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Objectives: In 1994, Robertson and Drummer formalised the responsibility analysis as an alternative to case-control studies in the study of road traffic crashes. Our objective was to assess whether published responsibility studies respected standards defining adequate case-control studies. Setting: Using Web of Science, Scopus and Google Scholar, we identified responsibility studies indexed until October 2013, which cited Robertson and Drummer’s paper. After reviewing titles, abstracts and reference lists, we selected original studies comparing responsible and non-responsible drivers, published in peer-reviewed journals or proceedings. Data and analysis: We applied a grid to judge the conformity of the responsibility assessment to the original definition, and whether methods addressing representativeness of selection, accuracy of measures of exposures, confounding variables, and power met standards defining adequate case-control studies. Results: Of 205 titles, we identified 20 papers. Methods of responsibility assessment were the original in three papers. Variations across studies concerned the number of mitigating factors included, or the use of questionnaires rather than police data (n=3). The ratio responsible/non-responsible drivers varied from 0.90 to 5.31, due to major variations in sampling methods, threshold selection, and data completeness. Selection or measurement issues were discussed in 13 papers, but seldom addressed in the design. A comparison of confounding factors in responsible and non-responsible drivers was presented in five papers. Conclusions: Basic requirements of case-control studies are often not or not clearly met in responsibility studies. There is a need to revisit the method and to adapt existing publication standards to the way responsibility studies are reported. [ABSTRACT FROM AUTHOR]

Background: The child active transportation literature has focused on walking, with little attention to risk associated with increased traffic exposure. This paper reviews the literature related to built environment correlates of walking and pedestrian injury in children together, to broaden the current conceptualization of walkability to include injury prevention. Methods: Two independent searches were conducted focused on walking in children and child pedestrian injury within nine electronic databases until March, 2012. Studies were included which: 1) were quantitative 2) set in motorized countries 3) were either urban or suburban 4) investigated specific built environment risk factors 5) had outcomes of either walking in children and/or child pedestrian roadway collisions (ages 0-12). Built environment features were categorized according to those related to density, land use diversity or roadway design. Results were cross-tabulated to identify how built environment features associate with walking and injury. Results: Fifty walking and 35 child pedestrian injury studies were identified. Only traffic calming and presence of playgrounds/recreation areas were consistently associated with more walking and less pedestrian injury. Several built environment features were associated with more walking, but with increased injury. Many features had inconsistent results or had not been investigated for either outcome. Conclusions: The findings emphasise the importance of incorporating safety into the conversation about creating more walkable cities. [ABSTRACT FROM AUTHOR]

Objective Vast amounts of injury narratives are collected daily and are available electronically in real time and have great potential for use in injury surveillance and evaluation. Machine learning algorithms have been developed to assist in identifying cases and classifying mechanisms leading to injury in a much timelier manner than is possible when relying on manua coding of narratives. The aim of this paper is to describe the background, growth, value, challenges and future directions of machine learning as applied to injury surveillance. Methods This paper reviews key aspects of machine learning using injury narratives, providing a case study to demonstrate an application to an established human-machine learning approach. Results The range of applications and utility of narrative text has increased greatly with advancements in computing techniques over time. Practical and feasible methods exist for semiautomatic classification of injury narratives which are accurate, efficient and meaningful. The human-machine learning approach described in the case study achieved high sensitivity and PPV and reduced the need for human coding to less than a third of cases in one large occupational injury database. Conclusions The last 20 years have seen a dramatic change in the potential for technological advancements in injury surveillance. Machine learning of 'big injury narrative data' opens up many possibilities for expanded sources of data which can provide more comprehensive, ongoing and timely surveillance to inform future injury prevention policy and practice. [ABSTRACT FROM AUTHOR]

