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Discusses the papers presented by Grigg and Farewell and Marshall and colleagues, regarding monitoring health care and clinical performance. Processes for which Grigg and Farewell compared risk-adjusted charting methods; Emphasis placed by Marshall and colleagues on the need to consider the performance of an entire system of charts; Issues regarding the proportion of emergencies detected.

Objective: to identify all published papers on risk factors and risk assessment tools for falls in hospital inpatients. To identify clinical risk assessment tools or individual clinical risk factors predictive of falls, with the ultimate aim of informing the design of effective fall prevention strategies. Design: systematic literature review (Cochrane methodology). Independent assessment of quality against agreed criteria. Calculation of odds ratios and 95% confidence intervals for risk factors and of sensitivity, specificity, negative and positive predictive value for risk assessment tools (with odds ratios and confidence intervals), where published data sufficient. Results: 28 papers on risk factors were identified, with 15 excluded from further analysis. Despite the identification of 47 papers purporting to describe falls risk assessment tools, only six papers were identified where risk assessment tools had been subjected to prospective validation, and only two where validation had been performed in two or more patient cohorts. Conclusions: a small number of significant falls risk factors emerged consistently, despite the heterogeneity of settings namely gait instability, agitated confusion, urinary incontinence/frequency, falls history and prescription of 'culprit' drugs (especially sedative/hypnotics). Simple risk assessment tools constructed of similar variables have been shown to predict falls with sensitivity and specificity in excess of 70%, although validation in a variety of settings and in routine clinical use is lacking. Effective falls interventions in this population may require the use of better-validated risk assessment tools, or alternatively, attention to common reversible falls risk factors in all patients. [ABSTRACT FROM AUTHOR]

Rationale: there are several well-developed statistical methods for analysing recurrent events. Although there are guidelines for reporting the design and methodology of randomised controlled trials (RCTs), analysis guidelines do not exist to guide the analysis for RCTs with recurrent events. Application of statistical methods that do not account for recurrent events may provide erroneous results when used to test the efficacy of an intervention. It is unknown what proportion of RCTs of falls prevention studies have utilised statistical methods that incorporate recurrent events. Methods: we conducted a systematic review of RCTs of interventions to prevent falls in community-dwelling older persons. We searched Medline from 1994 to November 2006. We determined the proportion of studies that reported using three statistical methods appropriate for the analysis of recurrent events (negative binomial regression, Andersen-Gill extension of the Cox madel and the WLW marginal model). Results: fewer than one-third of 83 papers that reported falls as an outcome utilised any appropriate statistical method (negative binomial regression, Andersen-Gill extension of the Cox model and Cox marginal model) to analyse recurrent events and fewer than 15% utilised graphical methods to represent falls data. Conclusion: RCTs that have a recurrent event end-point should include an analysis appropriate for recurrent event data such as negative-binomial regression, Andersen-Gill extension of the Cox model and/or the WLW marginal model. We recommend that researchers and clinicians seek consultation with a statistician with expertise in recurrent event methodology. [ABSTRACT FROM AUTHOR]

Background: around one-fourth of all falls in healthcare settings are falls from bed. The role of bedrails in falls prevention is controversial, with a prevailing orthodoxy that bedrails are harmful and ineffective. Objective: to summarise and critically evaluate evidence on the effect of bedrails on falls and injury Design: systematic literature review using the principles of QuoRoM guidance. Setting and Subjects: adult healthcare settings Review Methods: using the keyword, bedrail, and synonyms, databases were searched from 1980 to June 2007 for direct injury from bedrails or where falls, injury from falls, or any other effects were related to bedrail use. Results: 472 papers were located; 24 met the criteria. Three bedrail reduction studies identified significant increases in falls or multiple falls, and one found that despite a significant decrease in falls in the discontinue-bedrails group, this group remained significantly more likely to fall than the continue-bedrails group; one case-control study found patients who had their bedrails raised significantly less likely to fall; one retrospective survey identified a significantly lower rate of injury and head injury in falls with bedrails up. Twelve papers described direct injury from bedrails. Discussion: it is difficult to perform conventional clinical trials of an intervention already embedded in practice, and all included studies had methodological limitations. However, this review concludes that serious direct injury from bedrails is usually related to use of outmoded designs and incorrect assembly rather than being inherent, and bedrails do not appear to increase the risk of falls or injury from falls. [ABSTRACT FROM AUTHOR]

The Government White Paper Saving Lives: Our Healthier Nation (1999) provides a clear indication that accidents are a serious public health problem and have been targeted by the Department of Health as a key area for prevention over the next 10 years. School-based injury prevention programmes have been identified as one of the key settings for the implementation of the White Paper's heath promotion strategies. The Citizen Safety Project (CSP) is a peer-delivered injury prevention programme for Year 10 students (14-15 years) and Year 2 pupils (6-7 years). This paper summarizes the findings of a pilot study that assessed the feasibility of implementing the CSP in schools and of conducting a larger study. Working as part of their Personal Social Health Education lessons, 11 pairs (n = 22) of Year 10 students developed a project to take one accident prevention theme of their choice into a primary school to teach small groups of five or six Year 2 pupils (n = 55). A formative evaluation was conducted, based on interviews with Year 2 and Year 10 teachers (n = 2), and the diaries of Year 10 students. Knowledge of accident prevention and risk awareness was measured in Year 2 pupils using the Draw and Write technique, and impact on Year 10 students was measured using self-esteem and locus of control inventories. Using both statistical and thematic analysis the study concludes that the CSP is well accepted, improves knowledge in Year 2 pupils and boosts confidence in Year 10 students, while concurrently achieving key stage attainment targets. Implications of the study are discussed in terms of future research, as are recommendations with regard to modifications to the project. [ABSTRACT FROM AUTHOR]

