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The authors discuss their concerns on an article that cites the term, temporary brittle bone disease (TBBD). They express their frustrations that TBBD has been proposed again as an alternative explanation for suspected non-accidental injury. They explain the papers that lead to the development of the term. They also request the journal editors to retract articles by the advocate of the term citing TBBD.

Unintentional injuries are a major public health problem. This paper analyses coroners' inquests from Sussex, England, for the period 1485-1688 to consider the circumstances surrounding adult unintentional injury deaths. Parallels with the situation today are examined. Travel was found to be the most hazardous activity, drowning was also highly significant and there were large differences between men and women. [ABSTRACT FROM AUTHOR]

Systematic evidence reviews support the efficacy of physical activity programs and multifactorial strategies for fall prevention. However, community settings in which fall prevention programs occur often differ substantially from the research settings in which efficacy was first demonstrated. Because of these differences, alternative approaches are needed to judge the adequacy of fall prevention activities occurring as part of standard medical care or community efforts. This paper uses the World Health Organization Innovative Care for Chronic Conditions (ICCC) framework to rethink how fall prevention programs might be implemented routinely in both medical and community settings. Examples of innovative programs and policies that provide fall prevention strategies consistent with the ICCC framework are highlighted, and evidence where available is provided on the effects of these strategies on processes and outcomes of care. Finally, a "no wrong door" approach to fall prevention and management is proposed, in which older adults who are found to be at risk of falls in either a medical or community setting are linked to a standard fall risk evaluation across three domains (physical activity, medical risks, and home safety). [ABSTRACT FROM AUTHOR]

Objective: To demonstrate properties of the International Classification of the External Cause of Injury (ICECI) as a tool for use in injury prevention research. Methods: The Childhood Injury Prevention Study (CHIPS) is a prospective longitudinal follow up study of a cohort of 871 children 5–12 years of age, with a nested case crossover component. The ICECI is the latest tool in the International Classification of Diseases (ICD) family and has been designed to improve the precision of coding injury events. The details of all injury events recorded in the study, as well as all measured injury related exposures, were coded using the ICECI. This paper reports a substudy on the utility and practicability of using the ICECI in the CHIPS to record exposures. Interrater reliability was quantified for a sample of injured participants using the Kappa statistic to measure concordance between codes independently coded by two research staff. Results: There were 767 diaries collected at baseline and event details from 563 injuries and exposure details from injury crossover periods. There were no event, location, or activity details which could not be coded using the ICECI. Kappa statistics for concordance between raters within each of the dimensions ranged from 0.31 to 0.93 for the injury events and 0.94 and 0.97 for activity and location in the control periods. Discussion: This study represents the first detailed account of the properties of the ICECI revealed by its use in a primary analytic epidemiological study of injury prevention. The results of this study provide considerable support for the ICECI and its further use. [ABSTRACT FROM AUTHOR]

Background: Researchers have previously expressed concern about some national indicators of injury incidence and have argued that indicators should be validated before their introduction. Aims: To develop a tool to assess the validity of indicators of injury incidence and to carry out initial testing of the tool to explore consistency on application. Methods: Previously proposed criteria were shared for comment with members of the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group over a period of six months. Immediately after, at a meeting of Injury ICE in Washington, DC in April 2001, revised criteria were agreed over two days of meetings. The criteria were applied, by three raters, to six non-Fatal indicators that underpin the national road safely targets for Canada, New Zealand, and the United Kingdom. Consistency of ratings were judged. Consensus outcome: The development process resulted in a validation tool that comprised criteria relating to: (1) case definition, (2) a focus on serious injury, (3) unbiased case ascertainment, (4) source data for the indicator being representative of the target population, (5) availability of data to generate the indicator, and (6) the existence of a full written specification for the indicator. On application of these criteria to the six road safety indicators, some problems of agreement between raters were identified. Conclusion: This paper has presented an early step in the development of a tool for validating injury indicators, as well as some directions that can be taken in its further development. [ABSTRACT FROM AUTHOR]

This paper discusses the advantages of ketamine analgesia in the management of trapped patients after serious incidents. Four case histories and a review of the literature lead us to the conclusion that ketamine is the drug of choice in these situations.

In this paper some methodological problems particularly relevant to case-control studies of injury are illustrated by reference to previous childhood injury case-control studies. In contrast to studies of disease, where 'person time' constitutes the observational experience of interest, in injury studies person time engaged in a particular activity is often more appropriate. The implications for the definition of the study base are discussed. The potential for hospital admission bias in injury case-control studies is considered along with potential strategies for avoiding it. The importance of errors in exposure measurement, including those arising from inappropriate induction time assumptions, are illustrated. Finally, the potential for bias resulting from the combination of etiologically unrelated injury outcomes into a single outcome measure is illustrated and discussed. [ABSTRACT FROM AUTHOR]

