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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]

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]

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]

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 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]

To report public health practitioners’ perceptions of injury prevention in Changsha, China. We undertook a cross-sectional study at Changsha, Hunan, China. An anonymous self-reported survey was conducted to ascertain the proportion of respondents who answered negatively to questions about the value of injury prevention. Over 20% of respondents answered ‘unpreventable’ or ‘don’t know’ to whether injuries from natural environmental disaster, homicide/assault, poisoning, animal bite, cut/pierce, suffocation and electric current were preventable. More than 40% of respondents answered ‘no’ or ‘don’t know’ to whether the prevention of injuries from homicide/assault, cut/pierce, fall, suicide/self-harm, drowning, road traffic crash and fire/burn belonged to the job of public health. Only 48% of respondents supported building a division/office within the Centers for Disease Control and Preventions at all levels. Many public health practitioners in Changsha had misperception about injury prevention. Education and training are needed to correct their misperception. [ABSTRACT FROM AUTHOR]

Background: Cost-benefit analysis is a useful tool for priority setting in road safety. The value of statistical life (VOSL) is a metric used to estimate the benefits of road interventions in cost-benefit analyses. The International Road Assessment Program (iRAP), for example, created a rule-of-thumb to calculate VOSL benefits of road infrastructure when performing cost-benefit assessments in countries where data on VOSL are sparse. Aim: To evaluate the rapid assessment metric developed by iRAP and provide suggestions for improvement in these methods. Methods: We replicated iRAP calculations in order to make a critical assessment of the sources, results and conclusions. Conclusions: We found the iRAP metric a good example for highlighting some relevant aspects that should be considered in any VOSL estimation in order to enhance its use as a guiding principle for assessing road interventions. Specifically, we recommend the explicit disclosure of the assumptions, the use of sensitivity analysis and the avoidance of omitted variables bias. [ABSTRACT FROM AUTHOR]

Background This review considers barriers to, and facilitators of, success for interventions to reduce unintentional injury to children in the home through supply and/or installation of home safety equipment, and looks at risk assessments. Methods A systematic review of qualitative research. Bibliographic databases were searched for studies on interventions to reduce unintentional child injury in the home, or on related attitudes and behaviours. Studies were quality appraised, findings extracted, and a conceptual framework was developed to assess factors affecting the success of interventions. Results Nine peer-reviewed journal articles were included. Barriers and facilitators were highlighted at organisational, environmental and personal levels. Effective provision of safety equipment involves ongoing support with installation and maintenance. Take up and success of interventions depends on adjusting interventions according to practical limitations and parents' cultural expectations. A particular barrier was parents' inability to modify rented or shared accommodation. Conclusions The review highlights ways in which health inequalities affect the take up and success of home safety interventions, and how health workers can use this knowledge to facilitate future interventions. [ABSTRACT FROM AUTHOR]

Objective To quantify unintentional injuries associated with housing elements among children less than 18 years old treated in US hospital emergency departments. Methods The National Electronic Injury Surveillance System (NEISS) coding manual was reviewed, and all product codes that identified products permanently affixed to a home (housing elements) were identified. A query of the 2008 NEISS data for children under 18 determined the numbers of cases by severity code for each identified housing element. Housing elements were then tabulated by the number of cases for each severity code. The top 10 cases by severity code, (1) hospitalised or (2) treated in emergency departments, were included in a case review. Ten per cent of all cases or a minimum of 100 cases were randomly selected for review for each of the identified housing elements to assess if the case description could inform prevention efforts. Results Twelve housing elements (bathtub, cabinet, carpet, ceiling/wall, counter, door, fence, floor, nail, porch, stairs and window) were identified as the leading causes of injuries resulting in hospitalisations or emergency department visits. A list of potential interventions was generated based on the review of the case histories. Suggested changes for NEISS coding are also offered to enhance future prevention research. Conclusions NEISS is a valuable tool to identify home injury risks and inform design decisions for housing elements. Improved understanding of housing elements associated with injuries has the potential to enhance home inspection forms. However, interpretation of NEISS results is limited by lack of clarity about how the housing element was involved in the injury event. [ABSTRACT FROM AUTHOR]

