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Background: Smartphone cameras are rapidly being introduced in medical practice, among other devices for image-based teleconsultation. Little is known, however, about the actual quality of the images taken, which is the object of this study. Materials and Methods: A series of nonclinical objects (from three broad categories) were photographed by a professional photographer using three smartphones (iPhone® 4 [Apple, Cupertino, CA], Samsung [Suwon, Korea] Galaxy S2, and BlackBerry® 9800 [BlackBerry Ltd., Waterloo, ON, Canada]) and a digital camera (Canon [Tokyo, Japan] Mark II). In a Web survey a convenience sample of 60 laypeople “blind” to the types of camera assessed the quality of the photographs, individually and best overall. We then measured how each camera scored by object category and as a whole and whether a camera ranked best using a Mann–Whitney U test for 2×2 comparisons. Results: There were wide variations between and within categories in the quality assessments for all four cameras. The iPhone had the highest proportion of images individually evaluated as good, and it also ranked best for more objects compared with other cameras, including the digital one. The ratings of the Samsung or the BlackBerry smartphone did not significantly differ from those of the digital camera. Conclusions: Whereas one smartphone camera ranked best more often, all three smartphones obtained results at least as good as those of the digital camera. Smartphone cameras can be a substitute for digital cameras for the purposes of medical teleconsulation.

Study objective The study examines whether there are socioeconomic differences among young motorcycle drivers (aged 16–25) involved in road-traffic injuries with regard to age and injury severity. Design Nationwide retrospective register-based cohort study. Setting and participants Subjects born in 1970–1972 were extracted from the Swedish Population and Housing Census of 1985 ( n = 334 070). Individual records from the 1985 census were linked to police-reported data and hospital-based data for the period 1988–1995 on the basis of a search for each subject's first registered road-traffic injury as a motorcycle driver ( n = 2034). Information on household socioeconomic group was taken from the Swedish census of 1985. Two categories of crash severity were analysed (minor injury and severe/fatal injury), based on assessments of the police and according to length of hospitalization. Main results Incidence of motorcycle injury varies considerably according to age of driver, reaching a peak at the age of 17. The greatest differences in injury risk between socioeconomic groups are present when their members are aged 17–19. At the age of 18, subjects belonging to low socioeconomic positions run a risk of injury occurrence 2.5 times higher than those belonging to the highest socioeconomic category. Young drivers in lower socioeconomic groups have higher odds for both minor and severe injuries than their counterparts in the highest socioeconomic group, but there is no further increase for the latter. Conclusions The study demonstrates how crucial the first years of driving are in relation to injury, and how wide the gap is in terms of socioeconomic differences at these ages, suggesting that this is the most appropriate time for intervention.

To determine factors affecting the severity of motorcycle injuries, considering variables related to the individual, the environment, the vehicle, and the crash.This is a register-based retrospective cohort study. All individuals born in 1970-1972 (n = 334,070) were extracted from the Swedish Population and Housing Census of 1985 and followed up from 1988 to 2000, when aged 16-30. All subjects whose records indicated an injury as a motorcycle driver in the Swedish National Road Administration Accident Database were selected, and constituted the study population (n = 1,748). Factors related to the individual, the environment, the vehicle, and the crash were considered as exposure measures, whereas the outcome measure was the level of injury severity, based on assessments made on-site by police officers, in two categories: fatal/severe and minor. Associations between individual, environmental, vehicle and crash factors and injury severity were measured, using Chi-square, and through univariate and multivariate stepwise logistic regression.Factors such as alcohol consumption, traffic environment, speed limit, and type of crash were significantly associated (p0.0001) with injury severity. More specifically, a positive suspicion of alcohol consumption, driving in a rural area, and a posted speed limit over 50 km/hour were all factors positively associated (OR1.0) with the likelihood of being severely injured. On modeling all the variables together through stepwise logistic regression, positive suspicion of alcohol emerged as the strongest determinant (adjusted OR = 2.7) of a severe outcome. CONCLUSIONS. Motorcycle crashes still place a heavy burden on young drivers. Increased efforts are needed to prevent alcohol-related crashes-through law enforcement and a multiplicity of policies at local and national levels.

