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Background: Trauma is a leading cause of mortality and morbidity, disproportionately affecting low- and middle-income countries. Musculoskeletal trauma results in the majority of post-traumatic morbidity and disability globally. The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. Study objectives: The purpose of this study was to establish a practical list of performance indicators to evaluate and monitor the quality and equity of musculoskeletal trauma care delivery in health systems worldwide. Methods: A scoping review was performed that identified performance indicators related to musculoskeletal trauma care. Indicators were organized by phase of care (general, prevention, pre-hospital, hospital, post-hospital) within a modified Donabedian model (structure, process, outcome, equity). A panel of 21 experts representing 45 countries was assembled to identify priority indicators utilizing a modified Delphi approach. Results: The scoping review identified 1,206 articles and 114 underwent full text review. We included 95 articles which reported 498 unique performance indicators. Most indicators related to the hospital phase of care (n = 303, 60%) and structural characteristics (n = 221, 44%). Mortality (n = 50 articles) and presence of trauma registries (n = 16 articles) were the most frequently reported indicators. After 3 rounds of surveys our panel reached consensus on a parsimonious list of priority performance indicators. These focused on access to trauma care; processes and key resources for polytrauma triage, patient stabilization, and hemorrhage control; reduction and immobilization of fractures and dislocations; and management of compartment syndrome and open fractures. Conclusions: The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. To create quality and equitable trauma systems, musculoskeletal care must be incorporated into development plans with continuous monitoring and improvement. The performance indicators identified by our expert panel and organized in a modified Donabedian model can serve as a method for evaluating musculoskeletal trauma care. [ABSTRACT FROM AUTHOR]

Many road traffic injuries in low- and middle-income countries (LMICs) are to bus passengers. We sought to determine the availability, functionality, and observed vs. self-reported use of seatbelts in large intercity buses in Ghana. We observed seatbelt use for 1,184 passengers in 35 large intercity buses. We interviewed a separate group of 633 bus passengers. All buses observed had seatbelts and most (92.6%) were functional. A little over a fifth (21.6%) of passengers were observed to wear seatbelts. However, 34.5% of passengers in the self-reported survey indicated always wearing seatbelts when riding in buses. Passengers on 5 buses out of the 35 observed where the driver verbally prompted them to wear seatbelts were more likely (57.8%) to wear seatbelts than on the other buses (15.3%, p = 0.001). Comparing the self-reported survey with observations, passengers tended to overinflate seatbelt use by a factor of 1.6. This study provides useful information for efforts to increase and monitor seatbelt use among large intercity bus passengers in LMICs. Supplemental data for this article is available online at [ABSTRACT FROM AUTHOR]

Road construction activities are hazardous. Workers are exposed to hazards with high probability of illness, injury, disability or death. The objective was to determine road workers' perceptions of occupational hazards, ailments experienced and health seeking behaviour. This was an institution-based descriptive cross-sectional study using open-ended questions. A total of 353 road workers from Ashanti, Ahafo and Western North regions reported work-related hazards and ranked the top-3. Workers in each craft/stratum who gave consent were included in the study and interviewed. They also reported work-related ailments and health-seeking behaviour. The workers were primarily young (mean age 32.4 years) and male (97.7%). Most (70.2%) workers were contract/casual staff. Thirty eight hazards were reported, with the top five being dust (91.5% of workers reported this), extreme temperatures (72.0%), noise (40.5%), fumes (21.8%) and vehicles/trucks (21.1%). Most (86.8%) workers reported a workrelated ailment, with the most common being cough (41.1%) and headache (18.9%). Most (87.8%) workers with ailments sought treatment of any kind. Road construction workers in these regions of Ghana have good appreciation of hazards at work and the dangers they pose. Works supervisors should encourage workers on PPE use against dust, noise, fumes and good housekeeping. Regular worker-training on hazards is recommended. [ABSTRACT FROM AUTHOR]

Data recovery and climate reconstruction are an important support for climate change research, as they provide information from periods and areas with sparse meteorological networks. Various sources are currently in use for obtaining valuable evidence of past climate, such as ship logs, diaries, books, monastery documents. This study exploits newspaper reports in order to enrich the historical meteorological information over the territory of Romania, from the last two decades of the 19th century. At that time, the area belonged to the Austro‐Hungarian Empire and Kingdom of Romania, and the meteorological services from Budapest (since 1870) and Bucharest (since 1884) were the providers of official meteorological information. The digital archive of three newspapers (România Liberă, Gazeta de Transilvania and Foaia Poporului) was investigated and the meteorological information was extracted and aggregated into a database containing 2,132 unique entries clearly referenced in time and space. Each entry represents a meteorological event and several associated characteristics, such as date, location, impact and source. A verification procedure, consisting of comparisons with available measurements from the nearby weather stations and with a reanalysis dataset, was applied in order to validate the entries. The results show that the meteorological information was often present in the newspapers of the epoch. Some climatic features could be retrieved such as seasonality of extreme events, temperature and precipitation characteristics. This paper demonstrates the potential of the collected information to further enhance the understanding of climate change, impacts and climate perception at the end of the 19th century in Romania. [ABSTRACT FROM AUTHOR]