Background Characteristics of social environments are potential risk factors for adolescent injury. Impacts of social capital on the occurrence of such injuries have rarely been explored. Methods General health questionnaires were completed by 8910 youth aged 14 years and older as part of the 2010 Canadian Health Behaviour in School- Aged Children study. These were supplemented with community-level data from the 2006 Canada Census of Population. Multilevel logistic regression models with random intercepts were fit to examine associations of interest. The reliability and validity of variables used in this analysis had been established in past studies, or in new analyses that employed factor analysis. Results Between school differences explained 2% of the variance in the occurrence of injuries. After adjustment for all confounders, community social capital did not have any impact on the occurrence of injuries in boys: OR: 1.01, 95% CI 0.80 to 1.29. However, living in areas with low social capital was associated with lower occurrence of injuries in girls (OR 0.78, 95% CI 0.63 to 0.96). Other factors that were significantly related to injuries in both genders were younger age, engagement in more risky behaviours, and negative behavioural influences from peers. Conclusions After simultaneously taking into account the influence of community-level and individual-level factors, community levels of social capital remained a relatively strong predictor of injury among girls but not boys. Such gender effects provide important clues into the social aetiology of youth injury. [ABSTRACT FROM AUTHOR]

Objective To explore what the word accident means to the lay public. This interpretation is of interest because it has been raised by injury control professionals as one justification for discouraging use of that word. Methods A national telephone survey of 943 adults in the United States was conducted. Respondents were selected at random from households whose phone numbers were generated using random digit dialing techniques. Bivariate and multivariate analyses were performed to determine if respondent characteristics predicted their interpretations of the word accident . Results Eighty three per cent of respondents associated preventability with the word accident, and only 26% felt that accidents were controlled by fate. However, 71% thought that accidents could not be predicted, and 4% felt that accidents were done on purpose. Age, education, income, and race emerged as independent predictors of various accident interpretations. Conclusions Only in the case of “unpredictability” does the public's interpretation of the word accident match many experts' expectations. The concept of “unintentionality” is what seems to be communicated most strongly by use of the word accident . Persistent attempts on the part of injury control professionals to eliminate this word from social discourse may result in unintended consequences, which are discussed. [ABSTRACT FROM AUTHOR]

Background There are few population-based studies on household child injury in African countries. Objectives To determine the incidence, characteristics and risk factors of household and neighbourhood injury among children in semiurban communities in Kumasi, Ghana. Methods We conducted a cross-sectional populationweighted survey of 200 randomly selected caregivers of children under 18, representing 6801 households. Caregivers were interviewed about moderate to severe childhood injuries occurring within the past 6 months, for which the child staying home from school or activity, and/or required medical care. Multivariable logistic regression was used to identify factors associated with injury risk. Results Annual injury incidence was 593.5 injuries per 1000 children. Common causes of injury were falls (315.7 injuries per 1000 children), followed by cuts/ lacerations and burns. Most injuries (93.8%) were of moderate severity. Children whose caregivers were hourly workers (AOR=1.97; 95% CI 1.06 to 3.68) had increased odds of sustaining an injury compared to those of unemployed caregivers. Girls had decreased odds of injury (AOR=0.59; 95% CI 0.39 to 0.91). Cooking outdoors (AOR=0.45; 95% CI 0.27 to 0.76) and presence of cabinet/cupboards (AOR=0.41; 95% CI 0.24 to 0.70) in the house were protective. Among children under 5 years of age, living in uncompleted accommodation was associated with higher odds of injury compared with living in a rented single room (AOR=3.67; 95% CI 1.17 to 11.48). Conclusions The incidence of household and neighbourhood child injury is high in semiurban Kumasi. We identified several novel injury risk factors (hourly work, younger children) and protective factors (cooking outdoors, presence of cabinet/cupboards). These data may identify priorities for household injury prevention. [ABSTRACT FROM AUTHOR]