Objective: Infant and toddler subdural haemorrhages (SDH) are often considered indicative of abuse or major trauma. However, accidental impact events, such as falls, cause contact extra-axial haemorrhages (EAHs). The current study sought to determine frequency and clinical behaviour of EAHs with infant and toddler accidental and abusive skull fractures.Patients and Methods: Children aged <4 years with accidental skull fractures and abusive fractures identified by CT at two paediatric tertiary care centres. Clinical data were abstracted by child abuse paediatricians and images were reviewed by paediatric radiologists. Data were analysed using univariate and multivariate logistic regression as well as descriptive statistics.Results: Among 227 subjects, 86 (37.9%) had EAHs. EAH was present in 73 (34.8%) accidental and 13 (76.5%) of the abusive injuries. Intracranial haemorrhage rates were not different for children with major or minor accidents but were fewer than abused. EAH was equally common with falls <4 and >4 ft. EAH depths did not differ by mechanism, but 69% of accidental EAHs were localised solely at fracture sites vs 38% abuse. Widespread and multifocal EAHs were more common with abuse. Children with abuse or major accidental injuries presented with lower initial Glasgow Coma Scales than those with minor accidents. Abused children had initial loss of consciousness more often than those with either minor or major accidents.Conclusions: Simple contact EAHs were common among children with minor and major accidental skull fractures. Accidental EAHs were more localised with less neurological dysfunction than abusive. [ABSTRACT FROM AUTHOR]

The article comments on the paper "Sports injuries: population based representative data on incidence, diagnosis, sequelae, and high risk groups," by S. Schneider and colleagues in this issue. This paper offers information on the incidence of injury in Germany for the population aged 18-79 and determines which groups are high risk. This is important in order to weigh the positive effects of sports against the negative effects.

Teenage drivers, especially males, have higher rates of motor vehicle crashes and engage in riskier driving behavior than adults. Motor vehicle deaths disproportionately impact youth from poor and minority communities and in many communities there are higher rates of risky behaviors among minority youth. In this paper, the authors review the data on teens, risky driving behaviors, and morbidity and mortality. They identify areas in which known disparities exist, and examine strategies for changing teen driving behavior, identifying what has worked for improving the use of seat belts and for reducing other risky behaviors. A multifaceted, multilevel model based on ecological theory is proposed for understanding how teens make choices about driving behaviors, and to understand the array of factors that can influence these choices. The model is used to create recommendations for comprehensive intervention strategies that can be used in minority communities to reduce disparities in risk behaviors, injury, disability, and death. [ABSTRACT FROM AUTHOR]

Objective: To generate national representative data on the incidence, diagnosis, severity, and nature of medically treated sports injuries and to identify high risk groups. Methods: The first national health survey for the Federal Republic of Germany, conducted in the format of a standardised, written, cross sectional survey in the period October 1997 to March 1999, gathered data on the incidence of accident and injury and information on social demographics, injury related disability/time off work, and injury location/setting. The net sample comprised 7124 people aged 18-79. Results: 3.1% of adult Germans said they sustained a sports injury during the previous year, corresponding to an annual injury rate of 5.6% among those engaging in regular recreational physical activity and ranking sports injuries as the second most common type of accident. About 62% of all sports injuries result in time taken off work. The period of occupational disability is 14 days or less in around two thirds of these cases. The occupational disability rate alter occupational and traffic accidents is much higher by comparison. Dislocations, distortions, and/or torn ligaments make up 60% of all sports injuries, followed by fractures (18%), contusions, surface wounds, or open wounds (12%). Three out of four sports injury casualties are male. The incidence declines noticeably in higher age groups. Conclusions: Future injury prevention measures should focus on the high risk group of young male recreational athletes. The data indicate that the fear of damage to health and injury, believed to be significant internal psychological barriers to participation in sports, is largely unwarranted for the female population and/or older age groups. Sporting injuries are a marginal phenomenon among the female population and mobile seniors actively engaged in sports. [ABSTRACT FROM AUTHOR]

Objective: To replicate, in a more recent time period, a previous cross-sectional study to estimate the association between unionisation and the risk of workers' compensation injury claims.Methods: The sampling frame was workers' compensation company account records in the industrial, commercial and institutional construction sector in the province of Ontario, Canada, 2012-2018. Company unionisation status was determined through linkage with records of unionised contractors. Outcomes were cumulative counts of workers' compensation injury claims, aggregated to company business. Risk ratios were estimated with multivariable negative binomial regression models. Models were also fit separately to lost-time claims stratified by company size.Results: Business unionisation was associated with a lower lost-time claim incidence (crude risk ratio, CRR=0.69, 95% CI 0.65 to 0.74); adjusted risk ratio, ARR=0.75, 95% CI 0.71 to 0.80). In subgroup analyses, the magnitude of the ARR declined as company size decreased and was not statistically significant for the smallest-sized companies of ≤4 full-time equivalent employees. Unionisation was associated (positively) with the incidence of no-lost-time claims in a crude model, but not in an adjusted one (CRR=1.80, 95% CI 1.71 to 1.89; ARR=1.04, 95% CI 0.98 to 1.09).Conclusions: Company unionisation was associated with a lower risk of lost-time workers' compensation injury claims, corroborating a similar study from an earlier time period. The protective effect of unionisation declined as company size decreased. In contrast to the previous study, a positive relationship between company unionisation and no-lost-time claim incidence was not found, due in part to a methodological refinement. [ABSTRACT FROM AUTHOR]