Summary. The paper considers accidents on the different modes of transport. Accidents have many kinds of unwanted effects, though the paper focuses on just one: accidental fatalities. The paper reviews the main official sources of accident data and considers the use of past accident data. It then offers data and discussion on the numbers of accidental fatalities per year, passenger fatality rates, major accidents and the fatalities imposed by transport on third parties. The paper concludes with a brief discussion of communicating these results. [ABSTRACT FROM AUTHOR]

Background Consumption of alcohol is a risk factor for non-communicable and infectious diseases, mental health problems, and can lead injuries and violence. The aim of this study was to evaluate the prevalence of alcohol-involved deaths among decedents who died of external causes and underwent autopsy in Lithuania. Methods Study includes age persons of any age (from 0 to 110 years) who died and were autopsied in Lithuania from 1 January 2017 to 31 December 2020. Data were obtained from the Lithuanian State Register of Deaths and Their Causes. Results Among external causes of death, the presence of alcohol was detected in 55.0% of cases. Male decedents had a significantly higher number of positive BAC level recorded, at 46.6%, compared with female decedents (32.1%; P  < 0.001). The highest incidence of deaths where the alcohol was detected in the deceased's blood was found when the decedent was listed as being in the victims of assault group (71.5%, 95% CI 65.4–77.2). However, the highest median BAC score was found for those in the accidents group (59.7%, 95% CI: 58.2–61.2, BAC 2.42 ‰, IQR 1.86). Conclusions The findings of this study suggest that alcohol use may be a contributing factor in a wide range of fatal incidents, including accidents, injuries, and cases of violent intent. Inequalities between males and females were identified, with a higher proportion of males with alcohol detected in blood at the time of death. [ABSTRACT FROM AUTHOR]

China has seen a number of serious infrastructure construction accidents in recent years. The focus of this paper will be on urban rail. Much has been written about the technical and circumstantial causes for these accidents, but relatively little about the organizational framework and contractual arrangements which constitute the context within which safety measures fail to be monitored and enforced effectively during such construction projects. This article aims to show how existing contractual incentives provide incentives for various involved parties which lead them to make decisions where safety is sacrificed to the benefit of other values. By regarding the contractual arrangements as the outcome of a power game between principal, agents and sub-agents, the social mechanisms that evoke strategic behavior among key players are proposed to explain the context in which operational choices are made. The case of the Hangzhou subway construction disaster, which has been the most dramatic instance in China to date, is used to illustrate the mechanisms we propose in our theoretical framework. [ABSTRACT FROM AUTHOR]

The International Classification of Diseases (ICD) is used to categorize diseases, injuries, and external causes of injury, and it is a key epidemiologic tool enabling storage and retrieval of data from health and vital records to produce core international mortality and morbidity statistics. The ICD is updated periodically to ensure the classification system remains current, and work is now under way to develop the next revision, ICD-11. It has been almost 20 years since the last ICD edition was published and over 60 years since the last substantial structural revision of the external causes chapter. Revision of such a critical tool requires transparency and documentation to ensure that changes made to the classification system are recorded comprehensively for future reference. In this paper, the authors provide a history of the development of external causes classification and outline the external cause structure. They discuss approaches to manage ICD-10 deficiencies and outline the ICD-11 revision approach regarding the development of, rationale for, and implications of proposed changes to the chapter. Through improved capture of external cause concepts in ICD-11, a stronger evidence base will be available to inform injury prevention, treatment, rehabilitation, and policy initiatives to ultimately contribute to a reduction in injury morbidity and mortality. [ABSTRACT FROM PUBLISHER]

Objective: to review systematically the range of case definitions and methods used to measure falls in randomised controlled trials. Design/methods: a Cochrane review of fall prevention interventions was used to identify fall definitions in published trials. Secondary searches of various databases were used to identify additional methodological or theoretical papers. Two independent reviewers undertook data extraction, with adjudication by a third reviewer in cases of disagreement. Settings: community-dwelling and institutionalised older persons. Results: 90 publications met the predefined inclusion criteria. Of these, 44 provided no definition of the term fall. In the remainder, there were substantial variations in the definition and methods of measuring falls. Reporting periods ranged from 1 week to 4 years with only 41% using prospective data collection methods. Conclusion: the standard of reporting falls in published trials is poor and significantly impedes comparison between studies. The review has been used to inform an international consensus exercise to make recommendations for a core set of outcome measures for fall prevention trials. [ABSTRACT FROM AUTHOR]

An underlying assumption of this paper is that many `natural' disasters are the direct outcome of `deviant' political and economic decisions and actions by states. While focusing on three recent major earthquakes in Turkey, the paper explores the dynamic relationship between state power, corruption, corporate power and, to a limited extent, organized crime in the context of examining responsibility for earth quake-precipitated catastrophe. It documents the `network of responsibilities, opportunities and pressures' which combine as state crime to create earthquake disasters involving mass human rights violations. The paper argues for a reinterpretation of natural disasters in terms of human rights violations, while developing themes around state culpability which first emerged in an Economic and Social Research Council-funded study undertaken by the author (with Al Hussaini and Curry) on the 1999 Marmara earthquake in Turkey. [ABSTRACT FROM AUTHOR]