Objective: To explore the crash experience and crash consequences of newly licensed male and female drivers aged 18-29 years. Methodology: A national register-based population cohort of persons born between 1970 and 1972 was followed for the period 1988-2000 on the basis of crash data in Swedish police records. The analyses focused on two crash categories regardless of consequences: single car (SC) and car-to-motor vehicle (CMV). Results: Crash incidence for men was nearly double that of women in all age groups in both crash categories. Age had a protective effect for both sexes, especially for SC crashes. Males, but not females, showed a lag in time from driving license issue date to first crash for SC crashes, which increased with age of obtaining a license. Men's crash fatality rate was five times higher than that of women for SC crashes (32.2 and 6.1 per 1000, respectively), but the rate was comparable for CMV crashes (16.1 and 15.7, respectively). The crash morbidity rate was 25-30% higher for male drivers in both crash categories. Conclusions: Both young age and male sex emerge as important determinants of crash risk and crash consequences among young Swedish drivers.

Objective: The study examines whether socioeconomic and sex differences in road-traffic crashes leading to injury vary according to car-safety level. Method: Individuals records of subjects born 1970-1972 registered in the Swedish Census of 1985 (n = 334,070) are linked to road-traffic-crash data for the period 1988A¢??2000 for first police-registered two-car crashes leading to severe or fatal injury (n = 4875). Injuries are split into categories according to level of car safety on a five-point scale, based on criteria related to crash safety. Account is taken of both how the car is constructed and the effectiveness of its safety equipment (such as airbags and seat belts). For each car-safety level, relative risks are computed considering socioeconomic groups of origin, educational level, and sex. Results: No substantial differences between drivers in different socioeconomic positions of origin is observed except for crashes involving cars 30% better than average with regard to safety. There are consistent risk differences across all car-safety categories according to educational level. Male drivers show an elevated risk of injury in all car categories, except for cars with the poorest safety where they are at significant under-risk. Conclusions: Car-safety level impacts on social differences in road-traffic injury risks in specific and restricted manners. Car-safety development is an important factor in improved road safety, but it may not benefit all to the same extent.

A national register-based cohort study was conducted to explore whether the social patterning of car drivers suffering injury repetitions differs from that of once-injured drivers in a cohort of young persons in Sweden (aged 18-26). Injury repeaters were defined as individuals sustaining injuries as a car driver on more than one occasion over an 8-year period. Only subjects obtaining a driver's licence before the age of 27 were included in the study. The social variables considered were, in turn, gender, socioeconomic position of origin, and own educational attainment. Attention was also paid to age at licensing. Two types of comparisons were made, using odds ratios with 95% confidence intervals. First, the odds of injury repeaters were computed using the once-injured car drivers as a reference group. Second, odds were compiled for once, twice, and three or more times injured people, using the non-injured at all as a comparison group. The results show that, by and large, the injury-risk distribution of car drivers with injury repetition does not differ from that of one-injury drivers with regard to gender, education, or socioeconomic group. However, drivers from self-employed households show greater odds of injury repetition (OR 1.65, CI 1.02-2.67) than of one injury compared with drivers from the families of non-manual employees. Since the number of injury repeaters is low and their socioeconomic distribution is very similar to that of the once injured, there is no need to regard them as a group at excess risk or different from the one-time injured. Reducing risk levels and risk differentials for the one time injured should therefore receive priority with regard to traffic-injury prevention.

The aim of publishing this statement is to raise awareness among and promote a response by the international community to address the formidable challenges and pressing unmet needs facing the rehabilitation and recovery of the health sector in post-conflict situations. The aim is also to draw attention to the need for integrating health research into these efforts in order to provide evidence for the design of sector policies and intervention programmes. Lessons learnt from the Somali situation may be of great value to guide health sector development after civil unrest also in other settings – now and in the future. (Published: 30 March 2015) Citation : Glob Health Action 2015, 8 : 27381 - http://dx.doi.org/10.3402/gha.v8.27381