Objectives: To profile sleep duration and sleep efficiency in UK long-distance heavy goods vehicle (HGV) drivers and explore demographic, occupational and lifestyle predictors of sleep.Methods: Cross-sectional analyses were carried out on 329 HGV drivers (98.5% men) recruited across an international logistics company within the midland's region, UK. Sleep duration and efficiency were assessed via wrist-worn accelerometry (GENEActiv) over 8 days. Proportions of drivers with short sleep duration (<6 hour/24 hours and <7 hour/24 hours) and inadequate sleep efficiency (<85%) were calculated. Demographic, occupational and lifestyle data were collected via questionnaires and device-based measures. Logistic regression assessed predictors of short sleep duration and inadequate sleep efficiency.Results: 58% of drivers had a mean sleep duration of <6 hour/24 hours, 91% demonstrated <7-hour sleep/24 hours and 72% achieved <85% sleep efficiency. Sleeping <6 hour/24 hours was less likely in morning (OR 0.45, 95% CI 0.21 to 0.94) and afternoon (OR 0.24, CI 0.10 to 0.60) shift workers (vs night) and if never smoked (vs current smokers) (OR 0.45, CI -0.22 to 0.92). The likelihood of sleeping <7 hour/24 hours reduced with age (OR 0.92, CI 0.87 to 0.98). The likelihood of presenting inadequate sleep efficiency reduced with age (OR 0.96, CI 0.93 to 0.99) and overweight body mass index category (vs obese) (OR 0.47, CI 0.27 to 0.82).Conclusions: The high prevalence of short sleep duration and insufficient sleep quality (efficiency) rate suggest that many HGV drivers have increased risk of excessive daytime sleepiness, road traffic accidents and chronic disease. Future sleep research in UK HGV cohorts is warranted given the road safety and public health implications. [ABSTRACT FROM AUTHOR]

International comparisons of injury data may be useful for examining differences in risk and for suggesting potential interventions or hypotheses for future studies. However important issues to be considered in conducting comparisons are related to both the underlying quality of the data and how the data are collected. The International Collaborative Effort (ICE) on Injury Statistics grew out of concerns over the comparability of international injury data. This article outlines the history behind the development of the Injury ICE, brief descriptions of current and past projects, collaborations, and reflections on the value of collaboration. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is a public health concern that can occur in a range of contexts. Work-related TBI (wrTBI) is particularly concerning. Despite overall work-related injury claims decreasing, the proportion of claims that are wrTBI have increased, suggesting prevention and support of wrTBI requires ongoing attention.Objectives: This review aimed to provide updated information on the burden and risk factors of wrTBI among the working adult population.Methods: Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a combination of TBI, work, and epidemiology text words and medical subject headings. Two reviewers independently assessed articles for inclusion. Meta-analyses were conducted to estimate prevalence and mortality of wrTBI and a narrative synthesis was conducted to provide additional context.Results: Pooled proportions meta-analyses estimate that 17.9% of TBIs were work-related and 6.3% of work-related injuries resulted in TBI, with 3.6% of wrTBI resulting in death. Populations of wrTBI were predominantly male (76.2%) and were 40.4 years of age, on average. The most commonly reported industries for wrTBI were education and training, healthcare and social assistance, construction, manufacturing, and transportation. Falls, being struck by an object or person, motor vehicle collisions, and assaults were the most commonly reported mechanisms of wrTBI.Conclusions: A better understanding of the epidemiology of wrTBI can inform prevention and management strategies. This review highlights existing gaps, including a notable lack of sex or gender stratified data, to direct future investigation.Prospero Registration Number: CRD42020169642. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of the dietary patterns of truck drivers on their driving behaviours and the mediation effect of fatigue between these factors.Methods: A sample of 389 male truck drivers from a transport company in Suzhou, China completed the Food Frequency Questionnaire (FFQ), the Multidimensional Fatigue Inventory (MFI), the Positive Driver Behaviours Scale (PDBS) and the Driver Behaviour Questionnaire (DBQ). The associations among dietary patterns, fatigue and driving behaviour were examined using pathway analysis.Results: Four dietary patterns were identified based on principal component analysis: animal-derived foods, staple foods, snacks and vegetables. The pathway analysis showed that the vegetable-rich pattern had a direct positive impact on positive driving behaviour (β=0.211, p<0.001); the animal-derived pattern had a direct positive impact on errors (β=0.094, p<0.05) and ordinary violations (β=0.071, p<0.05); the snacks pattern had a direct negative impact on positive driving behaviour (β=-0.191, p<0.001); fatigue mediated the effect of dietary patterns on driving behaviours (p<0.001); and the staple foods had an indirect effect on driving behaviours.Conclusions: Overall, the driving behaviours of truck drivers are correlated with their dietary patterns. Drivers who preferred vegetables and staple foods had more positive driving behaviour, while the animal-derived food and snack patterns were related to dangerous driving behaviour. The experience of fatigue could explained the underlying mechanism between these factors. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a conference sponsored by World Health Organization (WHO) and National Institute of Public Health on the positive and negative influences of globalization on violence and injury prevention is presented. Topics include child abuse and maltreatment, youth violence, occupational injuries and, trauma care services. The conference was attended by a total of 538 participants from low-income and middle-income countries.