Summary. The paper describes our involvement in the high court reopened formal investigation into the sinking of the bulk carrier M. V. Derbyshire. The statistical problem that we addressed concerned the estimation of the probability that the ship had sunk from a particular form of structural failure, resulting from large wave impacts on the ship, for each of a range of possible sea-state and vessel conditions. We considered several statistical models for the wave impacts on the ship with the generalized Pareto distribution, motivated by extreme value theory, providing an excellent description and aiding the investigation to draw clear conclusions about the cause of the sinking. [ABSTRACT FROM AUTHOR]

As countries experience the 'epidemiological transition' with a relative decline in infectious diseases, accident rates tend to increase, particularly road traffic accidents. The health promotion interventions intended to prevent or minimize the consequences of accidents have been developed in predominantly Western, industrialized countries. Although some of these solutions have been applied with success to less developed countries, there are also good reasons why such solutions are ineffective when tried in a different context. Health promotion as developed in the West has a particular ideological bias, being framed within a secular, individualist and rationalist culture. Different cosmologies exist outside this culture, often described as 'fatalist' by Western commentators and as obstructing change. Changing these cosmologies or worldviews may not fit with the ethic of paying due respect to the cultural traditions of the 'target group'. Health promotion is therefore faced with a dilemma. In addition to different worldviews, the different levels of development also mean that solutions formulated in richer countries do not suit poorer countries. This paper uses a small exploratory study in a Yoruba town in Nigeria to examine these points. Interviews with key informants were held in March 1994 in Igbo-Ora and data were extracted from hospital records. Levels of accidents from available records are noted and people's ideas about accident prevention are discussed. Recommendations as to the way forward are then proposed. [ABSTRACT FROM AUTHOR]

Background Seasonal variation in mortality has been investigated in many countries but not, until recently, in Russia. There are some grounds for suspecting that it may differ in Russia from what is seen in western countries. This paper explores patterns of seasonal variation in mortality in Moscow between 1993 and 1995. Methods Analysis was based on individual data on deaths occurring in Moscow between January 1993 and December 1995, grouped by four-week period and by calendar month and on mean monthly temperature in Moscow for the same period. Crude, smoothed and deseasonalized trends were inspected. Auto-correlation functions were estimated and deaths were regressed against temperature. Results As in other northern hemisphere countries, there is a winter excess of deaths but this is much smaller than in many western countries. It is restricted to some causes of death, such as ischaemic heart disease and cerebrovascular disease, and is associated with low temperature. In contrast, there is a marked summer increase in deaths among young people, especially from accidents and other deaths associated with alcohol consumption. Over the three-year period studied, there was an initial underlying increase in alcohol related deaths that subsequently fell, coinciding with a previously observed increase in life expectancy. Conclusions It is possible that the low level of excess winter mortality reflects warmer indoor environments than in the west. The seasonal variation of deaths among young people reinforces evidence of the important role of alcohol in the Russian mortality crisis. [ABSTRACT FROM PUBLISHER]

Ride-hailing businesses, including Uber and Lyft, have reshaped road traffic since they first began operating in the United States approximately a decade ago. It follows that ride-hailing may also alter the incidence and distribution of road traffic crash injuries and deaths. The available evidence relating ride-hailing to crashes is critically reviewed in this article. We present a theoretical model that synthesizes the hypothesized mechanisms, and we identify common methodological challenges and suggest priorities for future research. Mixed results have been reported for the overall incidence of road traffic crash injuries and deaths, likely due to heterogeneous impacts on vehicular traffic flow (e.g. increasing the volume of vehicles); on vehicle-, person-, and event-level characteristics (e.g. reducing alcohol-impaired driver crashes); on road-user types (e.g. increasing pedestrian crashes); and on environmental conditions (e.g. reducing crashes most substantially where public transit access is poorest). The lack of a well-developed theory of human mobility and methodological challenges that are common to many ecological studies impede exploration of these sources of moderation. Innovative solutions are required to explicate ride-hailing's heterogeneous impacts, to guide policy that can take advantage of the public health benefits of ride-hailing, and to ensure that research keeps pace with technological advances that continue to reshape road traffic use. [ABSTRACT FROM AUTHOR]

Background The disproportionate burden of COVID-19 on ethnic minority populations has recently highlighted the necessity of maintaining accessible, routinely collected, ethnicity data within healthcare services. Despite 25 years of supportive legislation and policy in the UK, ethnicity data recording remains inconsistent, which has hindered needs assessment, evaluation and decision-making. We describe efforts to improve the completeness, quality and usage of ethnicity data within our regional health board, NHS Lothian. Methods The Ethnicity Coding Task Force was established with the aim of increasing ethnicity recording within NHS Lothian secondary care services from 3 to 90% over 3 years. We subsequently analysed these data specifically focusing on Accident and Emergency (A&E) use by ethnic group. Results We achieved 91%, 85% and 93% completeness of recording across inpatients, outpatients and A&E, respectively. Analysis of A&E data found a mixed pattern of attendance amongst ethnic minority populations and did not support the commonly perceived relationship between lower GP registration and higher A&E use within this population. Conclusions We identified a successful approach to increase ethnicity recording within a regional health board, which could potentially be useful in other settings, and demonstrated the utility of these data in informing assessment of healthcare delivery and future planning. [ABSTRACT FROM AUTHOR]

This article is a literature review of the aspects of military parachuting related to occupational medicine and focuses on ‘conventional’ military static line parachuting using a round parachute. The analysis of injuries resulting from military parachuting provide an excellent example of military occupational medicine practice. The techniques of military parachuting are described in order to illustrate the potential mechanisms of injury, and a number of ‘classical’ parachuting injuries are described. Finally some recommendations are made for the recording of parachute injuries which would assist in the international comparison of injury rates and anatomical distribution. [ABSTRACT FROM PUBLISHER]