ABSTRACT:This paper estimates the incidence (all ages) of spinal cord neurological impairment (SCI; traumatic and non traumatic) in New Zealand and describes pre-SCI characteristics and early post-SCI outcomes for participants (16-64 years) in this longitudinal study. Demographic and clinical data on all people admitted to New Zealand's two spinal units (mid-2007 to mid-2009 )were included for the estimate of incidence. Participants in this longitudinal study were asked at first interview about pre-SCI socio-demographic, health and behavioural characteristics, and about post-SCI symptoms, general health status (EQ-5D) and disability (WHODAS 12-item). Age-adjusted incidence rates (95% CI) for European,Maori, Pacific and 'Other' ethnicities were 29 (24-34), 46 (30-64), 70 (40-100) and 16 (9-22) per million, respectively. Interviews with 118 (73%) participants (16-64 years), occurred 6.5 months post-SCI. Most reported bother with symptoms, and problems with health status and disability. Compared with Europeans, the incidence of SCI is high among Maori and particularly high among Pacific people. Six months after SCI, proximate to discharge from the spinal units, considerable symptomatic, general health and disability burden was borne by people with SCI. [ABSTRACT FROM AUTHOR]

Background Disability, mortality and healthcare burden from fractures in older people is a growing problem worldwide. Observational studies suggest that aspirin may reduce fracture risk. While these studies provide room for optimism, randomised controlled trials are needed. This paper describes the rationale and design of the ASPirin in Reducing Events in the Elderly (ASPREE)-Fracture substudy, which aims to determine whether daily low-dose aspirin decreases fracture risk in healthy older people. Methods ASPREE is a double-blind, randomised, placebo-controlled primary prevention trial designed to assess whether daily active treatment using low-dose aspirin extends the duration of disability-free and dementia-free life in 19 000 healthy older people recruited from Australian and US community settings. This substudy extends the ASPREE trial data collection to determine the effect of daily low-dose aspirin on fracture and fall-related hospital presentation risk in the 16 500 ASPREE participants aged >70 years recruited in Australia. The intervention is a once daily dose of enteric-coated aspirin (100 mg) versus a matching placebo, randomised on a 1:1 basis. The primary outcome for this substudy is the occurrence of any fracture--vertebral, hip and non-vert-non-hip--occurring post randomisation. Fall-related hospital presentations are a secondary outcome. Discussion This substudy will determine whether a widely available, simple and inexpensive health intervention--aspirin--reduces the risk of fractures in older Australians. If it is demonstrated to safely reduce the risk of fractures and serious falls, it is possible that aspirin might provide a means of fracture prevention. Trial registration number The protocol for this substudy is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000347561). [ABSTRACT FROM AUTHOR]

Background Programme evaluations conducted alongside randomised controlled trials (RCTs) have potential to enhance understanding of trial outcomes. This paper describes a multi-level programme evaluation to be conducted alongside an RCT of a falls prevention programme (RESPOND). Objectives (1) To conduct a process evaluation in order to identify the degree of implementation fidelity and associated barriers and facilitators. (2) To evaluate the primary intended impact of the programme: participation in fall prevention strategies and the factors influencing participation. (3) To identify the factors influencing RESPOND RCT outcomes: falls, fall injuries and emergency department (ED) re-presentations. Methods/design 528 community-dwelling adults aged 60-90 years presenting to two EDs with a fall will be recruited and randomly assigned to the intervention or standard care group. All RESPOND participants and RESPOND clinicians will be included in the evaluation. A mixed methods design will be used and a programme logic model will frame the evaluation. Data will be sourced from interviews, focus groups, questionnaires, clinician case notes, recruitment records, participant-completed calendars, hospital administrative datasets and audio-recordings of intervention contacts. Quantitative data will be analysed via descriptive and inferential statistics and qualitative data will be interpreted using thematic analysis. Discussion The RESPOND programme evaluation will provide information about contextual and influencing factors related to the RESPOND RCT outcomes. The results will assist researchers, clinicians and policy makers regarding decisions about future falls prevention interventions. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated. [ABSTRACT FROM AUTHOR]