Ingested foreign body is an infrequent indication for emergency endoscopy in the adult gastroenterology practice. We describe the clinical features and endoscopic management of the first four cases of accidental ingestion of hijab pins by Muslim women in our unit, all presenting within a 12-month period. The pins were all successfully retrieved without any complications. In this report, we review published guidelines and the current literature, as well as discussing the approach (conservative vs proactive endoscopic retrieval) and timing of endoscopic treatment. The Muslim community may need to be alerted to the potential health hazard of hijab pins [ABSTRACT FROM AUTHOR]

This is Part 2 of 5 in the series of evidence statements from the IOC expert committee on exercise and pregnancy in recreational and elite athletes. Part 1 focused on the effects of training during pregnancy and on the management of common pregnancy-related symptoms experienced by athletes. In Part 2, we focus on maternal and fetal perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: Accidental poisoning in young children is common, but severe or fatal events are rare. This study was performed to identify the number of such events occurring in the UK and the medications that were most commonly responsible.Design: Analysis of national data sets containing information relating to severe and fatal poisoning in children in the UK.Data Sources: Office of National Statistics mortality data for fatal poisoning; Paediatric Intensive Care Audit Network admissions database and the National Poisons Information Service for severe non-fatal poisoning; Hospital Episode Statistics for admission data for implicated agents.Results: Between 2001 and 2013, there were 28 children aged 4 years and under with a death registered as due to accidental poisoning by a pharmaceutical product in England and Wales. Methadone was the responsible drug in 16 (57%) cases. In the UK, 201 children aged 4 years and under were admitted to paediatric intensive care with pharmaceutical poisoning between 2002 and 2012. The agent(s) responsible was identified in 115 cases, most commonly benzodiazepines (22/115, 19%) and methadone (20/115, 17%).Conclusions: Methadone is the most common pharmaceutical causing fatal poisoning and a common cause of intensive care unit admissions in young children in the UK. [ABSTRACT FROM AUTHOR]

Presents a paper on the impact of congential colour vision deficiency on education and unintentional injuries. Use of the 1958 British birth cohort to investigate the effects of color blindness on education and injuries; Methods used in the study; Findings which did not show any harm educationally nor did it show increased risk of nonintentional injury due to colour vision deficiency. [ABSTRACT FROM PUBLISHER]

Reports on the U.S. Joint Commission on Accreditation of Healthcare Organizations' issuance of an alert highlighting the dangers associated with bed rail related deaths. Number of deaths or injuries related to bed rails; Types of patients involved in the cases; Causes of asphyxiation.

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. Products under the purview of the Consumer Product Safety Commission are involved in a large share of injuries and injury costs in the USA. Methods. This study analyses incidence data from the National Electronic Injury Surveillance System (NEISS) and cost data based on the Injury Cost Model, integrated with the NEISS. We examined the magnitude of nonfatal consumer product related injury, the distribution of products involved in these injuries and the cost of these injuries. We compared these findings with an earlier identical study from 2000. Results. In 2008–2010, 43.8% of the annual 30.4 million non-fatal injuries treated in hospital emergency departments involved consumer products. Of these consumer product related injuries, in 2009–2010, just three product groups accounted for 77% of the $909 billion annual cost: sports and recreation; home structures and construction materials; and home furnishings and fixtures. Sports and recreation was a leading cause of injury costs among 5–24-year-olds, particularly football, basketball, bicycling, baseball/ softball and soccer. Since 1996, football surpassed basketball in becoming the number one cause of injury costs for children aged 10–19 years and the fifth ranked cause of product related injury costs overall. Among those over age 30 years, stairs and floors were a leading cause of consumer product related injury costs, in particular among those over age 70 years where they were responsible for over one-fifth of costs. Conclusions. The findings of this study highlight priority areas for intervention and generate questions for future research. [ABSTRACT FROM AUTHOR]

A case study of a nine month old boy is presented, who was admitted to emergency department with a head injury after falling from bed onto a carpeted floor and diagnosed with a depression of the right parietal bone.

The use of statistical process control (SPC) charts in healthcare is increasing. The general advice when plotting SPC charts is to begin by selecting the right chart. This advice, in the case of attribute data, may be limiting our insights into the underlying process and consequently be potentially misleading. Given the general lack of awareness that additional insights may be obtained by using more than one SPC chart, there is a need to review this issue and make some recommendations. Under purely common cause variation the control limits on the xmrchart and traditional attribute charts (eg, p-chart, c-chart, u-chart) will be in close agreement, indicating that the observed variation (xmr-chart) is consistent with the underlying Binomial model (p-chart) or Poisson model (c-chart, u-chart). However, when there is a material difference between the limits from the xmr-chart and the attribute chart then this also constitutes a signal of an underlying systematic special cause of variation. We use one simulation and two case studies to demonstrate these ideas and show the utility of plotting the SPC chart for attribute data alongside an xmr-chart. We conclude that the combined use of attribute charts and xmr-charts, which requires little additional effort, is a useful strategy because it is less likely to mislead us and more likely to give us the insight to do the right thing. [ABSTRACT FROM AUTHOR]