This paper is about accidents involving two risk-neutral parties. Both parties engage in actions that are profitable but affect the magnitude of possible bilateral accidents. We analyse how the action choices can be decentralized by liability rules that assign the accident costs to the two parties. If we allow for punitive damages, we can implement the first-best actions by a liability rule even if agents are not identical. Under this liability rule some individuals may be in expectation better off in the event of an accident than in the event of no accident. We provide conditions under which this problem does not arise. [ABSTRACT FROM AUTHOR]

With the successful conquest of childhood and contagious diseases, accidents have emerged as the leading cause of death among all persons upto the age of 36 and the fourth leading cause of death among persons of all ages. The purpose of the present paper is to develop the relevance of social research in the accident field on the following grounds, accidents may be regarded conceptually as a sociological phenomenon, the storehouse of sociological knowledge may profitably be drawn upon in accident research and the research experience of sociologists can help to improve the frequently deficient theory and methodology of current accident research. Accidents, as well as illnesses, may be seen as a legitimized form of reaction to stress in which the individual through no conscious fault of his own is forced to retreat from his ordinary social roles. Both accidents and illness differ from deliberately self-inflicted injuries or feigned illness in this respect. Accidents, like illnesses, may have positive functions other than the evasion of social responsibilities.

Background The number of seriously injured unprotected road users has increased during implementation of a road safety policy Vision Zero. The aim of the study is to identify factors associated with the increase in serious injuries among cyclists and pedestrians (even single pedestrian accidents) that occurred in an urban road space in a Swedish region 2003–17. The urban road space includes roads, pavements and tracks for walking and cycling. Methods Data were retrieved from STRADA (Swedish Traffic Accident Data Acquisition) and NVDB (National Road Database). Descriptive statistics and logistic regression with odds ratios for sex, age and part of road space were assessed. Results The number of seriously injured cyclists and pedestrians more than doubled from 2003 to 2017, with the greatest increase for pedestrians. Older age increased the probability of serious injury since 2012 for the group ≥ 80 years and since 2015 for the group 65–79 years. No significant effect of sex. Most injuries occur in areas not transformed by Vision Zero. Conclusions An increasing number of elderly persons in the generation born in the 1940s and increased life expectancy are important factors. There is a need to increase road safety measures that also promote active mobility. [ABSTRACT FROM AUTHOR]

Background Compared to men, women live longer but have more years with disability. We assessed the contribution of gender differences in mortality and disability, total and by cause, to women's excess unhealthy life years (ULYs). Methods We used mortality data for France 2008 from Eurostat, causes of death from the CépiDc-INSERM-database; and disability and chronic conditions data from the French Disability Health Survey 2008–09. ULYs were calculated by the Sullivan method. The contributions of mortality and disability differences to gender differences in ULY were based on decomposition analyses. Results Life expectancy of French women aged 50 was 36.3 years of which 19.0 were ULYs; life expectancy of men was 30.4 years of which 14.2 were ULYs. Of the 4.8 excess ULYs in women, 4.0 years were due to lower mortality. Of these 4.0 ULYs, 1.8 ULY originated from women's lower mortality from cancer, 0.8 ULY from heart disease and 0.3 ULY from accidents. The remaining 0.8 excess ULY in women were from higher disability prevalence, including higher disability from musculoskeletal diseases (+1.8 ULY) and anxiety-depression (+0.6 ULY) partly offset by lower disability from heart diseases (−0.8 ULY) and accidents (−0.3 ULY). Conclusion Lower mortality and higher disability prevalence contributed to women's longer life expectancy with disability. Women's higher disability prevalence due to non-fatal disabling conditions was partly offset by lower disability from heart disease and accidents. Conditions differentially impact gender differences in ULY, depending on whether they are mainly life-threatening or disabling. The conclusions confirm the health-survival paradox. [ABSTRACT FROM AUTHOR]

Background This study aims to examine potential road crash disparities across relative wealth and location of residence in Kenya by analyzing population-representative Demographic and Health Survey data. Methods Relative wealth was measured by household assets, converted into an index by polychoric principal components analysis. Location and sex-stratified associations between wealth quantiles and crashes were flexibly estimated using fractional polynomial models. Structural equation models were fit to examine whether observed differences may operate through previously identified determinants. Results In rural areas, crashes were least common for both the poorest men (−5.2 percentage points, 95% CI: −7.3 to −3.2) and women (−1.6 percentage points, 95% CI: −2.9 to −0.4). In urban areas, male crashes were lowest (−3.0 percentage points, 95% CI: −5.2 to −0.8) among the wealthiest, while they peaked in the middle of the female wealth distribution (2.0 percentage points, 95% CI: 0.3–3.8). Male differences operate partially though occupational driving and vehicle ownership. Urban female differences operate partially through household vehicle ownership, but differences for rural women were not explained by modeled determinants. Conclusions Relative wealth and road crash have opposite associations in rural and urban areas. Especially in rural areas, it is important to mitigate potential unintended effects of economic development. [ABSTRACT FROM AUTHOR]

