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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]

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]

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]

Objective We aim to calculate the 5-year mortality after surviving to hospital discharge after a firearm injury and estimate the association of firearm injury with later mortality. Methods We performed a retrospective cohort study of patients from an urban emergency department (ED) and trauma centre in Oakland, California, USA, in 2007. We created three cohorts of patients presenting for (1) gunshot wound (GSW), (2) MVC and (3) assault without a firearm. Demographic and clinical information was obtained from the clinical chart, and the California Department of Public Health Vital Statistics and Social Security Death Master File (2007-2012) were queried to identify patients who died. Results We analysed 516 GSW patients, 992 MVC patients and 695 non-GSW assault patients. Of the GSW patients, 86.4% were alive at 5 years. All-cause 5-year mortality among GSW victims surviving to discharge after injury was 5.1%. Compared with MVC patients, both GSW and non-GSW assault patients have higher risk of death at 5 years (HR 2.54 (95% CI 1.41 to 4.59) and HR 1.64 (95% CI 1.01 to 2.68), respectively), adjusting for age, sex and race. Risk of death was higher in the first year for the GSW cohort (HR 6.14 (95% CI 2.35 to 16.08) and HR 5.06 (95% CI 1.88 to 13.63) as compared with MVC and non-GSW assault cohorts, respectively). Homicide was the cause of death in 79.2% of GSW patients who died after surviving the index injury. Conclusion Among individuals presenting to the ED after injury or assault and surviving to discharge, firearm injury exposure is an important predictor of death within 5 years and most pronounced in the first year after injury. [ABSTRACT FROM AUTHOR]

Background This study aimed to increase safety knowledge and behaviour of US Hispanic custodial workers in healthcare through a culturally appropriate training and monitoring process. Method A single-group, repeated-measures, pre-test and post-test design was used to examine training effectiveness across four sets of behaviours with 23 Spanish-speaking workers. Results Small group, lecture-style training in Spanish with pictures and video resulted in significant improvements in knowledge and behaviour. However, additional analyses show that behavioural feedback was the critical component in improving safety behaviour during transfer of training. Discussion Findings from reaction, knowledge, behaviour and results measures suggest that group training and graphic feedback is culturally appropriate and effective with Hispanic workers. Further investigation is needed to understand cultural factors that facilitate effective development and delivery of safety training and feedback to US Hispanic workers. [ABSTRACT FROM AUTHOR]

Background Driver error and inadequate skill are common critical reasons for novice teen driver crashes, yet few validated, standardised assessments of teen driving skills exist. The purpose of this study is to evaluate the construct and criterion validity of a newly developed Simulated Driving Assessment (SDA) for novice teen drivers. Methods The SDA’s 35 min simulated drive incorporates 22 variations of the most common teen driver crash configurations. Driving performance was compared for 21 inexperienced teens (age 16 - 17 years, provisional license ≤ 90 days) and 17 experienced adults (age 25 - 50 years, license ≥ 5 years, drove ≥ 100 miles per week, no collisions or moving violations ≤ 3 years). SDA driving performance (Error Score) was based on driving safety measures derived from simulator and eye-tracking data. Negative driving outcomes included simulated collisions or run-off-the-road incidents. A professional driving evaluator/instructor (DEI Score) reviewed videos of SDA performance. Results The SDA demonstrated construct validity: (1) teens had a higher Error Score than adults (30 vs 13, p=0.02); (2) For each additional error committed, the RR of a participant ' s propensity for a simulated negative driving outcome increased by 8% (95% CI 1.05 to 1.10, p<0.01). The SDA-demonstrated criterion validity: Error Score was correlated with DEI Score (r= − 0.66, p<0.001). Conclusions This study supports the concept of validated simulated driving tests like the SDA to assess novice driver skill in complex and hazardous driving scenarios. The SDA, as a standard protocol to evaluate teen driver performance, has the potential to facilitate screening and assessment of teen driving readiness and could be used to guide targeted skill training. [ABSTRACT FROM AUTHOR]

Objective. Inexperienced, less-skilled driving characterises many newly licensed drivers and contributes to high crash rates. A randomised trial of TeenDrivingPlan (TDP), a new learner driver phase internet-based intervention, demonstrated effectiveness in improving safety relevant, on-road driving behaviour, primarily through greater driving practice diversity. To inform future learner driver interventions, this analysis examined TDP use and its association with practice diversity. Design. Posthoc analysis of data from teen/parent dyads (n=107), enrolled early in learner phase and assigned to treatment arm in randomised trial. Methods. Inserted software beacons captured TDP use data. Electronic surveys completed by parents and teens assessed diversity of practice driving and TDP usability ratings at 24 weeks (end of study period). Results. Most families (84%) used TDP early in the learner period; however, the number of TDP sessions in the first week was three times higher among dyads who achieved greater practice diversity than those with less. By week five many families still engaged with TDP, but differences in TDP use could not be detected between families with high versus low practice diversity. Usability was not a major issue for this sample based on largely positive user ratings. Conclusions. An engaging internet-based intervention, such as TDP, can support families in achieving high practice diversity. Future learner driver interventions should provide important information early in the learner period when engagement is greatest, encourage continued learning as part of logging practice drives, and incorporate monitoring software for further personalisation to meet family needs [ABSTRACT FROM AUTHOR]

Objective: To investigate the long-term effect of medically serious adverse medical events (AMEs) among older adults. Methods: We linked nationally representative survey and claims data from the Medicare Current Beneficiary Survey (1998–2004) with non-response files (1999–2005) and the Area Resource File, providing 12 541 beneficiaries with 428 373 person-months for analysis. Latent class analysis was used to assign severity status to episodes. Multinomial logistic regression was used to identify AME risk factors. The long-term consequences of AMEs on Medicare expenditures were examined by population average models. Survival analyses examined the long-term risk of death. Results: Nearly 19% of participants experienced at least one AME, with 62% from outpatient claims. The risk of AMEs is greater among participants in poorer health, and increases with comorbidity and with impairment in performing activities of daily living or instrumental activities of daily living. Medicare expenditures during an AME episode increased sharply and remained higher than what would have otherwise been expected in quarters following an AME episode, and failed to return to pre-AME expenditure levels. Differences in survival rates were observable long after the AME episode concluded, with only 55% of the patients sustaining an AME surviving to the end of the study. In contrast, nearly 80% of those without an AME were estimated to have survived. Conclusions: The impacts of AMEs are observable over extended periods of time and are associated with considerable excess mortality and costs. Efforts to monitor and prevent AMEs in both acute care and outpatient settings are warranted. [ABSTRACT FROM AUTHOR]

Objective: To measure the validity of safety behaviours, safety equipment use and hazards reported on a questionnaire by parents/carers with children aged under 5 years participating in a series of home safety case-control studies. Methods: The questionnaire measured safety behaviours, safety equipment use and hazards being used as exposures in five case-control studies. Responses to questions were compared with observations made during a home visit. The researchers making observations were blind to questionnaire responses. Results: In total, 162 families participated in the study. Overall agreement between reported and observed values of the safety practices ranged from 48.5% to 97.3%. Only 3 safety practices (stair gate at the top of stairs, stair gate at the bottom of stairs, stairs are carpeted) had substantial agreement based on the κ statistic (k=0.65, 0.72, 0.74, respectively). Sensitivity was high (≥70%) for 19 of the 30 safety practices, and specificity was high (≥70%) for 20 of the 30 practices. Overall for 24 safety practices, a higher proportion of respondents over-reported than under-reported safe practice (negative predictive value>positive predictive value). For six safety practices, a higher proportion of respondents under-reported than over-reported safe practice (negative predictive value