Background: Successful injury prevention requires identification and targeting of particularly vulnerable groups. Little is known about injury vulnerability patterns in Sudan. This paper aimed to fill this gap using survey data. Methods: Data from the Sudan Household Health Survey were used. This was a national cross-sectional interview survey of 83 510 individuals selected by multistage cluster random sampling. Multivariable Poisson regression was used to investigate the association of cause-specific injury that received care by traditional healers, outpatient care and inpatient care, and those that received only inpatient care, with age, gender, area of residence (urban or rural), socioeconomic status and education. Relevant interactions were tested. Results: Independent of other sociodemographic variables, men were at higher risk of road traffic injury (prevalence ratio (PR): 3.3 95% CI 2.4 to 4.7), falls (PR: 1.5, 95% CI 1.3 to 1.9), assault (PR: 3.0 95% CI 1.8–5) and mechanical injury (PR: 2.0 95% CI 1.2 to 3.1) that received any form of healthcare. Those aged 65 years and over also had the highest risk of those injury causes, while children under 5 years were the most likely to suffer burn injuries. Socioeconomic status was associated with assault (PR for the richest group 0.4 95% CI 0.2 to 0.8). Vulnerability patterns for injury that received inpatient care were fairly similar for some causes. Conclusions: In Sudan, existing disease prevention and health promotion programmes should expand to target men, children under 5 years, elderly people and those of low socioeconomic status with injury prevention interventions. Further research is needed to investigate the context-specific proximal risk factors that shape the various vulnerability patterns observed. [ABSTRACT FROM AUTHOR]

Objective This paper analyses costs and potential lives saved from a door-to-door smoke alarm distribution programme using data from a programme run by the Baltimore City Fire Department in 2010–2011. Design We evaluate the impact of a standard home visit programme and an enhanced home visit programme that includes having community health workers provide advance notice, promote the programme, and accompany fire department personnel on the day of the home visit, compared with each other and with an option of not having a home visit programme (control). Results Study data show that the home visit programme increased by 10% the number of homes that went from having no working alarm to having any working alarm, and the enhanced programme added an additional 1% to the number of homes protected. We use published reports on the relative risk of death in homes with and without a working smoke alarm to show that the standard programme would save an additional 0.24 lives per 10 000 homes over 10 years, compared with control areas and the enhanced home visit programme saved an additional 0.07 lives compared with the standard programme. The incremental cost of each life saved for the standard programme compared with control was $28 252 per death averted and $284 501 per additional death averted for the enhanced compared with the standard. Conclusions Following the US guidelines for the value of a life, both programmes are cost effective, however, the standard programme may offer a better value in terms of dollars per death averted. The study also highlights the need for better data on the benefits of current smoke alarm recommendations and their impact on injury, death and property damage. [ABSTRACT FROM AUTHOR]

Objective To evaluate the validity of a parent-reported survey to identify children's moderate and serious injuries in seven specific body regions using medical records as the 'gold standard'. Methods A prospective validation study was conducted in three urban paediatric emergency departments (EDs). 798 parents of 859 children treated for injuries at participating EDs between August 2010 and July 2011 completed either a telephone interview or self-administered paper survey at 2 weeks post-ED visit. Parents were asked to report child injuries to seven body regions: head, face, neck/spine/back, thorax, abdomen, upper extremities and lower extremities. Injury data were abstracted from medical records using a standardised protocol. Body region injury severity levels of none/ minor, moderate or serious were assigned to each subject based on the Abbreviated Injury Scale. Results The overall sensitivity, reflecting parents' ability to identify a documented moderate or greater severity injury, was 0.95 (95% CI 0.92 to 0.97). Sensitivities were >0.90 for the face, upper extremity and lower extremity regions; 0.80-0.90 for head, abdomen and neck/back/spine regions; and <0.60 for the thorax region. The overall sensitivity for identification of a serious injury was 0.71 (0.60 to 0.80). Conclusions This survey enables parents to accurately identify moderate and greater severity injuries to body regions, though it does not accurately identify serious injuries in most body regions except the extremities. The survey could serve as a screening tool to identify moderate and greater severity injuries in population-based surveillance systems, or as the primary outcome of interest in injury prevention studies. [ABSTRACT FROM AUTHOR]