Uber, the world's largest ridesharing company, has reportedly provided over 2 billion journeys globally since operations began in 2010; however, the impact on motor vehicle crashes is unclear. Theoretically, ridesharing could reduce alcohol-involved crashes in locations where other modes of transportation are less attractive than driving one's own vehicle while under the influence of alcohol. We conducted interrupted time-series analyses using weekly counts of injury crashes and the proportion that were alcohol-involved in 4 US cities (Las Vegas, Nevada; Reno, Nevada; Portland, Oregon; and San Antonio, Texas). We considered that a resumption of Uber operations after a temporary break would produce a more substantial change in ridership than an initial launch, so we selected cities where Uber launched, ceased, and then resumed operations (2013-2016). We hypothesized that Uber's resumption would be associated with fewer alcohol-involved crashes. Results partially supported this hypothesis. For example, in Portland, Uber's resumption was associated with a 61.8% reduction (95% confidence interval: 38.7, 86.4) in the alcohol-involved crash rate (an absolute decrease of 3.1 (95% confidence interval: 1.7, 4.4) alcohol-involved crashes per week); however, there was no concomitant change in all injury crashes. Relationships between ridesharing and motor vehicle crashes differ between cities over time and may depend on specific local characteristics. [ABSTRACT FROM AUTHOR]

Safe urban walking environments may improve health by encouraging physical activity, but the relationship between an individual's location and walking pattern and the risk of pedestrian--motor vehicle collision is unknown. We examined associations between individuals' walking bouts and walking risk, measured as mean exposure to the risk of pedestrian-vehicle collision. Walking bouts were ascertained through integrated accelerometry and global positioning system data and from individual travel-diary data obtained from adults in the Travel Assessment and Community Study (King County, Washington) in 2008-2009. Walking patterns were superimposed onto maps of the historical probabilities of pedestrian-vehicle collisions for intersections and midblock segments within Seattle, Washington. Mean risk of pedestrian-vehicle collision in specific walking locations was assessed according to walking exposure (duration, distance, and intensity) and participant demographic characteristics in linear mixed models. Participants typically walked in areas with low pedestrian collision risk when walking for recreation, walking at a faster pace, or taking longer-duration walks. Mean daily walking duration and distance were not associated with collision risk. Males walked in areas with higher collision risk compared with females, while vehicle owners, residents of single-family homes, and parents of young children walked in areas with lower collision risk. These findings may suggest that pedestrians moderate collision risk by using lower-risk routes. [ABSTRACT FROM AUTHOR]

Background: Track incidents including near misses and those causing injury or death are a psychological hazard for train operators. No study has directly investigated how train operators are affected depending on track incident outcome and few studies have investigated the impact of near misses. Aims: To compare sickness absence (SA) of London Underground train operators following track incidents categorized by outcome, including near misses. Methods: This was an observational study using historical data of track incidents from April 2008 to October 2013. Track incidents were divided into four categories according to outcome (near miss on platform, near miss on track, significant injury and fatality). Additional information on age, gender and previous relevant history was collected. Results: A total of 685 track incidents were analysed. There was a significant difference in SA taken after near misses ('no injury') incidents compared with significant injury and fatality ('injury') incidents (P < 0.001). There was also a significant difference in SA in train operators involved in a fatality incident compared with significant injury incidents (P < 0.05). Conclusions: SA in train operators following a track incident increases in line with the severity of the incident in terms of outcome. Fatal track incidents caused the highest level of SA followed by significant injury incidents. Near misses also caused substantial levels of SA. [ABSTRACT FROM AUTHOR]

Background: Numerous safety promotion interventions in schools exist but these are rarely subject to impact evaluation. Few available studies are focused on intermediate outcomes. Our objective is to evaluate the impact of prevention interventions on school injuries in a number of schools in Italy. Methods: A pre-post- study with a control group was used. One hundred and three intervention units were selected; control units were selected randomly from those which did not implement safety projects. The general objective was to promote a safety culture by increasing expertise and knowledge, and by enabling the adoption of appropriate behavior. All projects combined various elements: training and educational, information and communication, as well as organizational. The projects evaluated in this article were specifically aimed at safety in indoor premises; they were implemented in 2009-10. Injury rates standardized by gender were calculated for 5 school years (from 2007/2008 to 2011/2012) stratified by type of school and place of occurrence. To assess the effectiveness the difference-in-differences method was used. Results: Overall, 207 012 student-years and 2918 school injuries were considered. In all types of schools, the injury rates in indoor areas show a decreasing trend in the intervention units and an increasing trend in the control units. In high schools, there were no changes in the trend of injuries occurring in the gym and/or related to sports activities. Conclusions: The results suggest a positive short-term effect of the programs on injuries occurring in indoor premises. The quasi-experimental design has never been previously used to evaluate the effectiveness of a prevention program in schools. [ABSTRACT FROM AUTHOR]