Background: Although effective when used correctly, child restraint systems (CRS) are commonly misused. Caregivers must make accurate judgements about the quality of their CRS installations, but there is little research on the psychological, technological, or contextual factors that might influence these judgements. Methods: Seventy-five caregivers were observed installing a CRS into a vehicle and completed self-report surveys measuring risk appraisals, previous utilisation of CRS resources, task difficulty, and confidence that the CRS was installed correctly. Results: Approximately 30% of caregivers installed the CRS inaccurately and insecurely, but reported that it was correctly installed. Predictors of confidence were ease of use (β=0.47) and exposure to CRS resources (β=−0.34). Installation errors and CRS security were unrelated to caregivers’ confidence. Conclusions: An interdisciplinary approach is needed to understand factors influencing caregivers’ judgements about their installations, optimise channels to connect caregivers to CRS resources, and to design safety technologies in light of these findings. [ABSTRACT FROM AUTHOR]

Background Few studies have examined the impact of community-based smoke alarm (SA) distribution programmes on the occurrence of house fire-related deaths and injuries (HF-D/I). Objective To determine whether the rate of HF-D/I differed for programme houses that had a SA installed through a community-based programme called Operation Installation, versus non-programme houses in the same census tracts that had not received such a SA. Methods Teams of volunteers and firefighters canvassed houses in 36 high-risk target census tracts in Dallas, TX, between April 2001 and April 2011, and installed lithium-powered SAs in houses where residents were present and gave permission. We then followed incidence of HF-D/I among residents of the 8134 programme houses versus the 24 346 non-programme houses. Results After a mean of 5.2 years of follow-up, the unadjusted HF-D/I rate was 68% lower among residents of programme houses versus non-programme houses (3.1 vs 9.6 per 100 000 population, respectively; rate ratio, 0.32; 95% CI 0.10 to 0.84). Multivariate analysis including several demographic variables showed that the adjusted HF-D/I rate in programme houses was 63% lower than non-programme houses. The programme was most effective in the first 5 years after SA installation, with declining difference in rates after the 6th year, probably due to SAs becoming non-functional during that time. Conclusions This collaborative, community-based SA installation programme was effective at preventing deaths and injuries from house fires, but the duration of effectiveness was less than 10 years. [ABSTRACT FROM AUTHOR]

Objective This study investigated the relationship between the number of different medications dispensed (NDMD) to senior drivers and the risk of injurious road traffic crashes (RTCs). Design A matched case-control study with data from various population-based national registers was conducted. Cases were drivers aged 50-80 years involved in a crash in Sweden between 2005 and 2009. Only the first non-alcohol-related RTC was studied. Controls were residents with a valid license who did not crash. Four controls were matched by sex, age (year and month of birth), and place of residence. Exposure to NDMD prior to the crash date was assessed using four time periods: 1-8, 1-15, 1-30 and 1-90 days. Conditional logistic regression was used and analyses adjusted for civil status, occupation and dispensation of medications affecting the cardiovascular or nervous systems (C/N). Results ORs (95% CI) increased progressively with the NDMD. For 1-8 days the OR ranged from 1.15 (1.10 to 1.20) for 1-2 medications to 1.27 (1.13 to 1.42) for five or more medications. The magnitude of the effect declined gradually with longer exposure periods, but remained when five or more medications were used. Adjusting for C/N medications resulted in slightly higher effects; for 1-8 days it ranged from 1.16 (1.10 to 1.23) for 1-2 medications to 1.35 (1.17 to 1.56) for five or more, with similar trends by exposure period. The highest effects were seen for single crashes and for drivers aged 66-80 years. Conclusions The NDMD was linked to the likelihood of a senior driver being involved in an injurious RTC. The strength of the association steadily increased with increased NDMD, especially when medications were taken closer to the index date, or when more than five medications were dispensed. [ABSTRACT FROM AUTHOR]

This study examines the profile of injuries among adolescents in the United Arab Emirates (UAE) and identifies related factors associated with injury. A cross-sectional study design determined incidence of injury for a sample of 6363 adolescents. Data collected information on injury in the past 12 months, sociodemographic, behavioural and sensory data. Logistic regression modelling was used to examine predictors of physical injury for the past 12 months. Among participants, 18% experienced injury; the three top causes include accidental falls (38%), being struck by an object or person (18%), and motor vehicle injuries (MVI) (13%). The majority of injuries took place at the participant's home and surrounding area. Identified risk factors that are amenable for prevention include smoking behaviour, exposure to smoking, physical activity profile, family income, and speeding behaviour. Our findings highlight the need for public health policies and education programmes that reduce injury among the UAE adolescent population. [ABSTRACT FROM AUTHOR]

Background Firearms may be obtained illegally from federally-licensed dealers and pawnbrokers through surrogate (straw) purchases, undocumented purchases and theft. Some retailers knowingly make illegal sales. Objective To obtain information about the frequency of and risk factors for these events, and retailers' reactions to them, directly from licensed retailers. Methods Survey of a random sample of 1601 licensed dealers and pawnbrokers in 43 states who were believed to sell ≥50 firearms annually, conducted by mail during June.August 2011. Results The response rate was 36.9%, typical of establishment surveys using such methods. In the preceding year, 67.3% of respondents experienced attempted straw purchases; 42.4% experienced undocumented purchase attempts. For each event, 10% reported ≥1 occurrence/month. A quarter (25.6%) experienced firearm theft in the preceding 5 years. Pawnbroker status, sales volume, denied sales and sales of firearms that were subsequently traced by law enforcement were associated with all outcomes in multivariate analysis. Estimates of retailer involvement in illegal sales (median 3%, IQR 1-10%) were related in multivariate analysis to respondents' age and sex, and to denied sales. In a hypothetical case involving 50 illegal sales, respondents recommended prolonged incarceration (median 10 years, IQR 5-20 years) and a substantial fine (median $50 000, IQR $10 000-$250 000) for retailers and made similar recommendations for buyers. Conclusions Attempts to acquire firearms illegally from licensed dealers and pawnbrokers are common. Characteristics associated with frequency of occurrence may facilitate prevention efforts. Licensed retailers consider selling and buying firearms illegally to be serious crimes. [ABSTRACT FROM AUTHOR]