Objective Graduated Driver Licensing (GDL) has been implemented in Australia, Canada, New Zealand, USA and Israel. We conducted an exploratory summary of available data to estimate whether GDL effects varied with age. Methods We searched MEDLINE and other sources from 1991-2011. GDL evaluation studies with crashes resulting in injuries or deaths were eligible. They had to provide age-specific incidence rate ratios with CI or information for calculating these quantities. We included studies from individual states or provinces, but excluded national studies. We examined rates based on person-years, not license-years. Results Of 1397 papers, 144 were screened by abstract and 47 were reviewed. Twelve studies from 11 US states and one Canadian province were selected for meta-analysis for age 16, eight were selected for age 17, and four for age 18. Adjusted rate ratios were pooled using random effects models. The pooled adjusted rate ratios for the association of GDL presence with crash rates was 0.78 (95% CI 0.72 to 0.84) for age 16 years, 0.94 (95% CI 0.93 to 0.96) for 17 and 1.00 (95% CI 0.95 to 1.04) for 18. The difference between these three rate ratios was statistically significant: p<0.001. Conclusions GDL policies were associated with a 22% reduction in crash rates among 16-year-old drivers, but only a 6% reduction for 17-year-old drivers. GDL showed no association with crashes among 18-year-old drivers. Because we had few studies to summarise, particularly for older adolescents, our findings should be considered exploratory. [ABSTRACT FROM AUTHOR]

Relevant local injury epidemiology In Hong Kong, there were, on average, about 19 596 traffic crashes involving 157 deaths and 21 106 injured persons each year between 2006 and 2011. Scientific analyses were conducted by geographers and engineers primarily using the police crash database. Medical professionals have been analysing road traffic injury data from hospital discharge summaries. Moreover, community leaders have been trying to promote local safe communities. Best practices This paper describes the effort of a multidisciplinary team to address road safety problems and to sustain road safety benefits through a public health approach. The multidisciplinary team comprised a geographer, an engineer, medical professionals and community leaders. The project covered four tasks, namely data integration, identification of hazardous road locations, crash analysis and engineering study, and knowledge exchange through various activities involving a WHO-designated local safe community. Implementation The crash and hospital databases for a district in Hong Kong with 500 000 population were integrated. Based on the integrated database, the public health and people-based approach was adopted to identify hazardous road locations--hot zones--using geographical information systems. Specific hot zones having strong patterns of common factors were considered as treatable locations with a combination of low-cost remedial measures. The benefits of the project are sustained through various activities engaging the general public and major stakeholders. Research agenda More research should be conducted on how institutional support, scientific research and community involvement can be fruitfully combined to achieve the ultimate goal of sustained road safety benefits for people at the community level. [ABSTRACT FROM AUTHOR]

Background: This study assesses the impact on safety of a system designed to enhance sleep in car passengers. The system holds the head posteriorly and limits its rotation in the sagittal and frontal planes, modifying the occupant's head position. This device may have an influence on the interaction between the occupant and the vehicle restraint systems. Methods: It was a randomised, prospective, single-blind, cross-over controlled study in which 41 volunteers were exposed to using the system while riding as car passengers. Whether the device influenced the posture of the occupants and prevented them from adopting out-of-position (OOP) configurations was also analysed. Occupants were videotaped while they were using both the innovative system (cases) and their normal sleeping device (controls), if any. Results: Controls were exposed to OOP situations in 825 occasions (18.4%; 95% CI 17.3% to 19.6%), while cases were exposed in 416 occasions (9.3%; 95% CI 8.4% to 10.2%). The paper also analysed how many cases and controls were exposed at least once to a particular event and how frequent a single participant incurred in an OOP situation. In both cases, the innovative device showed a reduction in exposition. When OOP situations were grouped into severe, moderate and minor events, the innovative device produced a statistically significant reduction in the occurrence of severe and moderate events. Conclusions: A device originally designed to improve comfort and rest in car passengers has been found to reduce the exposure of the occupants to being OOP while resting in the car. [ABSTRACT FROM AUTHOR]

This paper presents the effect of first aid training on the first aid knowledge and skills of university drivers. The intervention group (n=98) received training on first aid and controls (n=78) received training on HIV/AIDS. First aid knowledge and skills were measured at baseline, immediately after the training and 4 months post-intervention. Changes in knowledge and skills were assessed using repeated measures analysis of variance. Knowledge scores were 51.2±14.8%, 59.6±12.8% and 57.6±12.8% (p>0.05) for intervention drivers versus 51.6±11.6%, 53.2±12.0% and 56.4±12.4% (p>0.05) in controls. The skill scores for intervention drivers were 49.2±14.2%, 78.3±12.9% and 77.5±11.7% (p0.05) for controls. Four months after intervention, >75% of the 13 intervention drivers who came across a crash had used the skills acquired. The intervention improved the first aid skills of intervention drivers. In view of the reduction in scores by the fourth month post-intervention, periodic refresher training is recommended to sustain the skills acquired. [ABSTRACT FROM AUTHOR]