Background Accidental non-fire-related (ANFR) carbon monoxide (CO) poisoning is a cause of fatalities and hospital admissions. This is the first study that describes the characteristics of ANFR CO hospital admissions in England. Methods Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010 were used. ANFR CO poisoning admissions were defined as any mention of ICD-10 code T58: toxic effect of CO andX47: accidental poisoning by gases or vapours, excluding ICD-10 codes potentially related to fires (X00-X09, T20-T32 and Y26). Results There were 2463 ANFR CO admissions over the 10-year period (annual rate: 0.49/100 000); these comprised just under half (48.7%) of all non-fire-related (accidental and non-accidental) CO admissions. There was seasonal variability, with more admissions in colderwinter months. Higher admission rates were observed in the north of England. Just over half (53%) of ANFR admissions were male, and the highest rates of ANFR admissions were in those aged >80 years. Conclusion The burden of ANFR CO poisoning is preventable. The results of this study suggest an appreciable burden of CO and highlight differences that may aid targeting of public health interventions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Reducing Inequalities in Non-Fatal Accidents in England," by M. McCarthy and P. Primatesta," published in a 2003 issue.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a persistent environmental contaminant. Although experimental evidence suggests that TCDD alters thyroid hormone levels in rodents, human data are inconsistent. In 1976, a trichlorophenol plant exploded in Seveso, Italy. Women living in highly exposed areas were followed through the Seveso Women's Health Study. TCDD concentrations were measured in 1976 (n = 981) and 1996 (n = 260), and levels of total thyroxine, free thyroxine, free triiodothyronine, and thyroid-stimulating hormone were measured in 1996 (n = 909) and 2008 (n = 724). We used conditional multiple linear regression and marginal structural models with inverse-probability-of-treatment weights to evaluate associations and causal effects. TCDD concentration in 1976 was inversely associated with total thyroxine level in 1996 but not in 2008. Associations were stronger among women who had been exposed before menarche. Among these women, associations between total thyroxine and concurrent 1996 TCDD were slightly weaker than those with 1976 TCDD. A model including both 1976 and 1996 measurements strengthened the relationship between 1976 TCDD and total thyroxine but drove the association with 1996 TCDD to the null. TCDD exposure was not associated with levels of other thyroid hormones. TCDD exposure, particularly exposure before menarche, may have enduring impacts on women's total thyroxine levels. Initial exposure appears to be more influential than remaining body burden. [ABSTRACT FROM PUBLISHER]

Background Climate change has contributed to increasing temperatures, earlier snowmelts and thinning ice packs in the Arctic, where crossing frozen bodies of water is essential for transportation and subsistence living. In some Arctic communities, anecdotal reports indicate a growing belief that falling-through-the-ice (FTI) are increasing. The objective of this study was to describe the morbidity and mortality associated with unintentional FTIs in Alaska. Methods We searched newspaper reports to identify FTI events from 1990 to 2010. We also used data from a trauma registry, occupational health and law enforcement registries and vital statistics to supplement the newspaper reports. Morbidity and mortality rates were calculated for Alaska Native (AN) people and all Alaskans. Results During the 21-year period, we identified 307 events, affecting at least 449 people. Events ranged from no morbidity to fatalities of five people. More than half of the events involved transportation by snow machine. Mortality rates were markedly higher for AN people than that for all Alaskans. Conclusions We provide a numeric estimate of the importance of FTI events in Alaska. FTIs may represent an adverse health outcome related to climate changes in the Arctic, and may be particularly critical for vulnerable populations such as AN people. [ABSTRACT FROM PUBLISHER]

The World Health Organization estimates that almost half of all premature deaths among 15- to 19-year olds can be attributed to injuries with most (95%) fatal injuries occurring in low- and middle-income countries. Yet the evidence base for adolescent injuries in low-income countries is poor. This article uses a mixed method approach to gain an understanding of patterns, causes and consequences of unintentional injuries among adolescents aged between 14 and 16 years in four low-income country settings. Survey data collected in 2009 in Ethiopia, India (Andhra Pradesh), Peru and Vietnam (from ∼900 adolescents in each country) were integrated with qualitative research (conducted between 2007 and 2011) with a nested sample of older cohort children in Ethiopia (n = 25) and India (n = 25) using an iterative process. Logistic regression models were fitted to examine potential risk factors for injuries. Injuries were a concern for adolescents in all countries and occurred during work, recreation and sports or transportation. Being male was associated with an increased risk for all types of injuries, whereas being poor was only significantly associated with work injuries. Area of residence (urban vs rural) made a difference in some countries and for some kinds of injuries as did perceived health status. Qualitative findings highlight the consequences of injuries not only for the adolescents but also for the social and economic status of the entire household. Injury prevention programmes need to be specific to cultural and environmental settings, expectations of adolescent’s responsibilities and responsive to the context of poverty. [ABSTRACT FROM AUTHOR]

Background Diving operations are technically complex, and the underwater environment poses a high risk of fatal or near miss accidents. Furthermore, long-term effects of diving on bone, the central nervous system and the lung have been observed in divers who have not experienced any diving-related accidents. Aims To compare total and cause-specific mortality among Norwegian professional divers by class of diving certificate, relative to the general population. Methods Data on mortality were obtained for divers in the Norwegian Inshore Diving Registry, which comprises data on all divers with a certificate valid for professional diving after 1980. By August 2010, 5526 male divers born between 1950 and 1990 were identified, 3130 of whom were fully certified professional divers. The rest of the Norwegian male population born in the same period (1 604 147) served as referents. Data on mortality were obtained by linkage to the Cause of Death Registry. Results Mortality was 23 per 1000 in professional divers and 24 per 1000 in referents. The hazard ratio was 0.79 (confidence interval [CI] 0.63–0.997). Diving-related accidents and suicide were the most common causes of death among divers. Both were significantly more common among divers with the higher level diving certificates. Conclusions Overall, mortality in professional divers was lower than that of the general population. However, professional divers had a higher risk of dying from work-related accident or suicide. [ABSTRACT FROM PUBLISHER]

Background Burns are a significant cause of mortality and morbidity in developing countries. We examined the epidemiology of unintentional burns in South Asia to identify trends and gaps in information. Methods A MEDLINE/PUBMED search (1970–2011) was undertaken on empirical studies that focused on burns in India, Pakistan, Bangladesh and Sri Lanka. Data analyzed included demographics, injury details and risk factors. Results Twenty-seven studies were identified, mostly from India. Burns were more common among males at younger ages (0–12 years) and among females from adolescence onward (>14 years). Flame-related burns and scalds accounted for over 80% of burns in most cases, and were the most common types of injuries observed among children and women with most burns occurring in the home. Electrical burns occurred mostly among men. Important risk factors for burns included low socioeconomic status, being younger, wearing loose, flammable clothing and the use of kerosene. Data on care-seeking and treatment were limited. Conclusions Preventing burns in the household in South Asia, particularly around kitchen activities, is essential. Children in South Asia are susceptible to burns and are an important target population. Future research should focus on filling the gaps in burn epidemiology found in this review. [ABSTRACT FROM AUTHOR]