Background Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. Methods Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Results Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Conclusion Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. [ABSTRACT FROM AUTHOR]

Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global programmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children. Copyright © 2009 World Health Organization [ABSTRACT FROM AUTHOR]

Musculoskeletal injuries are a major public health problem globally, contributing a large burden of disability and suffering. This burden could be considerably lowered by implementation of affordable and sustainable strategies to strengthen orthopaedic trauma care, especially in low- and middle-income countries. This article summarizes the global burden of musculoskeletal injuries and provides several examples of successful programs that have improved care of injuries in health facilities in low- and middle-income countries. Finally, it discusses WHO efforts to build on the country experiences and to make progress in lowering the burden of musculoskeletal injuries globally. [ABSTRACT FROM AUTHOR]

Hundreds of deaths and thousands of serious injuries occur at workplace every year in Vietnam, causing losses in life, labor productivity and burden to the society. However, these injuries are poorly reported and little effort has been made to prevent them. Using data from the Vietnam Multi-Center Injury Survey in 2001, this study sought to provide better data on the extent and nature of occupational injuries. The overall rate of occupational injuries was 26.01/1000 among people aged 18 years and older, with higher rates in rural than urban areas. Handicraft workers had the highest rate of injury (46.4/1000) followed by farmer and individuals working privately. These rates are all consistently higher than the rates from official reports. This study highlights the need for strengthening current occupational injury surveillance system, to provide better understanding of the problem for setting priority and creating evidence based prevention strategies. [ABSTRACT FROM AUTHOR]

Rationale: Although air bags have decreased the risk of serious injury from motor vehicle crashes, their deployment is not innocuous and can result in injury. The force of the deploying air bag can cause orbital blow-out fractures. We investigated the circumstances that predispose a crash occupant to this particular injury. Study Design: The authors conducted a case series. Methods: A total of 150 orbital fractures occurred among 2,739 occupants in crashes included in the Crash Injury Research and Engineering Network (CIREN) database from January 1997 to July 2005. Ten orbital blow-out fractures attributed solely to air bag deployment were extracted and four reported in depth. Occupant, vehicle, and crash characteristics were reviewed for predisposing similarities and to investigate the mechanism of injury. Results: All crashes had air bag deployment and a frontal or near-frontal principle direction of force. Nine of 10 injured occupants were positioned within the air bag's deployment zone at the time of impact as a result of a forward seat track position, falling asleep at the wheel, being unrestrained, or having decelerated before impact. Six of 10 occupants experiencing orbital blow-out fractures were of shorter than average height. Based on rigorous crash reconstructions, the orbital blow-out injuries were felt to be causally related to air bag deployment. Conclusion: Air bag deployment may result in orbital blow-out fractures. Occupants positioned in close proximity to the air bag during its deployment phase appear to be at increased risk for orbital blow-out fractures. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effectiveness of educational counselling programmes aimed at increasing parents' practice of childhood safety in Monterrey, Mexico, and to provide information aimed at helping to improve the effectiveness of future efforts in this field. METHODS: Three different counselling programmes were designed to meet the needs of the upper, middle and lower socioeconomic strata. Evaluation involved the use of baseline questionnaires on parents' existing safety-related practices for intervention and control groups and the administration of corresponding questionnaires after the programmes had been carried out. FINDINGS: Data were obtained on 1124 children before counselling took place and on 625 after it had been given. Overall safety scores (% safe responses) increased from 54% and 65% for the lower and upper socioeconomic strata, respectively, before counselling to 62% and 73% after counselling (P <0.001 for all groups). Improvements occurred both for activities that required caution and for activities that required the use of safety-related devices (e.g. helmets, car seats). However, scores for the use of such devices remained suboptimal even after counselling and there were wide discrepancies between the socioeconomic strata. The post-counselling scores for the use of safety-related devices were 55%, 38% and 19% for the upper, middle and lower socioeconomic strata, respectively. CONCLUSIONS: Brief educational interventions targeting parents' practice of childhood safety improved safe behaviours. Increased attention should be given to specific safety-related devices and to the safety of pedestrians. Educational efforts should be combined with other strategies for injury prevention, such as the use of legislation and the improvement of environmental conditions. Copyright © 2003 World Health Organization [ABSTRACT FROM AUTHOR]