Background and aims Bicycling may be less appealing in parts of the world where cycling is less safe. Differences between jurisdictions suggest route design is key to improving safety and increasing ridership. Previous studies faced difficulties in effectively assessing denominators for risk calculations and controlling confounding. This paper describes the advantages of the case-crossover design of the Bicyclists' Injuries and the Cycling Environment study to address these challenges to observational studies of cycling safety. Methods Injured cyclists were recruited from the emergency departments of five hospitals in Vancouver and Toronto, Canada. In 18 months, 690 participants were successfully recruited and interviewed. Each participant was interviewed to map the route of their injury trip, identify the injury site and select two control sites at random from the same route. Infrastructural characteristics at each study site were scored by site observers who were blinded as to whether sites were crash or comparison sites. Analyses will compare infrastructural variables between case and control sites with conditional logistic regression. Discussion This study presents a novel application of the case-crossover design to the evaluation of relationships between infrastructure and cycling safety while controlling confounders and exposure to risk. It is hoped that the value of this method and the efficiency of the recruitment process will encourage replication in other locations, to expand the range of cycling infrastructure compared and to facilitate evidence-based cycling infrastructure choices that can make cycling safer and more appealing. [ABSTRACT FROM AUTHOR]

Objective To examine the appropriateness of different statistical models in analysing falls count data.Methods Six count models (Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), zero-inflated NB (ZINB), hurdle Poisson (HP) and hurdle NB (HNB)) were used to analyse falls count data. Empirical evaluation of the competing models was performed using model selection criteria and goodness-of-fit through simulation. Data used were from a prospective cohort study of women aged 40e80 years. Results Of the 465 women analysed, 330 (71%) did not fall at all. The analyses identified strong evidence of overdispersion in the falls data. The NB-based regression models (HNB, ZINB, NB) were better performed than the Poisson-based regression models (Poisson, ZIP, HP). Vuong tests favoured the HNB model over the NB and ZINB models and the NB model over the ZINB model. Model accuracy measures and Monte Carlo simulation of goodness-of-fit confirmed the lack of fit of the Poissonbased regression models and demonstrated the best fit for the HNB model with comparable good fit for the ZINB and NB models. Conclusions Falls count data consisting of a considerable number of zeros can be appropriately modelled by the NBbased regression models, with the HNB model offering the best fit. The evaluation procedure presented in this paper provides a defensible guideline to appropriately model falls or similar count data with excess zeros. [ABSTRACT FROM AUTHOR]

Background Childhood falls are an important global public health problem, but there is lack of evidence about their prevention. Falls on one level result in considerable morbidity and they are costly to health services. Objective To estimate ORs for falls on one level in children aged 0-4 years for a range of safety behaviours, safety equipment use and home hazards. Design, setting and participants Multicentre case-control study at hospitals, minor injury units and general practices in and around four UK study centres. Participants included 582 children less than 5 years of age with a medically attended fall injury occurring at home and 2460 controls matched on age, sex, calendar time and study centre. Main outcome measure Fall on one level. Results Cases' most common injuries were bangs on the head (52%), cuts or grazes not needing stitches (29%) or cuts or grazes needing stitches (17%). Comparing cases to community controls in the adjusted analyses, significant findings were observed for only two exposures. Injured children were significantly less likely to live in a household without furniture corner covers (adjusted OR (AOR) 0.72, 95% CI 0.55 to 0.95), or without rugs and carpets firmly fixed to the floor (AOR 0.76, 95% CI 0.59 to 0.98). Conclusions We did not find any safety practices, use of safety equipment or home hazards associated with a reduced risk of fall on one level. Our findings do not provide evidence to support changes to current injury prevention practice. [ABSTRACT FROM AUTHOR]