A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns. [ABSTRACT FROM PUBLISHER]

Background: Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health. The literature posits that receipt of a large portion of annual income increases, in the short term, risk-taking behaviour and/or the consumption of health-damaging goods. This work implies the hypothesis that persons with an unexpected gain in income will exhibit an elevated risk of accidental death-the fifth leading cause of death in the USA. We test this hypothesis directly by capitalizing on a natural experiment in which Cherokee Indians in rural North Carolina received discrete lump sum payments from a new casino.Methods: We applied Poisson regression to the monthly count of accidental deaths among Cherokee Indians over 204 months spanning 1990-2006. We controlled for temporal patterns in accidental deaths (e.g. seasonality and trend) as well as changes in population size.Results: As hypothesized, the risk of accidental death rises above expected levels during months of the large casino payments (relative risk = 2.62; 95% confidence interval = 1.54-4.47). Exploratory analyses of ethnographic interviews and behavioural surveys support that increased vehicular travel and consumption of health-damaging goods may account for the rise in accident proneness.Conclusions: Although long-term income gains may improve health in this population, our findings indicate that acute responses to large income gains, in the short term, increase risk-taking and accident proneness. We encourage further investigation of natural experiments to identify causal economic antecedents of population health. [ABSTRACT FROM AUTHOR]

Background Little is known about how organizations perceive and monitor occupational injury and illness costs. Aims To explore perceptions of injury and illness costs, the extent to which organizations monitor their impact, attitudes towards this practice and views on using cost information in health and safety campaigns. Methods Interviews were conducted with 212 representatives from 49 small- and medium-sized enterprises (SMEs) and 80 large organizations from a range of industry sectors. Results Health and safety investments were driven by a range of factors, of which cost reduction was only one. Human costs were also considered important. Injuries were perceived to represent a substantial business cost by 10% of respondents from SMEs and 56% of those from large organizations. Most were uncertain about the financial impact of work-related illness. No organizations had attempted to monitor occupational illness costs. Injury costs had been assessed within 3 SMEs and 30 large organizations. Only 12% of SME representatives recognized the benefits of costing health and safety failures and around half were unreceptive to the use of cost information in health and safety promotions. Twothirds of those from large organizations recognized some benefit in measuring costs, and over threequarters welcomed the provision of industry-specific information. Conclusions Provision of information that focuses solely on the economic implications of occupational injury and illness may be of limited value and agencies involved in the promotion of health and safety should incorporate a range of information, taking into account the needs and concerns of different sectors. [ABSTRACT FROM AUTHOR]

Injury is a growing public health concern worldwide. Since severe injuries require urgent treatment, involving smooth, timely patient referral between facilities, strengthening of the referral system would reduce injury mortality. Smooth referral consists of identification of severe cases, organization of transportation, communication between facilities and prompt care at the receiving facility. This study examined these components of referral of injured patients in a representative sample of health centres (HCs) and referral hospitals (RHs) in Cambodia. [ABSTRACT FROM PUBLISHER]

Background The metal mining industry employs ∼15% of formally employed workers in Zambia, but there is little information about the magnitude of occupational injuries among the miners. Aims To determine the frequency rates of occupational injuries and fatalities among copper miners in Zambia. Methods A retrospective study of occupational injuries and fatalities at one of the largest copper mining companies in Zambia was undertaken for the period January 2005 to May 2007. Information on injuries and fatalities was obtained from the electronic accident survey database of the company. Analysis was restricted to fatalities and those injuries that had prompted medical attention and at least 1 day of absence from work. Annual injury and fatality frequency rates (injuries per 1000 employee years and fatalities per 100 000 employee years, respectively) were calculated. Results In the selected period, 165 injuries and 20 fatalities were recorded. The underground department had the highest frequency rates of fatalities (111/100 000 employee years) and injuries (5.5/1000 employee years). The most common cause of fatal injuries was fall of rock in the underground mines. The most frequent mechanism of injury was handling of tools and materials, and the most commonly injured body parts were the hands and fingers. Conclusions The fatality rate is high compared to reported values from the metalliferous mining industry in developed countries, strongly suggesting that measures should be taken to reduce risks, particularly at underground sites. [ABSTRACT FROM AUTHOR]

This study examines the effects on occupational injury claims of a recently implemented post-accident drug testing (PADT) program in a large retail chain. We find that claims have fallen significantly in affected districts, suggesting that PADT programs can reduce injury claims, even in workplaces that already utilize other forms of drug testing. Our results also suggest that some types of employees-such as full-time workers, male workers, and higher-tenure workers-are particularly responsive. Finally, we find some "circumstantial evidence" that a portion of the observed decline could be caused by employees' reduced willingness to report workplace accidents. [ABSTRACT FROM AUTHOR]

The article features a discussion on the most tragic episodes in eighteenth-century colonial and naval history, the expedition to Kourou in French Guyana of 1763-1765, of which the chevalier Etienne-Francois Turgot was the military governor. The first detailed account of the expedition was prepared by the Ministry of the Navy in 1842, at a time of renewed interest in France's tropical colonies.