Background Lower mortality has been systematically found in married when compared with non-married, especially in men, but little is known about marital status differences in mortality from external causes. Furthermore, the role of cohabitation and partnership history in the formation of these differences and how they have been changed over time are poorly understood. Methods The incidence of fatal and non-fatal cases of accidents, violence and suicides by partnership history was analysed during 1991-1997 and 2001-2007 in a representative sample of the Finnish population aged 26-59 years. HRs were calculated using Cox proportional hazards models. Results Incidence rates in accidents, violence and suicides were generally lower in men and women living with a partner than those living alone. Current cohabitation and previous divorce increased the risk of all of these outcomes when compared with married without previous divorce. Higher incidence rates were found in men who had divorced 3 years ago or earlier when compared with those who had divorced later. Generally, these differences were larger in fatal than in non-fatal cases and significantly larger in men. There was little change in these differences between 1991-1997 and 2001-2007. These differences were partly explained by socioeconomic factors but remained statistically significant also after these adjustments. Conclusions Currently living without a partner and cohabitation and previous divorce increased the risk of accidents, violence and suicides. This indicates that also other mechanisms than immediate support from a partner are important in the formation of marital status differences in mortality. [ABSTRACT FROM AUTHOR]

The article offers information related to children diseases. It says that a shift in practice towards conservative management of idiopathic thrombocytopenic purpura (ITP) in children was illustrated in Great Britain. It mentions a study on the prevalence of active gluten avoidance, which is greater than serologically diagnosed coeliac disease. It adds that readings of accidental/unintentional injuries (UI) in resourcepoor settings was reviewed.

OBJECTIVES: Given that the news media shape our understanding of health issues, a study was undertaken to examine the use by the US media of the expression ‘freak accident’ in relation to injury events. This analysis is intended to contribute to the ongoing consideration of lay conceptualisation of injuries as ‘accidents’. METHODS: LexisNexis Academic was used to search three purposively selected US news sources (Associated Press, New York Times and Philadelphia Inquirer) for the expression ‘freak accident’ over 5 years (2005–9). Textual analysis included both structured and open coding. Coding included measures for who used the expression within the story, the nature of the injury event and the injured person(s) being reported upon, incorporation of prevention information within the story and finally a phenomenological consideration of the uses and meanings of the expression within the story context. RESULTS: The search yielded a dataset of 250 human injury stories incorporating the term ‘freak accident’. Injuries sustained by professional athletes dominated coverage (61%). Fewer than 10% of stories provided a clear and explicit injury prevention message. Stories in which journalists employed the expression ‘freak accident’ were less likely to include prevention information than stories in which the expression was used by people quoted in the story. CONCLUSIONS: Journalists who frame injury events as freak accidents may be an appropriate focus for advocacy efforts. Effective prevention messages should be developed and disseminated to accompany injury reporting in order to educate and protect the public. [ABSTRACT FROM AUTHOR]

Objective To examine whether unintentionally injuring others is associated with subsequent mental illness, and whether mental illness is a risk factor for unintentionally injuring others. Methods Onset of first psychiatric diagnoses was compared with onset of first unintentional injuring. Multivariate logistic regression estimated the association between unintentional injuring and lifetime prevalence of mental illness, specifically of Diagnostic and Statistical Manual of Mental Disorders IV disorders associated with trauma exposure among respondents of part II of the National Co-morbidity Survey Replication a household survey of 5692 US adults. Analyses controlled for age, sex, race and having been injured in a serious accident. Results Of 5692 respondents, 110 reported unintentionally causing death or injury to another person. Unintentionally injuring others was a risk factor for subsequent mental health problems. Multivariate regression results showed an increased risk of subsequent depression (OR 3.1, CI 1.7 to 5.7), anxiety (OR 3.3, CI 1.6 to 6.6), posttraumatic stress disorder (PTSD) (OR 6.6, CI 3.1 to 14.0), alcohol use (OR 3.8, CI 1.9 to 7.3) and drug use (OR 8.0, CI 4.1 to 15.3). Conversely, mental health problems were a risk factor for unintentionally injuring another person. Multivariate regression results showed an increased risk of unintentional injuring among those with a prior diagnosis of depression, PTSD, alcohol use, and drug use. Conclusions After injuring, unintentional injurers are likely to experience depression, anxiety, PTSD and drug or alcohol abuse/dependence compared with non-injurers. Those diagnosed with depression, anxiety, PTSD, alcohol or drug or alcohol abuse/dependence are more likely to cause serious injuries to others. [ABSTRACT FROM AUTHOR]