Referral guidelines for burn care are meant to assist in decision-making as regards patient transfer and admissions to specialized units. Little is known, however, concerning how closely they are followed and whether they are linked to patient care. This is the object of the current study, focused on the paediatric burns centre of the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. All patients admitted to the centre during the winters of 2011–2015 (n = 1165) were included. The patient files were scrutinized to clarify whether the referral criteria in place were identified (seven in total) and to compile data on patient and injury characteristics. A case was defined as adherent to the criteria when at least one criterion was fulfilled and adherence was expressed as a percentage with 95% confidence intervals, for all years aggregated as well as by year and by patient or injury characteristics. The association between adherence to any individual criterion and hospital care (surgery or longer length of stay) was measured using logistic regressions. The overall adherence was 93.4% (100% among children under 2 years of age and 86% among the others) and it did not vary remarkably over time. The two criteria of “injury sustained at a specific anatomical site” (85.2%) and “young age” (51.9%) were those most often identified. Children aged 2 years or older were more likely to undergo surgery or to stay longer than those of young age (although a referral criterion) and so were those with higher injury severity (a referral criterion). In this specialized paediatric burns centre, children are admitted mainly according to the guidelines. However, given the high prevalence of paediatric burns in the region and the limited resources at the burns centre, adherence to the guidelines need to be further studied at all healthcare levels in the province.

Aim This study assessed whether photographs of burns on patients with dark-skin types could be used for accurate diagnosing and if the accuracy was affected by physicians’ clinical background or case characteristics. Method 21 South-African cases (Fitzpatrick grades 4–6) of varying complexity were photographed using a camera phone and uploaded on a web-survey. Respondents were asked to assess wound depth (3 categories) and size (in percentage). A sample of 24 burn surgeons and emergency physicians was recruited in South-Africa, USA and Sweden. Measurements of accuracy (using percentage agreement with bedside diagnosis), inter- ( n = 24), and intra-rater ( n = 6) reliability (using percentage agreement and kappa) were computed for all cases aggregated and by case characteristic. Results Overall diagnostic accuracy was 67.5% and 66.0% for burn size and depth, respectively. It was comparable between burn surgeons and emergency physicians and between countries of practice. However, the standard deviations were smaller, showing higher similarities in diagnoses for burn surgeons and South-African clinicians compared to emergency physicians and clinicians from other countries. Case characteristics (child/adult, simple/complex wound, partial/full thickness) affected the results for burn size but not for depth. Inter- and intra-rater reliability for burn depth was 55% and 77%. Conclusion Size and depth of burns on patients with dark-skin types could be assessed at least as well using photographs as at bedside with 67.5% and 66.0% average accuracy rates. Case characteristics significantly affected the accuracy for burn size, but medical specialty and country of practice seldom did in a statistically significant manner.

It is unknown whether road traffic crashes (RTCs) involving young unlicensed drivers follow the downward trend of those involving licensed drivers. Our national register-based study from 2000 to 2011 indicates that the downward trend for young unlicensed drivers (

Background Road traffic injuries (RTIs) are a substantial cause of mortality and disability globally. There is little published information regarding healthcare resource utilization following RTIs, especially in low and middle-income countries (LMICs). The aim of this study was to assess total hospital charges and length of stay (LOS) associated with RTIs in Iran and to explore the association with patients’ socio-demographic characteristics, insurance status and injury-related factors (e.g. type of road users and safety equipment). Method The study was based on the Iranian National Trauma Registry Database (INTRD), which includes data from 14 general hospitals in eight major cities in Iran, for the years 2000 to 2004. 8,356 patients with RTI admitted to the hospitals were included in the current study. The variables extracted for the analysis included total hospital charges and length of stay, age, gender, socio-economic and insurance status, injury characteristics, medical outcome and use of safety equipment among the patients. Univariable analysis using non-parametric methods and multivariable regression analysis were performed to identify the factors associated with total hospital charges and LOS. Results The mean hospital charges for the patients were 1,115,819 IRR (SD=1,831,647 IRR, US$128 ± US$210). The mean LOS for the patients was 6.8 (SD =8 days). Older age, being a bicycle rider, higher injury severity and longer LOS were associated with higher hospital charges. Longer LOS was associated with being male, having lower education level, having a medical insurance, being pedestrian or motorcyclist, being a blue-collar worker and having more severe injuries. The reported use of safety equipment was very low and did not have significant effect on the hospital charges and LOS. Conclusion The study demonstrated that the hospital charges and LOS associated with RTI varied by age, gender, socio-economic status, insurance status, injury characteristics and health outcomes of the patients. The results of the study provide information that can be of importance in the planning and design of road traffic injury control strategies.