Background: Elucidating the epidemiological status of injuries is a critical component of preventive strategies in countries with high incidence of injuries, like Iran. Population-based surveys are able to estimate all types of non-fatal injuries. Objectives: This study protocol is the core unit in describing Iran’s national cost and epidemiology of nonfatal injuries, and also as a guide for other studies. Study design and methods: In a cross-sectional study, 1525 primary sampling units are randomly selected with probability proportional to size regarding the number of households in each enumeration area based on Iran’s 2006 national census. Six of the households are randomly selected. One member of each household is chosen using Kish Grid tables. In all, 9150 subjects are selected. Data on demographics are collected. For each injury during the past three months, activity, place, mechanism, site, type and the place of treatment are coded to match the International Classification of Diseases, 10th revision 2012 (ICD10-2012) classifications. Subjects are contacted via telephone to obtain data on cost of injury. Finally, sampling weights are calculated so that data for each respondent can be inflated to represent other individuals in Iran. Quality control and quality assurance issues are discussed. Discussion: Our objectives will describe the present impact and the future priorities of injury prevention in Iran. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate the characteristics associated with fatal and non-fatal low-speed vehicle run-over (LSVRO) events in relation to person, incident and injury characteristics, in order to identify appropriate points for intervention and injury prevention. Methods: Data on all known LSVRO events in Queensland, Australia, over 11 calendar years (1999–2009) were extracted from five different databases representing the continuum of care (prehospital to fatality) and manually linked. Descriptive and multivariate analyses were used to analyse the sample characteristics in relation to demographics, health service usage, outcomes, incident characteristics, and injury characteristics. Results: Of the 1641 LSVRO incidents, 98.4% (n=1615) were non-fatal, and 1.6% were fatal (n=26). Over half the children required admission to hospital (56%, n=921); mean length of stay was 3.4 days. Younger children aged 0–4 years were more frequently injured, and experienced more serious injuries with worse outcomes. Patterns of injury (injury type and severity), injury characteristics (eg, time of injury, vehicle type, driver of vehicle, incident location), and demographic characteristics (such as socioeconomic status, indigenous status, remoteness), varied according to age group. Almost half (45.6%; n=737) the events occurred outside major cities, and approximately 10% of events involved indigenous children. Parents were most commonly the vehicle drivers in fatal incidents. While larger vehicles such as four-wheel drives (4WD) were most frequently involved in LSVRO events resulting in fatalities, cars were most frequently involved in non-fatal events. Conclusions: This is the first study, to the authors’ knowledge, to analyse the characteristics of fatal and non-fatal LSVRO events in children aged 0–15 years on a state-wide basis. Characteristics of LSVRO events varied with age, thus age-specific interventions are required. Children living outside major cities, and indigenous children, were over-represented in these data. Further research is required to identify the burden of injury in these groups. [ABSTRACT FROM AUTHOR]

Objective: To report the quantity and quality of published randomised controlled trails (RCT) on injury prevention in China. Design: Bibliometric analysis. Setting: China, 2001–2010. Data sources: The published RCTs that were indexed by four domestic electronic databases and two international databases between 1 January 2001 and 31 December 2010. Main outcome measures: Numbers and proportions of published RCTs and those that did not report or specify the quality items recommended by Cochrane Handbook for Systematic Reviews of Intervention V.5.0.0. Results: Of 4834 publications of injury prevention, 25 RCTs with 55 431 participants were identified. One study had no full text. Twenty-three RCTs were published in Chinese language. All 25 studies chose education as the intervention, including 19 studies using education as single intervention and 6 studies using education as a part of combined intervention. Eighteen of 19 studies that used injury incidence rate as the primary outcome measure; 10 studies reported 24–59% reductions in injury incidence rate in the intervention group, and 8 studies reported 24–76% rate difference between the intervention group and the control group after the implementation of intervention. Only 1 study reported no significant difference. The other 6 studies only reported improvements in knowledge, attitude and practice/ behaviour. None of 24 studies with full text included the information of ‘allocation concealment’, ‘blinding’ and ‘free of early stopping bias’. Conclusions: The value of 25 published RCTs cannot be determined due to the lack of quality information. More high-quality RCTs need to be performed in the future. [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]