Objectives Many colleges assess criminal histories during the admissions process, in part, to address violence on campus. This study sought to examine the utility of screening as a means of reducing violence. Methods Using cohort and case-control analyses, we identified college misconduct through college records and self-reports on a confidential survey of graduating seniors, and examined precollege behaviour as indicated on admissions records, a survey and criminal background checks. Results One hundred and twenty students met our case definition of college misconduct, with an estimated OR of 5.28 (95% CI 1.92 to 14.48) associated with precollege misconduct revealed on the college application. However, only 3.3% (95% CI 1.0% to 8.0%) of college seniors engaging in college misconduct had reported precollege criminal behaviours on their applications and 8.5% (95% CI 2.4% to 20.4%) of applicants with a criminal history engaged in misconduct during college. Discussion Though precollege behaviour is a risk factor for college misconduct, screening questions on the application are not adequate to detect which students will engage in college misconduct. This pilot work would benefit from replication to determine the utility of criminal background investigations as part of admissions. [ABSTRACT FROM AUTHOR]

Background This study examined the impact of transportation infrastructure at intersection and nonintersection locations on bicycling injury risk. Methods In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case-crossover design compared the infrastructure of injury and control sites within each injured bicyclist's route. Intersection injury sites (N=210) were compared to randomly selected intersection control sites (N=272). Non-intersection injury sites (N=478) were compared to randomly selected non-intersection control sites (N=801). Results At intersections, the types of routes meeting and the intersection design influenced safety. Intersections of two local streets (no demarcated traffic lanes) had approximately one-fifth the risk (adjusted OR 0.19, 95% CI 0.05 to 0.66) of intersections of two major streets (more than two traffic lanes). Motor vehicle speeds less than 30 km/h also reduced risk (adjusted OR 0.52, 95% CI 0.29 to 0.92). Traffic circles (small roundabouts) on local streets increased the risk of these otherwise safe intersections (adjusted OR 7.98, 95% CI 1.79 to 35.6). At non-intersection locations, very low risks were found for cycle tracks (bike lanes physically separated from motor vehicle traffic; adjusted OR 0.05, 95% CI 0.01 to 0.59) and local streets with diverters that reduce motor vehicle traffic (adjusted OR 0.04, 95% CI 0.003 to 0.60). Downhill grades increased risks at both intersections and non-intersections. Conclusions These results provide guidance for transportation planners and engineers: at local street intersections, traditional stops are safer than traffic circles, and at non-intersections, cycle tracks alongside major streets and traffic diversion from local streets are safer than no bicycle infrastructure. [ABSTRACT FROM AUTHOR]

Background The city of Winnipeg was the first among several jurisdictions in Manitoba, Canada, to introduce breed specific legislation (BSL) by banning pit-bull type dogs in 1990. The objective of the present work was to study the effectiveness of BSL in Manitoba. Methods Temporal differences in incidence of dog-bite injury hospitalisations (DBIH) within and across Manitoba jurisdictions with and without BSL were compared. Incidence was calculated as the number of unique cases of DBIH divided by the total person-years at risk and expressed as the number per 100 000 person-years. Year of implementation determined the pre-BSL and post-BSL period for jurisdictions with BSL; for jurisdictions without BSL to date, the entire study period (1984--2006) was considered as the preimplementation period. The annual number of DBIH, adjusted for total population at risk, was modelled in a negative binomial regression analysis with repeated measures. Year, jurisdiction and BSL implementation were independent variables. An interaction term between jurisdiction and BSL was introduced. Results A total of 16 urban and rural jurisdictions with pit-bull bans were identified. At the provincial level, there was a significant reduction in DBIH rates from the pre- BSL to post-BSL period (3.47 (95% CI 3.17 to 3.77) per 100 000 person-years to 2.84 (95% CI 2.53 to 3.15); p=0.005). In regression restricted to two urban jurisdictions, DBIH rate in Winnipeg relative to Brandon (a city without BSL) was significantly (p<0.001) lower after BSL (rate ratio (RR)=1.10 in people of all ages and 0.92 in those aged <20 years) than before (RR=1.29 and 1.28, respectively). Conclusions BSL may have resulted in a reduction of DBIH in Winnipeg, and appeared more effective in protecting those aged <20 years. [ABSTRACT FROM AUTHOR]

Objectives To estimate the overall and age-specific associations between obesity and extremity musculoskeletal injuries and pain in children. Methods This cross-sectional study used information from electronic medical records of 913 178 patients aged 2--19 years enrolled in an integrated health plan in the period 2007--2009. Children were classified as underweight, normal weight, overweight, or moderately/ extremely obese and, using multivariable logistic regression methods, the associations between weight class and diagnosis of upper or lower extremity fractures, sprains, dislocations and pain were calculated. Results Overweight (OR 1.18, 95% CI 1.15 to 1.20), moderately obese (OR 1.24, 95% CI 1.20 to 1.27) and extremely obese (OR 1.34, 95% CI 1.30 to 1.39) children had statistically significantly higher odds of lower extremity injuries/pain compared to normal weight, adjusted for sex, age, race/ethnicity and insurance status. Age-stratified analyses yielded similar results. No consistent association was observed between body mass index and injuries/pain of the upper extremities. Conclusions Greater body mass index is associated with increased odds of lower extremity injuries and pain issues. Because the benefits of physical activity may still outweigh the risk of injury, attention should be paid to injury prevention strategies for these children at greater risk for lower extremity injuries. [ABSTRACT FROM AUTHOR]

Objective To assess the personal, physical and psychosocial factors associated with wrist or hand pain in Australian hospital-based nurses. Methods Wrist or hand pain, associated disability and sickness absence, demographic, occupational, physical, psychosocial and personal factors among nurses working for three hospitals in Melbourne, Australia, were assessed in a cross-sectional study. Factors associated with wrist or hand pain in the past month were assessed using logistic regression. Results This analysis was based on 1111 participants. The prevalence of wrist or hand pain in the past month was 15.3%. Repeated movements of the wrist or finger >4 h (OR 2.63, 95% CI 1.80 to 3.84), high job strain (1.54, 1.04 to 2.28), job insecurity (1.55, 1.04 to 2.28), somatisation tendency (2.73, 1.75 to 4.26), pain catastrophising (1.56, 1.03 to 2.37), better mental (0.97, 0.95 to 0.99) and physical (0.96, 0.94-0.98) health and well-being were associated with wrist or hand pain in the past month, after adjusting for possible confounding factors. When all significant factors were examined in the same model, repeated movements of the wrist or finger >4 h (2.50, 1.71 to 3.67), somatisation (2.61, 1.65 to 4.13) and better physical health and well-being (0.96, 0.94 to 0.99) remained independently associated with wrist or hand pain in the past month. Conclusions This study highlights that wrist or hand pain is prevalent in hospital nurses. Workplace physical factors and personal factors were associated with wrist or hand pain. Further longitudinal investigation is needed to examine the predictive nature of these factors. [ABSTRACT FROM AUTHOR]