This study examined the hypothesis that media exposure and attention partially mediate the effects of variables such as demographics and personal experience on risk judgments. Risk judgments, including perceived severity, prevalence, controllability, familiarity, and concern about alcohol-related injuries, comprised the outcome measures. Alcohol-related injuries included assaults, motor vehicle crashes, and other injury incidents such as falls, fire, and drowning. Results supported the hypotheses of partial mediation with respect to most risk judgment factors. In particular, effects of education, gender, sensation seeking, and prior firsthand or secondhand experience with alcohol-related mishaps on judgments of concern and/or severity were partially mediated by media variables. The authors concluded that media effects on risk judgments can be usefully understood as pan of a larger social process in which media are selectively attended to due to exogenous influences pan of the effect of these exogenous influences on these social risk judgments was via these media influences. Media use variables also retain a degree of influence after controlling for these exogenous factors. [ABSTRACT FROM AUTHOR]

This article offers evidence on legal systems' detterrence of acts that may cause harm, which extends law-and-finance literature comparing common law and civil code systems. Fatality rates from two causes are used to gauge deterrence: (1) motor vehicle accidents and (2) accidents other than motor vehicle, Both vary significantly across countries classified by origin of legal system. The data cover 50 years, offering evidence on evolution of differences over time. Findings for accidents other than motor vehicle are evidence on legal system flexibility, as the diffuse set of causes increases the difficulty of specifying harmful actions ex ante. [ABSTRACT FROM AUTHOR]

Background Older women have been observed to have more serious injury particularly fractures after slips, trips or falls at the workplace. It is unclear whether this excess reflects a greater likelihood of falling or a greater proportion presenting with fractures once the fall has occurred.Methods Two studies were carried out: Study A, of 130 women who fell at work and matched referents, and Study B, of 120 women who fell at work and sustained a major fracture and 314 matched referents who fell but for whom no fracture was recorded. In Study A, the workplace of the case and referent was observed, questionnaires completed and objective health measures carried out. Study B relied on information obtained from the subject by postal questionnaire.Results Women who fell were older than referents matched on workplace and occupation, but age did not continue to be a significant factor after allowing for bodyweight and use of spectacles. Fractures were more common in older women who fell, particularly post-menopausal women with low body mass. The risk of fracture increased steadily with age without an obvious discontinuity around the likely age of menopause.Conclusions The observed excess of fractures in older women falling at work appeared to be explained by the greater risk of fracture among those who fell. [ABSTRACT FROM AUTHOR]

This retrospective cohort study evaluated the risk of adverse pregnancy outcomes following motor vehicle crashes during pregnancy. The authors assessed outcomes of pregnant women hospitalized for motor vehicle crashes in Washington State from 1989 to 2001 (n = 582). They used the Injury Severity Score (ISS) to classify 84 severely injured (ISS ≥9), 309 non-severely injured (ISS 1–8), and 189 uninjured (ISS 0) pregnant women and compared them with pregnant women who had not been hospitalized for a motor vehicle crash (n = 17,274). Of pregnant women in motor vehicle crashes, 82.9% were hospitalized and discharged without delivering, and 17.1% delivered at hospitalization. Compared with women not in motor vehicle crashes, severely and non-severely injured women were at increased risk of placental abruption and cesarean delivery, and their infants were at increased risk of respiratory distress syndrome and fetal death. Uninjured women were also at increased risk of preterm labor (relative risk = 7.9, 95% confidence interval: 6.4, 9.8) and placental abruption (relative risk = 6.6, 95% confidence interval: 3.9, 11.2) compared with women not in motor vehicle crashes. Pregnant women hospitalized following motor vehicle crashes are at increased risk of adverse pregnancy outcomes, regardless of the presence or severity of injuries. [ABSTRACT FROM AUTHOR]

Background There is a dearth of information examining minor injuries and cognitive failures in the workplace.Aims This study aims to describe the incidence of, and characteristics associated with, minor injuries, cognitive failures and accidents in the workplace.Methods The study was a community based postal questionnaire survey of people selected at random from the Electoral Registers of Cardiff and Merthyr Tydfil; 7980 questionnaires were returned.Results Frequent/very frequent minor injuries were reported by 9.8% of the workers and frequent/very frequent cognitive failures (e.g. problems of memory, attention or action) by 10.5%. Work accidents requiring treatment were reported by 5.6% of the workers. Minor injuries, cognitive failures and accidents were associated with a number of demographic and health factors. In addition, minor injuries, cognitive failures and accidents were found to be related to each other.Conclusions A large number of workers experience accidents and minor injuries at work. Minor injuries are not recorded by official sources but could have implications in productivity and worker health. Factors identified in this study, as associated with injuries or accidents, could be addressed by specific workplace policies or by raising individual awareness of the risks. [ABSTRACT FROM AUTHOR]

Two decades ago, the United Nations' ability to deal with disasters and emergencies was underdeveloped, essentially lacking the commitment and capacity to deal with what are now called‘humanitarian crises’. Two decades later the UN, its programmes and specialized agencies, has increased its technical and tactical abilities to respond to such crises in ways that are far more systematic and coherent. And yet, despite such important developments, the UN is not strategic in its approach and cannot escape the pressure of political manipulation that threatens the fundamental humanitarian principles of impartiality, neutrality and independence. At the same time, the process by which the UN increased and now maintains its enhanced humanitarian role has made the institution far more self-obsessed. These trends do not bode well when confronted with the grave prospect of an increasingly disaster and emergency-prone world. Nevertheless, this article concludes with prescriptions that would make the UN far more capable of dealing with the sort of humanitarian challenges that may have to be faced over the next two decades. [ABSTRACT FROM AUTHOR]