Recent affluence, assisted by exploitation of hydrocarbon, has sparked unprecedented economic growth and influx of all façades of modernity in Oman. Different statistical models have examined the relationship between economic growth, motorization rates, and road traffic fatalities. However, such a relationship in Oman has never been described.To describe and analyze the trend of road traffic injuries (RTIs) in relation to motorization rates and economic growth during the period from 1985 to 2009 using Smeed's (1949) model and Koren and Borsos's (2010) model.The study is based on national data reported between 1985 and 2009. Data on the population and gross domestic product (GDP) per capita in U.S. dollars were gathered from the Ministry of National Economy reports. Data on the number of vehicles and road traffic crashes, fatalities, and injuries were gathered from the Royal Oman Police (ROP) reports. Crash, fatality, and injury rates per 1000 vehicles and per 100,000 population were computed. Linear regression analysis was carried out to estimate the average annual changes in the rates. Smeed's (1949) and Koren and Borsos's (2010) models were used to predict the relations between motorization and road traffic fatalities in Oman. In addition, a cross-sectional analysis of year 2007 data for a number of Arab countries was carried out.The GDP per capita increased from US$6551 in 1985 to US$25,110 in 2009 with an annual increase of UR$547 per capita. The motorization rates increased by 36 percent from 1745 per 10,000 population in 1985 to 2382 per 10,000 population in 2009. Both Smeed's (1949) and Koren and Borsos's (2010) models had a high goodness of fit, with R(2) greater than 0.70. This indicated that road traffic fatalities in Oman may have a direct relationship with increased motorization. The cross-sectional analysis showed that the relation between crash fatalities and motorization rates in Oman and the United Arab Emirates can be better explained by Koren and Borsos's (2010) model than other countries.Recent economic growth in Oman was associated with an increase in motorization rates, which in turn has resulted in an increased burden of road traffic fatalities and injuries.

Objective Adverse living standards are associated with poorer child health and safety. This study investigates whether adverse housing and neighbourhood conditions contribute to explain country-level associations between a country9s economic level and income inequality and child mortality, specifically injury mortality. Design Ecological, cross-sectional study. Setting/subjects Twenty-six European countries were grouped according to two country-level economic measures from Eurostat: gross domestic product (GDP) and income inequality. Adverse country-level housing and neighbourhood conditions were assessed using data from the 2006 European Union Income Social Inclusion and Living Conditions Database (n=203 000). Main outcome measure Child mortality incidence rates were derived for children aged 1–14 years for all causes, all injuries, road traffic injuries and unintentional injuries excluding road traffic. Linear regression analysis was applied to measure whether housing or neighbourhood conditions have a significant association with child mortality and whether a strain modified the association between GDP/income inequality and mortality. Results Country-level income inequality and GDP demonstrated a significant association with child mortality for all outcomes. A significant association was also found between housing strain and all child mortality outcomes, but not for neighbourhood strain. Housing strain partially modified the relationship between income inequality and GDP and all child mortality outcomes, with the exception of income inequality and road traffic injury mortality showing full mediation by housing strain. Conclusions Adverse housing conditions are a likely pathway in the country-level association between income inequality and economic GDP and child injury mortality.

Background Burn injuries are a leading cause of premature death worldwide and are largely attributable to poor living conditions. Timely care is a prerequisite to reduce morbidity and mortality and it can be significantly improved by smartphone-based consultation systems. The overall aim of this project is to assess how an mHealth system for acute burn injury care can impact on the delivery of emergency care for burns victims in terms of clinical management. Methods The clinical quality includes assessments of diagnostic accuracy and patient management. Bedside diagnosis or image based diagnosis by burns experts will be used as gold standard. Technology Usability Evaluation Model will be used to assess how the users experience the system. Results A tele-consultation system for acute burn care is currently under implementation in the Western Cape, South Africa. An application (app) is installed on a smartphone located in each of the emergency services of 8 hospitals to transmit visual and textual information between emergency staff at point of care and a network of burns specialists. A stepwise implementation of the system will start in Tanzania in the beginning of 2016. The burn specialists already involved in South Africa will act as experts for Tanzania. The evaluation will build on an evaluation already started in South Africa. The first part of the evaluation will include the hospitals currently using the mHealth system in the Western Cape, South Africa and 2–3 hospitals in Tanzania. The mHealth system and results of the evaluation will be presented at the conference. Conclusions Low cost and timely alternatives to burn injury control are a pressing need in many low- and middle-income settings and countries. This project is a determinant step in that direction and can lead to the implementation of a viable, inclusive, and environment friendly mHealth system.