Background Pedestrian incidents represent an increasing proportion of serious injuries resulting from motor vehicle collisions in Canada. However, few studies have examined the effect of pedestrian crossing location in urban areas on injury severity. The objective of this study was to investigate the relationship between pedestrian-motor vehicle collision injury severity and crossing location. Methods This study was a population-based analysis of police-reported pedestrian collision data. The study group was pedestrian collisions from 1 January 2000 to 31 December 2009 in Toronto. Main outcome measures were a binary indicator of severe injury, and a four-level categorical variable of injury severity. The exposure variable was crossing at mid-block with no traffic control compared to signalised intersection. Analysis was via binary and multinomial logistic regression models to estimate ORs of injury severity with 95% CIs. Results The analysis included 9575 pedestrian-motor vehicle collisions, of which 7325 occurred at signalised intersections when crossing and 2230 occurred at uncontrolled mid-block locations when crossing without right of way. Uncontrolled mid-block collisions resulted in greater injury severity when controlling for road type. The odds of severe injury were 1.75 (95% CI 1.07 to 2.86) for children, 2.55 (95% CI 2.13 to 3.05) for adults and 1.68 (95% CI 1.23 to 2.28) for older adults. The odds of death at uncontrolled mid-block crossings were 4.97 (95% CI 3.11 to 7.94) in adults and 3.49 (95% CI 2.07 to 5.89) in older adults. Conclusions Crossing at uncontrolled mid-block locations resulted in greater injury severity compared with crossing at signalised intersections. This has important implications for pedestrian behaviour and traffic environment design and emphasises the need for safe pedestrian crossings on urban roads. [ABSTRACT FROM AUTHOR]

Background Gang violence accounted for 20% of homicides in large cities from 2002 to 2006. Preventing gang affiliation (ie, youth who either desire or have gang membership) might reduce subsequent gang activity. Previous research has focused on identifying risk factors for gang affiliation; however, little information is available on protective factors. Aim To identify risk and protective factors to provide more direction for gang violence prevention strategies. Methods The author analysed cross-sectional survey data from 4131 youths in grades 7, 9, 11 and 12. Data were collected in 2004 from students in a high-risk, urban public school district. Regression analyses were conducted to assess the association between gang affiliation and alcohol and drug use, delinquency, depressed mood, suicidal ideation, peer victimisation, parental monitoring and positive reinforcement, adult, family and peer support, coping skills, and school connectedness. Analyses were controlled for sex, race/ethnicity and age. Results An estimated 7% of youths were gang affiliated. Adjusting for all factors, gang affiliation was positively associated with engaging in any delinquent behaviours (prevalence OR: 2.07; 95% CI 1.18 to 3.64), frequent alcohol use (OR: 2.62; 95% CI 1.85 to 3.72) and frequent drug use (OR: 1.95; 95% CI 1.15 to 3.29). Gang affiliation was negatively associated with moderate levels of parental monitoring (OR: 0.67; 95% CI 0.54 to 0.85) and coping skills (OR: 0.54; 95% CI 0.42 to 0.71). Conclusions The findings suggest the potential benefit of increasing parental monitoring and coping skills and reducing delinquency, alcohol use and drug use to prevent gang affiliation. [ABSTRACT FROM AUTHOR]

Objective The goal of the study was to systematically review available evidence regarding differences in injury incidence between rural and urban paediatric populations in Canada and the USA. Data source Eight electronic databases, institutional websites and reference lists of relevant studies including published and unpublished reports. Selection criteria Population-based observational studies or surveys published from 1970 to February 2011 that compared injury incidence or injury-related healthcare outcomes between rural and urban children (<18) living in Canada or the USA. Data collection and analysis Two reviewers independently applied selection criteria and assessed methodological quality of studies. Data were extracted by one author and independently verified by the second author. Injury rate ratios for rural and urban children were extracted or calculated. Data were synthesised descriptively due to substantial heterogeneity among studies. Results A total of 41 studies were included for this review (seven surveys and 34 studies using administrative health databases). Internal validity of included studies was moderate. Rural children were at higher risk of overall injury, motor vehicle crash injury and suicide, whereas urban children in the USA experienced higher rates of firearm-related homicides. Greater rural-urban injury disparities were likely to be found between more extreme rural and urban areas. In particular, children in remote rural areas are at increased risk of severe injuries than urban counterparts. Overall, healthcare costs per child for injury were higher for rural children. Conclusion These findings indicate the need of developing geographic area-specific injury-prevention strategies. Future research is required to investigate rural-urban disparity for less-studied injuries and related health outcomes (eg, disability). Systematic review registration number CRD42011001244 (PROSPERO 2011). [ABSTRACT FROM AUTHOR]

Objective: Comparison of characteristics of fire with non-fire households to determine factors differentially associated with fire households (fire risk factors). Design, setting and subjects: National household telephone survey in 2004-2005 by the US Consumer Product Safety Commission with 916 fire households and a comparison sample of 2161 non-fire households. There were an estimated 7.4 million fires (96.6% not reported to fire departments) with 130 000 injuries. Main outcome measure: Bivariate analysis and multivariate logistic regression analyses to assess differences in household characteristics. Results: Significant factors associated with fire households were renting vs. owning (OR 1.988 p<0.0001); household members under 18 year of age (OR 1.277 p<0.0001); lack of residents over 64 years old (OR 0.552 p=0.0007); and college or higher education (some college OR 1.444 p=0.0360, college graduate OR 1.873, p<0.0001, postgraduate OR 2.156 p<0.0001). Not significant were age of house; race; ethnicity; and income. Number of smokers was borderline significant (OR 1.132 p=0.1019) but was significant in the subset of fire households with non-cooking fires (OR 1.383 p=0.0011). Single family houses were associated with non-fire households in the bivariate analysis but not in the multivariate analyses. Conclusion: Renting, household members under 18 years old and smokers are risk factors for unattended fires, similar to the literature for fatal and injury fires. Differences included household members over 65 years old (associated with non-fire households), college/ postgraduate education (associated with fire households) and lack of significance of income. Preventing cooking fires (64% of survey incidents), smoking prevention efforts and fire prevention education for families with young children have the potential for reducing unattended fires and injuries. [ABSTRACT FROM AUTHOR]