Objective This report examines unintentional injury deaths among children with and without a history of child maltreatment. Methods Data are from reviews of 1192 unintentional injury deaths occurring among children in Texas during 2005e2007. The study examined differences in child demographic characteristics, injury mechanism, and supervisor status at time of death between children with and without maltreatment history by using descriptive statistics and c2 tests. Separate analyses compared characteristics of asphyxia, drowning, and poisoning deaths. Results In 10% of the unintentional injury deaths that were reviewed, the child had a history of maltreatment. The prevalence of a history of maltreatment was highest among black decedents and lowest among white decedents. Prevalence of a history of maltreatment was highest among infant decedents and lowest among youth decedents, ages 10e14 years. Among deaths where there was no maltreatment history, 54% were due to motor vehicle related incidents, whereas 51% of deaths among children with maltreatment history were caused by drowning, asphyxia, and poisoning. Supervisors of child decedents with a history of maltreatment were significantly more likely to have been alcohol impaired (6.9% vs 1.6%; p<0.0005), or asleep (12.1% vs 6.6%; p¼0.03) at the time of death. Differences between child decedents with and without maltreatment history were observed in infant sleep surface in suffocation deaths, location and barrier type in drowning deaths, and substance type in poisoning deaths. Conclusions These data show that the mechanisms and circumstances surrounding unintentional injury deaths among children with a history of maltreatment differ from those without a history of maltreatment. This underscores the need for appropriate interventions to prevent unintentional and intentional injuries in families with a history of maltreatment. [ABSTRACT FROM AUTHOR]

This study compares skiing and snowboarding injuries in terrain parks versus slopes at two ski areas, 2000e05. A total of 3953 (26.7%) injuries occurred in terrain parks, predominantly among young male snowboarders. Terrain park injuries were more likely to be severe, involving head (RR 1.31, 95% CI 1.16 to 1.48) or back (RR 1.96, 95% CI 1.67 to 2.29). [ABSTRACT FROM AUTHOR]

Method: New Zealand national Accident Compensation Corporation injury data for the period 1999 to 2007 were searched for rugby league injury cases. Data were analysed by demographics, body region, nature/severity of injury, and medical procedure and costs. Results: A total of 5941 injury entitlement claims were recorded over the study period with a significant decrease observed in the injury rate between the 1999-2000 and 2002-2003 reporting years. The total cost of the injuries for the study period was $42 822 048 (equivalent to £15 916 072). The mean (SD) number of injury entitlement claims per year was 743 (271) and yearly cost was $5 352 760 (£1 989 880) ($2 485 535 (£923 994)). The knee was the most commonly reported injury site (225 per 1000 entitlement claims; $8 750 147 (£3 252 020)) and soft tissue injuries were the most common injury types (474 per 1000 entitlement claims; $17 324 214 (£6 438 599)). Accounting for only 1.8% of total injury entitlement claims, concussion/brain injuries accounted for 6.3% of injury entitlement costs and had the highest mean cost per claim ($25 347 (£9420)). The upper and lower arm recorded the highest mean injury site claim cost of $43 096 (£16 016) per claim. The 25-29 age group recorded 27.7% of total injury entitlement claims and 29.6% of total injury entitlement costs, which was slightly more than the 20-24 age group (27.3% claims; 24.7% costs). Nearly 15% of total moderate to serious injury entitlement claims and 20% of total costs were recorded from participants 35 years or older. Discussion: This study identified that the knee was the most common injury site and soft tissue injuries were the most common injury type requiring medical treatment, which is consistent with other international studies on rugby league epidemiology. This study also highlights that the rate of injury and the average age of injured rugby league players increased over time. The high cost of concussion/brain injuries is a cause for concern as it reflects the severity of the injuries. Conclusion: Injury prevention programmes for rugby league should focus on reducing the risk of concussion/brain injury and knee and soft tissue injury, and should target participants in the 20-30 years old age range. More longitudinal epidemiological studies with specific details on injury mechanisms and participation data are warranted to further identify the injury circumstances surrounding participation in rugby league activities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate whether home safety education and safety equipment provision increases thermal injury prevention practices or reduces thermal injury rates and whether the effect of interventions differs by social group. METHODS: Systematic review and meta-analysis using individual participant data (IPD) evaluating home safety education with or without provision of free or discounted safety equipment provided to children or young people aged 0–19 years. Main outcome measures: possession of functional smoke alarm, fitted fireguard and fire extinguisher; keeping hot drinks or food and keeping matches or lighters out of reach; having a safe hot water temperature and rate of medically attended thermal injuries. RESULTS: Home safety interventions were effective in increasing the proportion of families with a functional smoke alarm (odds ratio (OR) 1.83, 95% CI 1.22 to 2.74) and with a safe hot tap water temperature (OR 1.35, 95% CI 1.01 to 1.80). There was some evidence they increased possession of fitted fireguards (OR 1.39, 95% CI 1.00 to 1.94), but there was a lack of evidence that interventions reduced medically attended thermal injury rates (incident rate ratio (IRR) 1.12, 95% CI 0.81 to 1.56). There was no consistent evidence that the effectiveness of interventions varied by social group. CONCLUSIONS: Home safety education, especially with the provision of safety equipment, is effective in increasing some thermal injury prevention practices, but there is insufficient evidence to show whether this also reduces injury rates. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess extent of coder agreement for external causes of injury using ICD-10-AM for injury-related hospitalisations in Australian public hospitals. METHODS: A random sample of 4850 discharges from 2002 to 2004 was obtained from a stratified random sample of 50 hospitals across four states in Australia. On-site medical record reviews were conducted and external cause codes were assigned blinded to the original coded data. Code agreement levels were grouped into the following agreement categories: block level, 3-character level, 4-character level, 5th-character level, and complete code level. RESULTS: At a broad block level, code agreement was found in over 90% of cases for most mechanisms (eg, transport, fall). Percentage disagreement was 26.0% at the 3-character level; agreement for the complete external cause code was 67.6%. For activity codes, the percentage of disagreement at the 3-character level was 7.3% and agreement for the complete activity code was 68.0%. For place of occurrence codes, the percentage of disagreement at the 4-character level was 22.0%; agreement for the complete place code was 75.4%. CONCLUSIONS: With 68% agreement for complete codes and 74% agreement for 3-character codes, as well as variability in agreement levels across different code blocks, place and activity codes, researchers need to be aware of the reliability of their specific data of interest when they wish to undertake trend analyses or case selection for specific causes of interest. [ABSTRACT FROM AUTHOR]