Background Every year, 1.3 million people are killed and up to 50 million are injured in road traffic accidents worldwide. The burden of road traffic injury has shifted from the premature death to a reduced quality of life (QoL) for those injured, therefore it is important to understand the effect of road traffic injury (RTI) on QoL. We aimed to assess and conclude the current knowledge about the relationship between RTI and QoL. Methods A systematic review of the literature on QoL after an RTI, in both adults and paediatric populations, from 3 databases (Pubmed, PsychInfo and SafetyLit) over the last fourteen years was undertaken. The methodological quality of the studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale. Results Nineteen articles were included and assessed for quality. In general, the QoL scores of those injured were similar to population norms at the first assessment, followed by a drop from the first assessment to the second assessment. The majority of the participants reported an increase of QoL from the second assessment to the third assessment but they never reached the population norms at the last follow-up (range 6 weeks to 2 years). Age, gender, socioeconomic status, injury severity, injury type, and PTSD were associated with poorer QoL. Conclusions The available literature regarding the QoL of persons injured in road traffic accidents is heterogeneous in regards to aims and tools used for assessment. Our review confirmed that independent of how QoL was measured, the overall QoL is significantly reduced after an RTI compared to the general population norms. Persons who are older, of female gender, lower socioeconomic status, diagnosed with PTSD, with more severe injuries or injuries to the lower limbs are more vulnerable to loss of QoL following an RTI compared to other patient groups injured in road traffic accidents.

Background Children are more likely to be accompanied by the age 10 after which their independent mobility increases initially as pedestrian and bicyclists, and later as drivers of motorcycles and four-wheelers. The mobility patterns of children were mostly surveyed in high or upper middle income countries. The aim of this study was to understand the mobility in children to and from school in urban dense lower middle income country. Methods This survey of school children was conducted from September to December 2014 in Karachi, Pakistan. Children in grades 6–10 approximately age 10–14 years from a random sample of 58 schools were interviewed face to face and their parents were interviewed on telephones. Mobility pattern was compared across gender. Results There were 1288 children and 732 parents interviewed. On the day of survey, majority of children reported walking (72%) to schools (58.6% girls’ vs 41.4% boys). Majority of parents (71%) also reported walking as the travel model of children to and from school. There were 22% boys who came to school on their own compared to 16% girls however more girls (30%) were accompanied with someone compared to boys (5.4%). While according to parents 49% of boy children and 29% of girl children were allowed to go school on their own. Less than half (43%) of children were allowed to cross main roads (same ratio of boys and girls). There were three-fourth girls who thought their parents never trust them when they were in road traffic on their own. Conclusions Although walking is the common travel mode of both boys and girls for their schools but parents’ license for mobility varies by sex of the children with more restrictions for girls.

Background All around the world, injuries in childhood have an important impact on individual and population health. Childhood unintentional injuries are a leading cause of death globally among children and young people aged 0–17 years. The latest updates on the Global Burden of Diseases shows that injury is the fourth leading cause of deaths among children below 15 years of age. Child mortality due to injury is a public health problem internationally and in Europe. Socioeconomic position inequalities in childhood injuries are well known, but there is less information on how child mortality by injuries is socially patterned by parental education. There is a need to evaluate published evidence. Methods Using Arksey and O’Malley’s and Levac et al methodological frameworks for scoping review methodology as a guide, our scoping review of published literature begins by searching several databases: PubMed, Scopus, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and the Educational Resources Information Centre (ERIC) and web of science. A possible research question will be: What is known from the existing literature about the effect of parental education on childhood injuries? The scoping review will consider all study designs including qualitative and quantitative methodologies. Bibliographic data and abstract content will be collected and analysed using a tool developed iteratively by the research team. Results This study will provide a broad overview of the research literature specific to differences in socioeconomic inequalities in childhood injuries, measured by parental educational attainment. Potential gaps in the research on the possible effect of parental education on childhood injuries will be identified, and thus, the results will inform future research directions. Conclusions The findings of this scoping review protocol will be used to determine the evidence coming from the research literature about the relationship and influence of parental education (mother and/or father education) in the frequency of childhood injuries. We will disseminate our findings through the presentation in the 12th World Safety Conference, as well as through articles published to generate key messages most relevant.