Background Fires and burns are a leading cause of unintentional injury death in the USA. Although it has been anecdotally reported that vacant dwellings are at a higher risk for fire, the association between vacancy and fire risk at the individual household level has not been empirically measured. Methods In this cross-sectional study, geocoded residential vacant properties (VP) and fire events are analysed in Baltimore City at the census tract level and the individual household level. Results On average, a 10% increase in the proportion of vacancies in a census tract was associated with a 9.9% increase in fires (95% CI: 5% to 15%). Random-effects Poisson models, controlling for housing and neighbourhood conditions, found contagion effects. The risk of fire in an occupied dwelling increased by 8% (95% CI: 1% to 10%) for every vacant structure within 10 m, and the risk of fire decreased by half (95% CI: 45% to 62%) for every km between an occupied dwelling and vacant building. Close proximity to VP was associated with trash fires within dwellings (p¼0.039) and structure fires (p¼0.012). Conclusions We believe that this is the first study to demonstrate increased risk posed by nearby VP at the household level, confirming earlier ecological analyses of the role of VP as strong correlates of home fires. Measurement of this risk can motivate property owners, policy makers and insurers to invest in risk reduction measures that include building maintenance and trash removal. INSET: Father charged with firearm offence: son shot by brother. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To quantify the concordance of hospital child maltreatment data with child protection service (CPS) records, and identify factors associated with linkage. METHODS: Multivariable logistic regression analysis was conducted following retrospective medical record review and database linkage of 884 child records from 20 hospitals and the CPS in Queensland, Australia. RESULTS: Nearly all children with hospital assigned maltreatment codes (93.1%) had a CPS record. Of these, 85.1% had a recent notification. 29% of the linked maltreatment group (n=113) were not known to the CPS prior to the hospital presentation. Almost one third of children with unintentional injury hospital codes were known to the CPS. Just over 24% of the linked unintentional injury group (n=34) were not known to the CPS prior to the hospital presentation but became known during or after discharge from hospital. These estimates are higher than the 2006/2007 annual rate of 2.39% of children being notified to the CPS. Rural children were more likely to link to the CPS, and children were over three times more likely to link if the index injury documentation included additional diagnoses or factors affecting their health. CONCLUSIONS: The system for referring maltreatment cases to the CPS is generally efficient, although up to 1 in 15 children had codes for maltreatment but could not be linked to CPS data. The high proportion of children with unintentional injury codes who linked to CPS suggests that clinicians and hospital-based child protection staff should be supported by further education and training to ensure children at risk are being detected by the child protection system. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous case–control studies on bicycle helmet efficacy are mostly Anglo-Saxon, and based on data from the early 1990s when hard-shell helmets were common. METHODS: In France, the Rhône county (1.6 million inhabitants) is covered by a road trauma registry that includes emergency department visits, hospital admissions, and fatalities. Over the 1998–2008 period, 13 797 cyclist casualties were identified. The injuries sustained were coded using the Abbreviated Injury Scale (AIS) for injuries to the head (AIS1+ and AIS3+), face (AIS1+), or neck (AIS1+). The study uses a case–control design where the control group includes cyclists injured below the neck—that is, not injured in the region associated with the helmet. We first adjusted for age, gender, and type of crash, as in a previously published Cochrane review. Then we adjusted for injury severity based on non-head, face, or neck injury, and when relevant, for crash location: type of road, urban/rural area. RESULTS: The fully adjusted ORs of helmeted versus unhelmeted cyclists are: for AIS1+ head injuries, 0.69 (95% CI 0.59 to 0.81); for AIS3+ head injuries sustained in urban areas, 0.34 (95% CI 0.15 to 0.65), those sustained in rural areas, 0.07 (95% CI 0.02 to 0.23); for AIS1+ facial injuries, 0.72 (95% CI 0.62 to 0.83); and for AIS1+ neck injuries, 1.18 (95% CI 0.94 to 1.47). CONCLUSION: This study confirms the protective effect for head and facial injuries, even though soft-shell helmets have now become more common. The reduction of risk is greater for serious head injuries. The study is inconclusive about the risk for neck injuries. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine prevalence and potential risk factors for post-deployment injury among Iraq and Afghanistan combat veterans enrolled in Veterans Affairs (VA) healthcare. A national, stratified sample of Iraq/Afghanistan combat Veteran VA users was surveyed in 2008. Mental and physical health, including medically-treated injuries sustained since deployment, were self-reported. Injury risk was estimated using survey logistic regression. Stratified ORs and 95% CIs were adjusted for potential confounders and non-response bias and weighted to represent the target population. Nearly half the population reported post-deployment injuries. In multivariate models, veterans with probable posttraumatic stress disorder (OR=2.1; 95% CI 1.3 to 3.5), self-reported diagnosed depression (OR=3.6; 95% CI 1.8 to 7.0) and anger problems (OR=2.4; 95% CI 1.4 to 4.2) had greater odds of post-deployment injury. Deployment-related injuries were also strongly associated with odds of post-deployment injury. Results suggest that mental health disorders increase the odds of post-deployment injury among combat veteran VA users. Longitudinal research examining these associations is warranted. [ABSTRACT FROM AUTHOR]

Background Many injury studies use samples of hospital patients. If a study requires further contact, consent is usually required but the sample may be biased if many fail to consent. Objective To determine whether wording requiring 'active' consent resulted in more refusals than wording that was 'passive'--that is, where consent is implied in the absence of direct refusal. Methods Subjects were injured children seen in the emergency departments in five hospitals where the Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) operates. For CHIRPP, parents or older children complete a one-page questionnaire to describe the injury; one question seeks consent to follow-up for research. Three of the hospitals use passive wording for this question and two use active wording. All cases where CHIRPP coordinators completed forms using the medical record were treated as refusals. It was hypothesised that there would be a significant association between the form of wording (active or passive) and the rate of consent, and that this association would be affected by socio-demographic and clinical variables. Results On average, 64.5% of parents gave consent for follow-up at hospitals using passive consent wording versus 42% where active consent wording was used. Passive wording consistently yielded a higher percentage of consents for all variables. The differences were greater than 5% for families living in census tracts with low median household incomes and greater than 10% for those age 15-19 years. For parent completed forms the adjusted OR for active wording was 0.48 (95% CI 0.43 to 0.54). Conclusion Caution is needed when interpreting results from studies using hospital samples, especially when wording of consent for follow-up requires direct affirmation. [ABSTRACT FROM AUTHOR]

Objective To increase the number and quality of injury prevention recommendations made by Washington State (USA) child death review teams. Design Before and after study design involving four intervention teams and 21 comparison teams. Methods Intervention teams received injury prevention training, collaborative process improvement coaching, and access to web based prevention resources. An equal number of randomly selected child death review case reports filed with the state before the intervention by the intervention and comparison teams were included in the baseline sample. All reports submitted by the intervention and comparison teams after the intervention were included in the follow-up sample. Reports were scored on the completeness of prevention related data elements and on the quality of written prevention recommendations. Results Data completion for prevention relevant items increased in intervention teams from 73% at baseline to 88% at follow-up. In comparison teams, this measure fell from 77% to 56% over the same period. The quality of written recommendations produced by intervention teams increased from 4.3 (95% CI 3.4 to 5.1) to 7.6 (95% CI 6.7 to 8.5), while comparison teams showed no significant change (4.0 (95% CI 2.5 to 5.3) to 3.7 (95% CI 2.2 to 5.2)). Specifically, improvements were noted in the identification of evidence based best practices and the development of clear, actionable written recommendations. Conclusion Injury prevention recommendations are generated in the systematic local review of child deaths. This process can be analysed, measured, supported, and improved. [ABSTRACT FROM AUTHOR]

Aim This qualitative study of a small number of child death overview panels aimed to observe and describe their experience in implementing new child death review processes, and making prevention recommendations. Methods Nine sites reflecting a geographic and demographic spread were selected from Local safeguarding Children Boards across England. Data were collected through a combination of questionnaires, interviews, structured observations, and evaluation of documents. Data were subjected to qualitative analysis. Results Data analysis revealed a number of themes within two overarching domains: the systems and structures in place to support the process; and the process and function of the panels. The data emphasised the importance of child death review being a multidisciplinary process involving senior professionals; that the process was resource and time intensive; that effective review requires both quantitative and qualitative information, and is best achieved through a structured analytic framework; and that the focus should be on learning lessons, not on trying to apportion blame. In 17 of the 24 cases discussed by the panels, issues were raised that may have indicated preventable factors. A number of examples of recommendations relating to injury prevention were observed including public awareness campaigns, community safety initiatives, training of professionals, development of protocols, and lobbying of politicians. Conclusions The results of this study have helped to inform the subsequent establishment of child death overview panels across England. To operate effectively, panels need a clear remit and purpose, robust structures and processes, and committed personnel. A multiagency approach contributes to a broader understanding of and response to children's deaths. [ABSTRACT FROM AUTHOR]