BACKGROUND: Injuries are the leading cause of public hospital admission in Sri Lanka. Data on injury epidemiology to plan prevention programmes to reduce injury burden are not readily available. OBJECTIVES: To assess the incidence of various types of injuries in the Galle district, Sri Lanka. METHODS: 9568 individuals of all ages were selected from 2000 households in a population-based cross-sectional survey using a stratified cluster sampling technique. Data on non-fatal injuries in the last 30 days irrespective of severity, fatal injuries and those that resulted in disability in the last 12 months were documented. Proxy data were used for half of the injury cases. RESULTS: 195 (2%) individuals reported non-fatal injuries during the last 30 days, giving an age-sex-urban-rural adjusted annual incidence of 24.6 per 100 population. The leading causes of non-fatal injuries were falls (adjusted annual incidence 6.7 per 100 population, 95% CI 6.0 to 7.3) and mechanical injuries (6.3; 95% CI 5.7 to 6.8), followed by road traffic injuries (4.9; 95% CI 4.4 to 5.5). 114 (58.5%) individuals needed outpatient care and 50 (25.6%) needed inpatient care for their injuries. The annual injury mortality rate and disability rate were 177 (95% CI 72 to 283) and 290 (95% CI 250 to 330) per 100 000 population, respectively. CONCLUSIONS: Nearly one in four people reported non-fatal injury; the majority sought medical attention in this population. It is important to utilise injury epidemiology to develop and implement interventions to reduce the burden of injuries in the population and on the hospitals in Sri Lanka. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between uncorrected or untreated vision problems and occupational injuries in the adolescent and adult population in Australia. Design: National Health Survey conducted via personal interviews with a stratified random sample. Setting: Population-based. Subjects: Individuals selected from the total population aged 15 or older. Exposure measures: Information on uncorrected or untreated vision problems was collected by personal interview via responses to screening questions. Main outcome measures: Information on occupational injuries also collected via personal interview. Results: After adjustment for potential confounders, the odds of occupational injury increased by ~60% (OR = 1.57, 95% CI = 1.11 to 2.24) for those who had any uncorrected or untreated vision problems, and by 3½ times (OR = 3.52, 95% CI = 1.64 to 7.55) for those with untreated macular degeneration compared with healthy subjects. Conclusions: Uncorrected or untreated vision problems, particularly macular degeneration, significantly increased the risk of occupational injury. Vision examination should be recommended and implemented regularly for all workers. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of protective headgear in adolescent football (soccer) players. Design: Cross-sectional study. Setting: Oakville Soccer Club, Oakville, Canada. Participants: Football players aged 12-17 years. Intervention: A questionnaire examining the 2006 football season using self-reported symptoms. Main outcome measures: The number of concussions experienced during the current football season, the duration of symptoms, injuries to the head and face and any associated risk factors for these injuries. Results: In the population studied, 47.8% had experienced symptoms of a concussion during the current football year. 26.9% of athletes who wore headgear (HG) and 52.8% of those who did not wear headgear (No-HG) had concussions. Approximately 4 out of 5 athletes in each group did not realize they had suffered a concussion. More than one concussion was experienced by 50.0% of the concussed HG athletes and 69.3% of the concussed No-HG group. 23.9% of all concussed players experienced symptoms for at least 1 day or longer. Variables that increased the risk of suffering a concussion during the 2006 football year included being female and not wearing headgear. Being female and not wearing football head-gear increased the risk of suffering an abrasion, laceration or contusion on areas of the head covered by football headgear. Conclusion: Adolescent football players experience a significant number of concussions. Being female may increase the risk of suffering a concussion and injuries on the head and face, while the use of football headgear may decrease the risk of sustaining these injuries. [ABSTRACT FROM AUTHOR]

Reports on Canada's Division of Health Surveillance and Epidemiology's introduction of an interactive web site tool for Canadian Injury Statistics, Injury Surveillance Online.