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: Unintentional injury is the leading cause of preventable death in children in the UK, and 0-4- year-olds frequently attend emergency departments following injuries in the home. Parenting programmes designed to support parents, promote behaviour change and enhance parent-child relationships have been shown to improve health outcomes in children. It is not known whether group-based parenting programmes have the potential to prevent unintentional injuries in preschool children. Methods: A study to develop a group-based parenting programme to prevent unintentional home injuries in preschool children, and assess the feasibility of evaluation through a cluster-randomised controlled trial. The intervention, designed for parents of children who have sustained a medically attended injury, will be developed with two voluntary sector organisations. The feasibility study will assess ability to recruit parents, deliver the programme and follow-up participants. Participants will complete questionnaires at baseline, 3 months and 6 months, and report injuries in their preschool children using a tool designed and validated for this study. Qualitative methods will assess user and deliverer perceptions of the programme. Discussion: This study will develop the first group-based parenting programme to prevent injuries in preschool children, and design tools for parent-reported injury outcomes. A key challenge will be to recruit parents to participate in a manner that is nonstigmatising, and does not result in feelings of guilt or belief that they are perceived to be a bad parent. The findings will be used to prepare a trial to assess the effectiveness and cost-effectiveness of the intervention. [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]

Background The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. Methods Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. Findings 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. Interpretation Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns. [ABSTRACT FROM AUTHOR]

Background The authors studied injury mortality in Denmark among refugees and immigrants compared with that among native Danes. Method A register-based, historical prospective cohort design. All refugees (n = 29 139) and family reunited immigrants (n = 27 134) who between 1 January 1993 and 31 December 1999 received residence permission were included and matched 1:4 on age and sex with native Danes. Civil registration numbers were crosslinked to the Register of Causes of Death, and fatalities due to unintentional and intentional injuries were identified based on ICD-10 diagnosis. Sex-specific mortality ratios were estimated by migrant status and region of birth, adjusting for age and income and using a Cox regression model after a median follow-up of 11-12 years. Results Compared with native Danes, both female (RR = 0.44; 95% CI 0.23 to 0.83) and male (RR = 0.40; 95% CI 0.29 to 0.56) refugees as well as female (RR = 0.40; 95% CI 0.21 to 0.76) and male (RR = 0.22; 95% CI 0.12 to 0.42) immigrants had significantly lower mortality from unintentional injuries. Suicide rates were significantly lower for male refugees (RR = 0.38; 95% CI 0.24 to 0.61) and male immigrants (RR = 0.24; 95% CI 0.10 to 0.59), whereas their female counterparts showed no significant differences. Only immigrant women had a significantly higher homicide rate (RR = 3.09; 95% CI 1.11 to 8.60) compared with native Danes. Conclusions Overall results were advantageous to migrant groups. Research efforts should concentrate on investigating protective factors among migrants, which may benefit injury prevention in the majority population. [ABSTRACT FROM AUTHOR]

