common among male Omani drivers and the TPB can be used to understand the factors associated with it.

Problem and Objective Studies focusing on the socioeconomic distribution of fall injuries among children are few and show mixed results. Previous studies are mainly area-based and no studies have investigated the relationship between family socioeconomic position and subgroups of fall injuries. The current study examines whether socioeconomic position affect the risk of having fall related injuries of different types. Method This population-based cohort study links Swedish national register data for a cohort of 1 544 047 individuals born between 1977 and 1991. Individual records from the 1985 census were linked to the National Hospital Discharge Register for the period 1998–2004. Fall injuries requiring hospitalisation were recorded (n=38 529). Logistic regressions were used to measure the effect (odd ratios) of socio-economic position on eight subgroups of fall injuries (based on external codes, ICD-10). Results An analysis of all types of fall aggregated (W00-W19) showed no significant differences between young people from different socioeconomic groups. However, analyses of subgroups of falls showed that children of manual workers had significant higher odds of having injuries related to falls from playground equipment (OR 1.35 (1.21 to 1.50), stairs (OR 1.48, CI 1.30 to 1.69), trees (1.36 (1.17 to 1.58) and falls from buildings (OR 1.38 CI 1.18 to 1.60). On the other hand, children in lower socioeconomic groups had significantly lower odds for sport related falls compared to children of parents who are intermediate- and high level salaried employees. Conclusion This study indicates that when falls are split into subgroups the effect of low socioeconomic position can be both protective and aggravating.

Background Child injury mortality and morbidity are a public health concern in European countries and data are scarce. Cross-national efforts are needed to identify high-risk groups, follow trends and assist in establishing European-wide safety legislation. This study investigates fatal child injuries in the home, as compared to those in transport in European countries. Methods Injury mortality was extracted from the WHO Mortality Database for the years 2002-2004. The mortality per 100 000 population was calculated by age group for 16 contributing countries, grouped by their economic level of development. Results Fatal home injuries were highest in children under five and then sharply decreased, as opposed to road traffic injuries which increased with age. The majority of the upper middle economy countries tended to have higher home injury incidence rates compared to the high income countries. The top five injury causes all countries aggregated were drowning/submersion, thermal injuries, poisoning, falls and homicide, all of which account for almost 90% of home injury deaths. Conclusion Home injuries were the leading cause of injury death in children under five in the countries under study and the inequalities found among the countries indicate potential for improvement. Evidence-based interventions exist to prevent these injuries and the barriers to their implementation ought to be determined and addressed.

Objectives To determine the predicting effect on youth suicide of prior episodes of injuries of various intent (ie, inter-personal and self-directed violence, unintentional and undetermined intent) and the extent to which any association is influenced by family socioeconomic status. Methods A nationwide register-based cohort study was conducted covering all Swedish subjects born between January 1977 and December 1991 (N=1 616 342, male/female ratio=105). The cohort subjects were followed up from January 1998 to December 2003, when aged 726 years. Poisson regression and the likelihood ratio test (CI 95%) were used to assess the age-adjusted effect of hospitalisation for injuries of various intents on youth suicide and its effect once adjusted for family sociodemographic and social circumstances. Results Each set of exposures independently and significantly predicted suicide mortality. Being hospitalised for self-inflicted injuries or injuries of undetermined intent was associated with a risk of suicide 36–47 times that of subjects never hospitalised in the period under study (95% CI 28.36 to 45.58 and CI 26.67 to 83.87 for self-inflicted injuries and for events of undetermined intent, respectively; overall p Conclusion Youth suicide is predictable not only by prior suicide attempts but even by prior exposure to injurious assaults and unintentional injuries leading to hospitalisation, regardless of family socioeconomic status.

Background Road traffic crashes are a major cause of death and injury, especially in low and middle-income countries (LMICs). Improvements in prehospital trauma care can help minimise mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in LMICs with a high rate of RTIs such as Iran. The aim of current study was to explore barriers to and potential facilitators for providing effective prehospital trauma care for RTI victims in Iran based on the experience and perception of prehospital trauma care professionals. Methods This study conducted using a grounded theory approach. Participants of the study were 15 prehospital trauma care professionals. The data collected via indepth interviews and were analysed using the constant comparative method. Results Seven categories emerged through data analysis: (1) administration and organisation, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organisations, (6) laypeople and (7) infrastructures. The lack of interaction and common understanding was identified as the core category. Moreover, a conceptual model was developed based on the categories. Conclusions According to the findings, improving the interaction within the current prehospital trauma care system and building a common understanding of the role of the emergency medical services were identified as the key issues for developing an effective prehospital trauma care system in the country.