There is increasing concern in Australia about safety in the thoroughbred racing industry, but there has been no reported analysis of injury data. This review analyses injury and workers' compensation data recorded in Victoria. On the basis of the results, it is recommended that the injury and incident data collection systems are improved such that they are not only more complete but also accumulate more detailed information about the location of an incident or injury event, the activity at the time of the incident or injury event, and factors that may have influenced the occurrence. [ABSTRACT FROM AUTHOR]

Background: Deficiencies in emergency department (ED) charting is a common international problem. While unintentional falls account for the largest proportion of injury related ED visits by youth, insufficient charting details result in more than one third of these falls being coded as "unspecified". Non-specific coding compromises the utility of injury surveillance data. Objective: To re-examine the ED charts of unspecified youth falls to determine the possibility of assigning more specific codes. Methods: 400 ED charts for youth (aged 0-19 years) treated at four EDs in an urban Canadian health region between 1997 and 1999 and coded as "Other or unspecified fall" (ICD-9 E888) were randomly selected. A structured chart review was completed and a blinded nosologist recoded the cause of injury using the extracted data. Differences in coding specificity were compared with the original data, and logistic regression was undertaken to examine variables that predicted assignment of a specific E-code. Results: A more specific code was assigned to 46% of cases initially coded as unspecified. Of these, 73% were recoded as "Slips, trips, and stumbles" (E885), which still lacks the specificity required for injury prevention planning; 2% of charts had no fall documented. Multivariate analysis revealed that dichotomized injury severity (adjusted odds ratio (OR) = 1.75 (95% confidence interval, 1.11 to 2.78)), arrival at the ED by ambulance (adjusted OR = 5.41 (1.07 to 27.0)), and the availability of nurse's notes or triage forms, or both, in the chart (adjusted OR = 3.75 (2.17 to 6.45)) were the strongest predictors of a more specific E-code assignment. Conclusions: Deficiencies in both chart documentation and coding specificity contribute to the use of non-specific E-codes. More comprehensive triage coding, improved chart documentation, and alternative methods of data collection in the acute care setting are required to improve ED injury surveillance initiatives. [ABSTRACT FROM AUTHOR]

Objectives: To compare the causes of non-fatal work and non-work injuries and the places or environments where they occur. It has been suggested that many injuries may have similar etiologies on and off the job and thus involve some common prevention strategies. However lack of comparable data on work relatedness has prevented testing this proposition. Methods: The National Health Interview Survey (NHIS) now collects information on the cause, location, and work relatedness of all medically attended injuries. National US estimates of non-fatal work and non-work injuries were compared by cause and place/location for working age adults (18–64 years). Results: Overall 28.6% of injuries to working age adults were work related (37.5% among employed people). The causes and locations of many work and non-work injuries were similar. Falls, overexertion, and struck/caught by were leading causes for work and non-work injuries. Motor vehicle injuries were less likely to be work related (3.4% at work v 19.5% non-work) and overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults were less than 1% of work injuries and 1.8% of non-work injuries. Both work and non-work injuries occurred in every location examined-including the home where 3.5% of injuries were work related. Conclusions: Work and non-work injuries share many similarities suggesting opportunities to broaden injury prevention programs commonly restricted to one setting or the other. Comprehensive efforts to prevent both non-work and work injuries may result in considerable cost savings not only to society but also directly to employers, who incur much of the associated costs. [ABSTRACT FROM AUTHOR]

Objective: To characterize the trend of wheelchair related injuries over time, and describe the demographics and characteristics of wheelchair users' injuries by age group. Methods: Data from the National Electronic Injury Surveillance System (NEISS) were analyzed. Results: In 2003, more than 100 000 wheelchair related injuries were treated in emergency departments in the US, double the number reported in 1991. Tips and falls accounted for 65–80% of injuries across all age groups of wheelchair users. The majority of children's injuries occurred at locations outside of homes and institutions/hospitals in environments with stairs, ramps, and curbs (57.3%). In contrast, injuries among adult users were more likely to occur in homes, hospitals, and institutions (45–90%). Conclusions: Wheelchair related injuries may have increased in the US during the past decade. Prevention efforts should address the interacting complex factors that influence risk of injury while using a wheelchair. [ABSTRACT FROM AUTHOR]

Study objective: To investigate the effect of recall on estimation of non-fatal injury rates. in Tanzania. Design: Retrospective population based survey. Setting: Eight branches in an urban area and six villages in a relatively prosperous rural area in Tanzania. Subjects: Individuals of all ages living in households selected by cluster sampling. Main outcome measures: Estimated non-fatal injury rates calculated at each of the 12 recall periods (one to 12 months before the interview). Results: Out of a population of 15 223 persons, 509 individuals reported 516 injuries during the preceding year. Of these 313 (61.5%) were males and 196 (38.5%) females. The data showed notable declining incidence rates from 72 per 1000 person-years when based on a one month recall period to 32.7 per 1000 person-years for a 12 month recall period (55% decline). The decline was found for injuries resulting in fewer than 30 days of disability whereas rates for severe injuries (disability of 30 days or more) did not show a consistent variation with recall period. Decline in injury rates by recall period was higher in rural than in urban areas. Age, sex, and education did not notably affect recall. Conclusions: Longer recall periods underestimate injury rates compared with shorter recall periods. For severe injuries, a recall period of up to 12 months does not affect the rate estimates. It is essential that a recall period of less than three months be used to calculate injury rates for less severe injuries. [ABSTRACT FROM AUTHOR]