Background Decreasing Injuries from ALcohol (DIAL) is a randomised control trial of a telephone brief intervention (BI) with injured emergency department (ED) patients with high-risk alcohol use. Here the authors examine 12-month outcomes of the intervention's effect on alcohol use, alcohol-related injuries and alcohol-related negative consequences. Methods ED research assistants recruited adult injured patients who screened positive for high-risk alcohol use and were to be discharged home. After discharge, all participants received by telephone an assessment of their alcohol use, alcohol-related injuries, and alcohol-related negative consequences and then were randomised to treatment or standard care. Treatment consisted of two telephone sessions of BI focusing on risky alcohol use. Both groups were reassessed after 12 months. Results At 12 months, 249 (89%) participants completed follow-up assessments. After using a log transformation, the difference in alcohol-related injuries between baseline and 12-month follow-up was greater in the BI group than the standard care group (p=0.04); this is an effect size of Cohen's d=0.21. No difference between groups was found when comparing change in alcohol consumption and other alcohol-related negative consequences at 12 months. Conclusions These findings suggest that a telephone BI with injured ED patients may decrease alcohol-related injuries. Identifying patients with risky alcohol use in the ED and then subsequently delivering the intervention by telephone after discharge has promise as a model for BI and deserves further study. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objectives Exploring the characteristics of recommendations generated from medicolegal death investigations is an important step towards improving their contribution to injury prevention. This study aimed to: (1) quantify coroners' recommendations; and (2) examine the nature of these recommendations according to public health principles of injury causation and prevention. Methods Deaths where coroners' recommendations were and were not made in the State of Victoria, Australia during the period 1 July 2000 to 30 June 2005 were compared by sex, age group and underlying cause of death. The nature of recommendations made was examined retrospectively using a derived model based onprinciples of injury causation and prevention, comprising seven elements: (1) priority population; (2) risk/ contributing factors; (3) countermeasure; (4) level of intervention; (5) strategy for implementation; (6)organisation; (7) time frame for implementation. Results: Coroners' recommendations were relatively rare, made in only 6% of external-cause deaths. When coroners did make recommendations, they were statistically significantly more likely for persons aged 0-14 years and deaths resulting from transport crashes, complications of medical and surgical care, drowning and inanimate mechanical forces. Of the coroners' recommendations,∼ 70% included at least four of the model's seven elements. The elements 'counter measure'and 'level of intervention' were most commonly specified by coroners (∼ 95% ) in their recommendations.Conclusions This study shows that highly evolved medicolegal death investigation systems may not draw systematically from the scientific research evidence base to inform the formulation of coroners' public health and safety recommendations. To maximise its contribution to fatal injury prevention, the medicolegal death investigation may benefit from incorporation of a public health perspective. [ABSTRACT FROM AUTHOR]

Objective To identify independent factors associated with caregiver supervision levels at beaches. Methods Children (aged 1e14 years) engaged in beach play and their caregivers were observed at Australian beaches during SeptembereApril, 2008/09. Caregiver, child, and environmental factor data were collected and recorded on a validated observation instrument. The main outcome of interest was a continuous measure of supervision. After adjusting for potential clustering by beach/state, multivariable linear regression was used to identify independent factors associated with caregiver supervision. Results Four independent predictors of supervision and one interaction effect (child age by the caregiver and child position on beach) were identified. Caregivers who were supervising from a different position to where the child was playing were less likely to provide high supervision, as were older caregivers (>35 years) compared to younger caregivers (#34 years). Compared to children playing alone, children playingwith one, or two or more others were less likely to receive high supervision, and children aged 1e4 yearswere likely to receive higher supervision than older children. Conclusion This study provides new knowledge about underlying factors associated with the level of caregiver supervision in beach settings. Future studies should continue to explore independent predictors of supervision so that effective programmes, which focus on caregiver supervision, can be targeted to address poor supervision practices. [ABSTRACT FROM AUTHOR]

Background Many home fires begin in the kitchen. Kitchen smoke alarms are more likely to produce nuisance alarms, but few previous studies have examined the role of alarm sensor and battery types on the functionality of smoke alarms located nearest to the kitchen. Methods Data were analysed from a 2×2 factorial randomised controlled trial conducted in rural Iowa homes (n=628). Enrolled households were randomly assigned into one of four smoke alarm/battery combinations: ionisation/zinc, ionisation/lithium, photoelectric/zinc and photoelectric/lithium. Alarm functionality was determined using a smoke test. Alarm type and battery type were compared using an intent-to-treat analysis. Logistic regression was used to identify factors that might impact the functionality of smoke alarms located nearest to the kitchen 42 months after installation. Results Photoelectric alarms with lithium batteries had the highest rate of functionality (90.2%), whereas ionisation alarms with carbon/zinc batteries had the lowest (76.5%). Forty-two months following installation, 6.4% more of photoelectric alarms were functional than ionisation alarms, and 7.9% more of alarms with lithium batteries were functional than those with carbon/zinc batteries. Logistic regression revealed that when the indicator of nuisance alarms was included, the effect of alarm type became statistically insignificant and ionisation alarms were less likely to be functional at 42 months, partly due to increased nuisance alarms. Conclusions Alarm type is an important consideration for certain locations. Photoelectric alarms may be more appropriate for installation nearest to the kitchen despite their increased cost. These findings can help guide consumer choices to increase protection against home fire-related injuries and deaths. [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]