Background Gender differences have been reported both in exposure to and outcome of burn injuries. Whereas the general gender distribution of burns is relatively well known, few studies have examined gender differences in incidence and management of burns for different burn mechanisms in sub-Saharan Africa. Methods The study is cross sectional and based on case reports of patients seeking care for a burn injury at Emergency Centres in eight health care facilities in the Western Cape Province, South Africa between June 2012 and May 2013 (n = 1915). Gender specific incidence rates were compiled for age groups 0–4, 5–9, 10–14, 15–19, 20–54 and 55+. Differences in proportions in men and women were examined for AIS, length of stay and disposition. All analyses were stratified by burn mechanism. Results Children 0–4 years have the highest incidence of burns with boys and girls relatively equally affected. Gender differences in burn incidence are found in ages 20 years and older. Men 55 years and older have a higher risk compared to women for hot liquid burns whereas men aged 20–54 have a higher risk of fire burns. While no gender differences in children are observed in injury management, adult men are significantly more transferred than women (all burn mechanisms aggregated) while women with both hot liquid and fire burns are treated as outpatients to a higher extent. No gender difference in AIS or length of stay are found among adults. Conclusions Even though burn incidence is highest among children, gender differences in burn incidence and management are mainly visible in adults. Results about men being transferred and women treated as outpatients to a higher extent in spite of similar AIS raise the question of hidden gender biases in the healthcare.

Background In 2010 more than half of road traffic injury (RTI) deaths occurred to pedestrians, bicyclists and motorcyclists defined as vulnerable road users (VRUs). Lower middle income countries account for the highest proportion of VRU deaths. The distribution of RTI burden by road user type in children globally, regionally and by income levels is unclear. To investigate country-level changes over time in global child RTI deaths among VRUs and non-VRUs with respect to region, economy between 1990 and 2013 Methods Country-level data were extracted from the Global Burden of Disease study, split into seven geographical regions and four income levels (low-income [LICs], lower-middle [LMICs], upper-middle [UMICs] and high-income [HICs]). Death rates and percent change in rates between 1990 and 2013 were calculated for road users aggregated, and independently for VRUs and non-VRUs. Results Child RTI death rates decreased globally, by region and across all country economic categories between 1990 and 2013 (a global average of 32% reduction in RTI death rates from 1990 to 2013 and a range of 28% (LICs)−54%(HICs). Reductions were also found for both VRUs (35%) and non-VRUs (25%) except in LICs where a 16% increase arose among non–VRUs. This applies particularly to those LICs from South Asia (26%). Death rates of VRUs (35%) in the LMICs of Sub –Saharan Africa also reported increments. For VRUs, the decrease was more than twice higher in HICs (58%) and LICs (44%) compared to UMICs (20%) or LMICs (23%). Conclusions The distribution of RTI death varies across different economic categories and regions of the world by road user type.

Background The relationship between lower economic level and high injury rates in children is well established, but less is known about how development measures shape child injury inequalities, especially in low- and middle-income countries. The aim of this study is to assess the strength of the relationship between child injury mortality rates and existing country level development measures in Sub-Saharan Africa and South Asia, the two regions with the highest child injury mortality rates globay. Methods This was an ecological, cross-sectional country level study in 54 countries comprising the Sub-Saharan Africa and South Asia region participating in the Global Burden of Disease (GBD) project. The outcome measure was injury mortality rates per 100,000 for the 1–14 age group calculated from the GBD 2013, 2000, 1990. Country level measures chosen to reflect the core domains of development relevant to child well-being (economy/socioeconomic status, governance and human rights) were extracted from the World Bank Open Database, the Institute for Economics and Peace and the Economist Intelligence Unit. Pearson’s correlation coefficient was used to examine the association between development measures and all injuries/unintentional/intentional child mortality rates for both regions combined in 2013. Injury mortality rates were then presented for each region in 1990, 2000 and 2013. Results Development variables that showed significant correlation with unintentional injury mortality included: Democracy Index, improved water source for the rural population, infant mortality rate, under-5 mortality rate, maternal mortality rate, life expectancy at birth and private prepaid plans. None correlated with intentional injuries. There was a decrease in all injury and unintentional mortality rates for both regions from 1990 to 2013; intentional rates increased 1990 to 2000 and are now (2013) decreasing again. Conclusion Injury mortality rates declined overall in both regions from 1990 to 2013 but within and between regional differences exist and must be addressed in order to reduce child injury inequality on a global scale; further research is needed to improve our understanding of how development affects these rates.