Objective To illustrate the benefits and utility of the child death review (CDR) reporting system when examining risk factors associated with infant death occurring within two subgroups of sudden unexpected infant deaths (SUID)dunintentional suffocation and sudden infant death syndrome (SIDS)din a large urban county in Wisconsin. Design Retrospective CDR data were analysed, 2007e2008, for Milwaukee County, Wisconsin. Patients or subjects Unintentional suffocation and SIDS infant deaths under 1 year of age in Milwaukee County, Wisconsin, 2007e2008, with a CDR record indicating a death in a sleep environment. Main outcome measure Study examined demographic characteristics, bed-sharing, incident sleep location, position of child when put to sleep, position of child when found, child's usual sleep place, crib in home, and other objects found in sleep environment. Results Unintentional suffocation (n¼11) and SIDS (n¼40) classified deaths with CDR data made up 18% (51/283) of all infant deaths in Milwaukee County from 2007 to 2008. The majority of infants who died of unintentional suffocation (n¼9, 81.8%) or SIDS (n¼26, 65.0%) were black and under the age of 3 months. Bedsharing was involved in most of the unintentional suffocation deaths (n¼10, 90.9%) and the SIDS deaths (n¼28, 70.0%). All unintentional suffocation deaths (n¼11, 100%) and the majority of SIDS deaths (n¼31, 77.5%) took place in a non-crib sleeping environment. Conclusions The study demonstrates how CDR provides enhanced documentation of risk factors to help steer prevention efforts regarding SUID deaths in a community and reaffirms infants in an unsafe sleep environment have an increased risk of death. [ABSTRACT FROM AUTHOR]

Outside-the-boot parachute ankle braces (PABs) worn during US Army paratrooper training have been shown to reduce the risk of severe ankle injuries. In spite of evidence to the contrary, anecdotal reports continue to suggest increases in risk of other types of injury, and the cost of obtaining and periodically replacing the PAB has been used to justify its discontinued use. The authors identified inpatient and outpatient treatment for injuries during US Army paratrooper training. Those undergoing training during two periods when PAB use was mandated had 40% lower risks of ankle injury (brace I, RR=0.60 (95% CI 0.47 to 0.75); brace II, RR=0.62 (95% CI 0.49 to 0.78)), with no difference in risks of other types of injury. There were no differences in risk of ankle injury during periods when brace use was not mandated. The PAB is safe, effective and cost effective. [ABSTRACT FROM AUTHOR]

Background: Few studies document the health burden attributable to intimate partner violence (IPV) at the population level. Objectives: To document injuries resulting from IPV and women's use of healthcare for treatment of IPV injuries using the New Zealand Violence Against Women Study. Methods: A cross-sectional household survey was conducted using a population-based cluster sampling scheme. In total, 2855 women aged 18--64 years were interviewed about their experience of IPV, injuries resulting from violence, and their use of healthcare services. Results: Of the 956 women who had experienced physical and/or sexual IPV in their lifetime, half were injured at least once as a result of the violence. The most common injuries were abrasions and bruises; followed by cuts, punctures, bites; and injuries to the eye or ear. Many women reported that they needed healthcare for treatment of IPV injuries, yet most (86%) did not receive healthcare on all occasions it was needed. Half of ever-injured women who received treatment told a healthcare provider the reason for their injury. Among those who did not disclose, shame was the most frequent reason for not telling, followed by fear of further violence. Conclusions: This population-based study documents the injury-burden created by IPV, to individuals, healthcare systems, and the population. Implications include supporting healthcare providers to respond to victims of violence and the need for prevention strategies at the population level. [ABSTRACT FROM AUTHOR]

Objective: To measure the effect of the WHO Safe Communities model approach to increasing child restraint use in motor vehicles. Design: Pre- and post-intervention observations of restraint use in motor vehicles in several sites in the target area, and in a comparison area community. Setting: Community; southeast Dallas, Texas, 2003--2005. Interventions: A multifaceted approach to increasing use of child safety seats, booster seats and seat belts that included efforts in schools, day care centres, neighbourhoods and a local public clinic, along with child safety seat classes and a low-cost distribution programme. Main outcome measures: Prevalence of restraint use among children 0e8 years old riding in motor vehicles. Results In the target area, the adjusted child restraint use increased by 23.9 percentage points versus 11.8 in the comparison area (difference 12.1; 95% CI 9.9 to 14.3), and adjusted driver seat belt use increased by 16.3 percentage points in the target area versus 4.9 in the comparison area (difference 11.4; 95% CI 11.0 to 11.7). Multivariable multilevel analysis showed that the increase in the target area was significantly greater than in the comparison area for child restraint use (OR 1.6; 95% CI 1.2 to 2.2), as well as for driver seat belt use and proportion of children riding in the back seat. Conclusions: The Safe Communities approach was successful in promoting the use of child restraints in motor vehicles through a multifaceted intervention that included efforts in various community settings, instructional classes and child safety seat distribution. [ABSTRACT FROM AUTHOR]

Background Approximately 70-80 New Zealanders have spinal cord impairment (SCI) due to injury (2/3) or disease (1/3) each year. They had been socialised as non-disabled people. Following paralysis, interrelationships between body, self and society change. Little is known of the impact of these changes on life histories, life chances and life choices of people with SCI. This has negative implications for the design of rehabilitation and disability support services in New Zealand. Furthermore, the trajectory of disability is affected by previous socioeconomic conditions. How specific supports following SCI (eg, rehabilitation and compensation funded by the Accident Compensation Corporation; ACC) can change this trajectory is unknown. Objectives To explore the interrelationships of body, self and society for people with SCI and how these have shaped life chances, life choices and subjectivity. To investigate how entitlement to rehabilitation and compensation through ACC affects socioeconomic and health outcomes. Setting New Zealand. Design A prospective cohort study; mixed methods. Participants 112 people with SCI admitted for the first time to one of New Zealand's two spinal units without serious cognitive injury. Data Structured interviews with all participants (n=112); qualitative interviews with a selected subgroup (n=20); clinical data collected at the time of admission. Exposures include: demographics, comorbidity, previous health and socioeconomic status, SCI resulting from illness or injury, income support, health and social services. Outcome measures Socioeconomic status, health, participation and life satisfaction. Analysis Descriptive statistics; differences tested by paired t tests or McNemar tests; multiple regression and mixed models. Qualitative analysis will be interpretive. [ABSTRACT FROM AUTHOR]

To describe the presence of alcohol, cannabis and amphetamines in work-related injury deaths in Victoria, 2001-6, an observational study of work-related deaths reported to the State Coroner's Office, Victoria, Australia was conducted. Case and postmortem forensic toxicology data were obtained from the National Coroner's Information System for work-related injury deaths with positive toxicology screens. Over 6 years there were 43 worker deaths in a total of 355 unintentional work-related injury deaths. The coroner mentioned the presence of alcohol/drugs in 22 of the 43 worker deaths with positive toxicology screens. Toxicology screens were positive for alcohol and/or drugs in 79 work-related deaths overall. Overall, alcohol was present in 26 (7%) work-related deaths and cannabis or amphetamines in 20 (6%). Incidents were mainly transport related. Alcohol and/or drugs were present in a significant portion of work-related deaths. Research is needed to determine the relative contribution of alcohol and drugs compared with other contributing factors to work-related deaths. [ABSTRACT FROM AUTHOR]