Introduction Child pedestrian fatalities associated with motor vehicles reversing or moving at low speed are difficult to identify in surveillance data. This study aims to determine the incidence of fatalities associated with what is thought to be an under-reported and preventable fatal injury mechanism.Methods The term low speed vehicle run-over (LSVRO)incidents encompasses pedestrian fatalities where vehicles run-over a child at low speed. Data were obtained for children aged 0e15 years in the Australian state of Queensland (January 2004eDecember 2008). Results There were 15 deaths (12 boys and 3 girls) during 2004e2008 (rate:1.67/100 000). Over half were aged 0 and 1 years of age (n¼8; 53.3%, rate: 14.67/100 000), and one quarter were 2 and 3 years of age (n¼4, 27%, rate 7.46/100 000). There were no LSVRO deaths recorded among 10e15 year olds. Most (13/15) of the incidents occurred on private property, and only two occurred on a street/road. Almost half of the fatalities were caused by a four wheel drive (4WD) vehicle; large family sedans were involved in four fatalities, and heavy vehicles were involved in three deaths. In 11 of the fatalities, parents were the drivers of the vehicle involved (mothers 5; fathers 6). In nine, the vehicle involved was reversing before it came in contact with the child. Fatalities occurred in each of the Socio-Economic Indexes For Areas (SEIFA) levels. Conclusion The unique data provided by the child death review team has signalled that LSVRO fatalities are a significant problem in Queensland. The Commission for Children and Young People and Child Guardian (CCYPCG) continue to collect data, which, when combined, will provide outcomes that will act as an impetus for promoting intervention and child advocacy. [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]

Objectives Parental supervision reduces young children's risk of unintentional injuries, but supervision by older siblings has been shown to increase risk. The current study explored how this differential risk of injury may arise. Methods The supervision behaviours of mothers were compared to those of their older children when each was the designated supervisor of a young child in their family in a setting having 'contrived hazards'. Results Mothers engaged in more proactive safety behaviours by removing hazards, whereas older siblings more often modelled injury-risk behaviours by interacting with hazards, and supervisees were likely to interact with hazards the older sibling touched. Supervisees displayed more injury-risk behaviours when supervised by a sibling, yet sibling supervisors were less attentive to supervisee risk behaviours than mothers. Supervisees also were more non-compliant with older siblings than mothers when requested to stop risk taking. Conclusions Both supervisor and supervisee behaviour patterns contribute to increase the risk of injury when older siblings supervise younger ones. [ABSTRACT FROM AUTHOR]

Background Increased belt-positioning booster seat (BPB) awareness and access have led to increased use in the USA. Although transportation in Beijing is rapidly becoming ‘motorised’, Beijing's population has limited awareness of or access to BPBs. Objective To explore the efficacy and acceptability of using a US-developed BPB use promotion intervention in Beijing. Design Methods were adapted from a previously executed US-based study involving parents of 3–8-year old children. Focus groups (five groups, 71 participants) elicited behavioural antecedents to BPB use and reactions to video interventions promoting BPB use: a Chinese-produced instructional video and an English-language (dubbed into Mandarin) video that delivered concrete, theoretically driven messages through a personal story. Immediately after the focus groups, participants were provided with education and a free BPB. Participants were contacted 6 weeks later via telephone about use, knowledge and attitudes. Results Chinese parents saw safety as the most important benefit of BPB use; lack of accurate knowledge about and access to BPBs were parents' most prevalent barriers. Chinese participants described the videos as persuasive and instructional. At 6 weeks, participants remembered the messages of the English-language video, and reported BPB use increased from a baseline of 15.5% to 85.5%. Conclusions This study shows the possibility of exporting US-designed prevention interventions dubbed into Mandarin without the need to alter their original context (in this case, an African American family in a US setting) into a Chinese context. Successful cultural translation involved ensuring that the behavioural antecedents targeted in the intervention (eg, barriers and benefits) were of relevance to the Chinese population. [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]