Introduction Severe burn injuries require timely medical attention at an appropriate level of care. Correct referral of patients with burns depends on accurate estimation of injury severity. This study aims to determine how often patients at a trauma unit in a large referral hospital in South Africa are referred to the Burn Unit according the guidelines for burn referrals. Methods Patients presenting with a burn injury to the trauma unit at the Red Cross War Memorial Children’s Hospital (RXH) during a 7-months period were included in the study. Patient medical records were studied and compared to the Western Cape Guidelines for referral of patients with burns to determine the number of patients that met the criteria, as well as the number who did not meet the criteria. Result In total, 702 patients were included in the study. The most common reasons for referral were patients “under two years of age”, and “burns to special areas”. Out of the 702 patients that were seen at the trauma unit, 499 were transferred to the burns unit. Out of the 499 patients who were referred, 94% met the criteria for referral. Out of the patients who were not referred to the burns unit, 80% also met the criteria for referral. This group of patients differed in that they had significantly smaller burns compared to those who were referred. Conclusion The data suggests that most patients were referred according to the guidelines, with a potential over-triage in very few cases. However, a large numbers of patients met the criteria for referral but were not transferred to the burns unit. These burns were mostly minor burns that likely did not require specialist care. In conclusion, while referral guidelines do catch the patients that need referral, they also catch many that do not need referral.

Background Oman has one of the highest road traffic fatality rates in the world. Speeding behaviour has been recognised as one of the most important risk factor in fatal road traffic crashes (RTCs) in the Sultanate of Oman in the year 2011. The aim of this study was to identify factors that are associated with self-reported speeding behaviour based on the Theory of Planned Behaviour (TPB). Methods The study was cross sectional. A total of 1800 Omani male drivers in the age range of 17–45 years were recruited during March 2013 from directorate of vehicle registration using systematic random sampling technique based on their seat number. A questionnaire was developed and used to collect data concerning socio-demographic characteristics, driving behaviour, driving history and the subscales of TPB. The questionnaire was assessed for validity and reliability. Multivariate logistic regression was used to examine the association between the constructs of TPB and speeding behaviour. Results The response rate was 71.4%. The mean age was 29 ± 6.6 (mean ± standard deviation) years. Only 14% (n = 174) of the drivers reported that they never or very rarely exceeded the speed limit when given the chance. The drivers with younger age, having children, high monthly income, having motoring and speeding offences were more likely to speed compared to other drivers. The odds of speeding among those who said their speed was “much faster” compared to other drivers was 4.7 (Odds Ratio (OR) = 4.7, 95% CI: 1.6, 13.8). Around 46% of the sample had got speeding offences. Speeding behaviour is significantly predicted by attitude and subjective norms. Speeding behaviour is significantly predicted by intention to respect the speed limits (OR = 0.72, 95% CI: 0.72, 0.76) and by attitude, subjective norms and perceived behavioural control. Conclusions Speeding behaviour is common among male Omani drivers and the TPB can be used to understand the factors associated with it.

Background The increasing number of older road users represents a public health issue because older individuals are more susceptible to traffic injury and mortality than the general population. This study investigated the association between socio-demographic factors and traffic injury and traffic mortality for the general population and among older road users in Japan. Methods An ecological study was conducted using national data in Japan. Multivariate regression methods were applied to investigate the association of traffic injury and traffic mortality for the general population and among older road users with significant demographic, economic, road traffic, and medical/cultural factors. Results Income per capita, total road length, and alcohol consumption per person were significantly associated with traffic injury and traffic mortality both for the general population and among older road users in Japan. Income per capita and alcohol consumption per person were negatively associated with traffic mortality for both groups. Meanwhile, for both groups, income per capita was positively associated with traffic injury, while total road length and alcohol consumption per person were negatively associated with traffic injury. Conclusions The effects of socio-demographic factors on traffic injury and traffic mortality in Japan were similar for both the general population and older road users. The study results suggest that injury preventive measures designed for the general population will be beneficial also for older road users in Japan.