Objective To assess the effect on collisions with injuries of a 61% reduction in the number of traffic citations issued by police officers over a 21-month period. Methods Using descriptive analyses as well as ARIMA intervention time-series analyses, this study estimated the impact of this reduction in citations issued for traffic violations on the monthly number of collisions with injuries. Results Simple descriptive analysis reveals that the 61% reduction in the number of citations issued for traffic violations during the experimental period coincided with an increase in collisions with injuries. Results from the interrupted time-series analyses reveal that, on average, eight additional collisions with injuries occurred every month during which the number of tickets issued for traffic violations was lower than normal. As this pressure tactic was applied for 21 months, it is estimated that this situation was associated with approximately 184 additional collisions with injuries: equivalent to 239 traffic injuries (either deaths, minor or serious injuries). Conclusion In the province of Quebec, police officers are an important component of road safety policy. Issuing citations prevents drivers from adopting reckless driving habits such as speeding, running red lights and failing to fasten their seat belt. [ABSTRACT FROM AUTHOR]

Objectives To describe the sources that active offenders in Trinidad and Tobago use to obtain firearms and report their motivations for obtaining them. To estimate relationships between gang involvement, drug selling, and firearm ownership (or possession). Setting Port of Spain (Republic of Trinidad and Tobago). Methods A cross-sectional research design was used to collect self-report data from 421 recently booked arrestees (within 72 h of their arrest) in the Port of Spain Police District Detention Center. A survey instrument was used to collect data on firearm acquisition, drug use, gang membership and other behaviours. The sample provides insights about guns in the lives of arrestees in Trinidad and Tobago. Results 15% of respondents reported ever owning (or possessing) a firearm. Among the possessor group, 82% owned a gun primarily for defensive purposes, but approximately half reported using a gun in a crime. Nearly half of gun possessors stored their guns in outside locations. Firearm possession was greater among arrestees involved in gangs and those involved in drug selling. Conclusions A comprehensive approach of prevention, intervention, and suppression strategies that are intended to prevent gun-related incidents should be focused on gangs, drugs, and guns. Searches for high-risk firearms should focus on public areas where gang members live and socialise. The study shows the value of collecting data from offender-based populations in the region for the purpose of directing violence-prevention strategies. [ABSTRACT FROM PUBLISHER]

Objective To assess whether higher mortality rates among individuals in motor vehicle crashes in areas with low population density depend on injury type and severity or are related to the performance of emergency medical services (EMS). Methods Prehospital and hospital deaths were studied in a population-based cohort of 41 243 motor vehicle crashes that occurred in Sweden between 1998 and 2004. The final multivariable analysis was restricted to 6884 individuals in motor vehicle crashes, to minimise the effects of confounding factors. Results Crude mortality rates following motor vehicle crashes were inversely related to regional population density. In regions with low population density, the unadjusted rate ratio for prehospital death was 2.2 (95% CI 1.9 to 2.5) and for hospital death 1.5 (95% CI 1.1 to 1.9), compared with a high-density population. However, after controlling for regional differences in age, gender and the type/severity of injuries among 6884 individuals in motor vehicle crashes, low population density was no longer associated with increased mortality. At 25 years of age, predicted prehospital mortality was 9% lower (95% CI 5% to 12%) in regions with low population density compared with high population density. This difference decreased with increasing age, but was still 3% lower (95% CI 0.5% to 5%) at 65 years of age. Conclusions The inverse relationship between population density and mortality among individuals in motor vehicle crashes is related to pre-crash factors that influence the type and severity of injuries and not to differences in EMS. [ABSTRACT FROM PUBLISHER]

Purpose To determine intentional injury burden, incident characteristics, and outcomes among Ugandan youth. Methods A cross sectional analysis of trauma registry data from accident and emergency units of five regional referral hospitals was conducted. Data had been prospectively collected from all patients accessing injury care at the five sites between July 2004 and June 2005: youth records were analysed. Results Intentional injuries among youth victims, especially school-age males, are common in all five regions, constituting 7.3% of their injury burden with a male dominance. Intentional youth victimisation mainly occurred at home, on roads, and in public places; incidents were largely due to blunt force, stabs/cuts, and gunshots in general, although variations in causes were evident depending on age. Intentional injuries among the youth victims often manifested as head, neck, and face injuries: 2% were severe and there were 4%case fatalities at 2 weeks. Conclusions and recommendations Intentional injuries among youth victims, especially school-age males, are important contributors of injury burden in all five sites. Homes, roads, and public places are unsafe for Ugandan youth. Although guns were used in all five sites, less lethal mechanisms (blunt force, stabs/cuts, and burns) are the most common with variations between locations. Incidents involving teenage housewives could reflect underlying problem of domestic violence. Community based studies could be highly informative. Youth should be prioritised for prevention of injuries both in and out of school. [ABSTRACT FROM PUBLISHER]

Providers in an urban emergency department (ED) responded to a confidential, online survey assessing their beliefs and practices with respect to reducing a suicidal person's access to lethal means of suicide. 26% of respondents (37% of ED nurses, 23% of ED physicians, and 9% of psychiatrists) believed that all of the jumpers from the Golden Gate Bridge would have found a lethal suicide alternative had a barrier been present, and an additional 38% thought that most would have. Two-thirds of respondents believed that providers in the ED should always ask suicidal patients about access to firearms, yet 52% (67% of nurses, 54% of ED physicians, and 13% of psychiatrists) reported rarely or never doing so. Psychiatrists were more likely than ED staff to report always asking. Further understanding these attitudes and behaviours could enhance suicide prevention activities in the ED. [ABSTRACT FROM AUTHOR]

Objectives To estimate the rate of unintentional drowning mortality and hospitalised morbidity using population-based, population-risk and person-time denominator data and to compare the estimates obtained. To then compare exposure-based rates for drowning with road traffic death rates. Method Retrospective analysis of unintentional drowning mortality and hospitalised morbidity of New South Wales (NSW, Australia) residents 16+ years of age during 1 January to 31 December 2005. Information on population-risk and person-time risk was obtained from the 2005 NSW Population Health Survey. Analysis of road traffic death data from NSW and population and person-time risk estimates from the Survey of Vehicle Use, Household Travel Surveys and Roads and Traffic Authority Speed Surveys in 2005. Results Estimated drowning mortality and hospitalised morbidity rates for adults were higher using population-risk and person-time risk exposures compared to a population-based exposure. Population-based estimates of road traffic mortality were four times higher than drowning mortality rates. In contrast, exposure adjusted person-time estimates for drowning were 200 times higher than road traffic fatalities. Conclusions Many injury risks are underestimated when the total age-specific population is used to calculate an injury rate instead of actual population-risk or person-time exposure. This can result in the identification of misleading priorities for injury prevention. Drowning risk is strikingly higher than previously thought based on population-based estimates. This information is important for decision-making and policy development as it provides a basis for comparing the inherent risk in exposure to hazards with potential to cause injury. [ABSTRACT FROM AUTHOR]

Research question Is length of stay (LoS) in hospital a stable proxy for severity of injury when monitoring time trends in serious injury incidence? Objective To investigate whether LoS metrics (mean, median and proportion exceeding several LoS thresholds) have changed over time for injury diagnoses with known severity. Design Time series investigation. Subjects and setting New Zealand population admitted to hospital for injury and discharged during the period 1989 to 1998. Main outcome measures Interpolated median and geometric mean lengths of stay, as well as the proportion of cases that have an LoS greater than or equal to 3, 4, 7 and 14 days in hospital. Methods ICD-9-CM diagnoses that are approximately homogeneous in regard to severity of injury (ICD-HS diagnoses) were identified. Trends were investigated in the LoS statistics for: injury and non-injury diagnoses combined; all injury diagnoses; major body sites of injury; severity strata; and ICD-HS diagnoses. Results Almost without exception, there was a decline in the LoS statistics over time for all diagnoses, all injury diagnoses, each body site of injury investigated, severity strata, and the ICD-HS diagnoses. Conclusions Reductions in median and geometric mean LoS over time, as well as reductions in the proportion exceeding selected LoS thresholds, were due to factors other than reductions in the incidence of serious injury; for example, changes in service delivery over time. An LoS threshold should not be used as a proxy for severity of injury if the goal is to monitor time trends in injury incidence. [ABSTRACT FROM AUTHOR]

Purpose To obtain a better understanding of the issues that influence hip protector use among community-dwelling older adults. Methods The study used a longitudinal, crossover design. A convenience sample of 32 participants used four different brands of hip protectors, each for a 1-week period. Data were collected by weekly telephone interviews and a mailed questionnaire administered at baseline and follow-up. Participant perceptions regarding hip protectors were assessed using both open-ended questions and Likert-type items. Results The most common concerns about hip protectors mentioned in response to open-ended questions involved: discomfort, poor fit, inconvenience and unfavourable effects on appearance. Participants spontaneously mentioned at least one of these barriers in over 70% of the interviews. In contrast, participants spontaneously mentioned the protective benefits offered by hip protectors in only 16% of the interviews. The intention to continue using a particular hip protector after the study ended was associated with the number of hours the hip protector was worn during the study (p<0.01). After controlling for other variables, beliefs concerning the amount of protection that a hip protector provided was positively associated with the number of hours the hip protector was worn during the study (p<0.05) and the intention to continue using the hip protector after the study (p<0.01). Conclusion Study findings suggest that the use of hip protectors by community-dwelling older adults is influenced by beliefs about both barriers to use and the amount of protection provided. [ABSTRACT FROM AUTHOR]

This study examined the degree to which legislation intended to reduce the incidence of cigarette-caused fires influenced the behaviours of a cohort of smokers in Ontario. A random digit dialled telephone survey of adult smokers residing in Ontario was conducted in 2005, ending 1 month prior to the reduced ignition propensity (RIP) regulation's implementation date. A follow-up survey was conducted one year later. Of the baseline participants, 73.0% (n=435) completed the follow-up survey. The frequency of fire risk behaviours was similar across both surveys. At baseline, only 3.7% of smokers interviewed reported that their cigarettes went out on their own 'often' while smoking. Following the implementation of the reduced ignition propensity legislation, this increased significantly to 14.7%. Results suggest that the proportion of Ontario smokers who reported engaging in behaviour such as leaving a cigarette burning unattended and smoking in bed actually declined, although these declines were not statistically significant across all measures of fire risk. [ABSTRACT FROM AUTHOR]

In order to determine the accuracy of self-report of on-road crashes and traffic offences among participants in the DRIVE study, 2991 young drivers in New South Wales, Australia who completed the follow-up questionnaire were asked whether they had been involved in an on-road crash or were convicted for a traffic offence while driving during the year prior to the survey. This information was linked to police crash data to determine the level of accuracy of self-report of on-road crashes. There was a high level of accuracy in young drivers' self-report of police recorded crashes (85.1%; 95% CI 78.2% to 92.1%) and of police recorded traffic offences (83.0%; 95% CI 79.4% to 86.6%). Results suggest that surveys may be useful tools for estimating the incidence of on-road crashes and traffic offences in young drivers. The findings are particularly relevant to jurisdictions where access to administrative data is limited. [ABSTRACT FROM AUTHOR]

Background The benefits of correctly using size-appropriate restraints for children travelling in cars are well established, and considerable research has focused on the determinants of appropriate restraint choice. There are few studies of the factors associated with incorrect use. Objective To determine predictors of incorrect restraint use by child occupants and how these differ from inappropriate use. Methods A stratified multistage cluster sample of child occupants aged 0-10 years in New South Wales, Australia was used. Observation of restraint type and inspection of correctness of use was performed on arrival at schools, childcare centres, and child health clinics. An interview was conducted with the driver. Logistic regression was performed to estimate the effects of parental, family, and other characteristics on the likelihood of moderate or serious incorrect restraint use for restraint classes (rear/forward facing, booster, and seatbelt). Results Significant factors varied depending on age and restraint class. Older child restraint users (OR per year of age 0.27, 95% CI 0.07 to 0.98) and seatbelt users (OR per year of age 0.54, 95% CI 0.45 to 0.64) were less likely to be incorrectly using their restraints than younger users. Child restraint and booster users from non-English speaking families were more likely to be incorrectly using their restraints. Having more children in the car appeared to reduce incorrect use for booster (OR 0.18, 95% CI 0.06 to 0.57) and seatbelt users (OR 0.39, 95% CI 0.16 to 0.93). Conclusions There is a need to reduce incorrect restraint use by both education and improved restraint design. Education aimed at reducing incorrect use may need to be targeted differently to appropriate use programmes, as the predictive factors differ. [ABSTRACT FROM AUTHOR]

Objective To provide an overview of the two-stage case-control study design and its potential application to ED injury surveillance data and to apply this approach to published ED data on the relation between brain injury and bicycle helmet use. Methods Relevant background is presented on injury aetiology and case-control methodology with extension to the two-stage case-control design in the context of ED injury surveillance. The design is then applied to data from a published case-control study of the relation between brain injury and bicycle helmet use with motor vehicle involvement considered as a potential confounder. Taking into account the additional sampling at the second stage, the adjusted and corrected odds ratio and 95% confidence interval for the brain injury-helmet use relation is presented and compared with the estimate from the entire original dataset. Contexts where the two-stage case-control study design might be most appropriately applied to ED injury surveillance data are suggested. Results The adjusted odds ratio for the relation between brain injury and bicycle helmet use based on all data (n=2833) from the original study was 0.34 (95% CI 0.25 to 0.46) compared with an estimate from a two-stage case-control design of 0.35 (95% CI 0.25 to 0.48) using only a fraction of the original subjects (n=480). Conclusion Application of the two-stage case-control study design to ED injury surveillance data has the potential to dramatically reduce study time and resource costs with acceptable losses in statistical efficiency. [ABSTRACT FROM AUTHOR]