Background Sweden has had a restrictive alcohol policy, but there are gender and geographical differences in alcohol consumption and injury rates within the country. Whether and how the Swedish alcohol environment influences gender differences in injuries in young people is still unclear. Thus, the aim of this study was to analyse the associations between the local alcohol environment and age- and gender-specific nonfatal injury rates in people up to 24 years in Sweden. Methods The local alcohol environment from 14 municipalities was studied using indicators of alcohol access, alcohol consumption and alcohol-related crimes. A comprehensive health care register of nonfatal injuries was used to estimate mean annual rates of nonfatal injuries by gender and age group (2000–2005). Pearson’s correlation coefficients were used to analyse linear associations. Results Associations were shown for both alcohol access and alcohol consumption with injury rates in boys aged 13–17 years; no other associations were observed between alcohol access or per capita alcohol consumption and nonfatal childhood injuries. The prevalence of crimes against alcohol laws was associated with injury rates in children of both genders aged 6–17 years. Conclusions This study found no strong area-level associations between alcohol and age and gender specific nonfatal injuries in young people. Further, the strength of the area-level associations varied by age, gender and type of indicator used to study the local alcohol environment.

Background: Injuries are the major cause of death and disability in European children. This study explored socioeconomic and gender structures in association with nonfatal childhood injury rates by sex and age groups in Sweden. Methods: Six indicators of socioeconomic structure and three indicators of gender structure were combined using principal component analysis. Sex- and age-specific mean annual injury rates of fourteen Swedish municipalities were estimated (2000–2005). The associations were analysed with Pearson’s correlation coefficients. Results: Narrow gender ratio in unskilled occupations and in politics was positively associated with injuries in girls 6–17 years (r ≥ 0.7) and with fractures in boys 6–12 years of age (r = 0.5). Wider income distribution was negatively associated (r ≥ -0.4) with boys’ injuries and positively associated with fractures in girls 13–17 years (r = 0.5). Relative wealth and male manager dominance was negatively associated with injuries in children 0–5 years (r = -0.4). Relative poverty was not associated with nonfatal childhood injuries. Conclusions: The strength of the associations between socioeconomic and gender structures and nonfatal childhood injury rates varied by sex, age group and type of injury. Childhood injury preventive interventions should consider the local gender structure, area-level wealth and area-level income distribution, and not only area-level poverty.

Injuries are a leading public health problem for children worldwide, with the majority of disability and death occurring in low- and middle-income settings. In sub-Saharan Africa (SSA), injuries ha...

Background Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in low- and middle-income countries (LMICs) with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. Methods A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. Results Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1) administration and organization, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organizations, (6) laypeople and (7) infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. Conclusions Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process.

Background Children's independent mobility differs between groups of adolescents, but knowledge is lacking on how mobility-limiting factors interact. This study explores the association between factors that can affect young adolescents' mobility, searching for typical patterns within a geographical area where mobility is both relatively high and promoted (in this case Stockholm County, Sweden). An additional question is how clusters of limiting factors and demographic attributes relate to active commuting to school. Methods A sample of 7th grade students (ca 13-14 years old) in Stockholm County, Sweden, answered a survey (n = 1008). A cluster analysis was performed on variables descriptive of the respondents and of potential limitations to their independent mobility, such as fears, coping, traffic situation in the neighbourhood and parent/child opinions on mobility (18 variables and 50 categories). Active commuting to/from school was compared using proportion (with 95% confidence intervals) by cluster. Results Five consistent and distinct clusters were identified. Among the most discriminating factors were fears experienced in the neighbourhood, strategies to cope with fear, type of housing and traffic environment. Girls were over-represented in the two clusters most typical of respondents experiencing fears (either several of these or darkness in particular) and boys in two others where housing (house vs. apartment) and neighbourhood conditions played a more determinant role. The proportion of active commuting among respondents was quite similar over clusters but was nonetheless higher in the cluster (over girls) reporting more fears and other factors limiting mobility. Conclusions Whereas fears - and coping - are more typical of adolescent girls in the formation of the clusters, household and neighbourhood characteristics are more typical of boys. Broadly speaking, there seem to be two groups of girls with fears but these differ based on types of fear, ways of coping with fear and their living conditions. The association between the limitations to mobility and active commuting is unclear, the latter being higher among those disclosing a broader range of limiting factors, including fears.

Hervé Kuendig1, Lucie Laflamme2, Gerhard Gmel1, Jean-Bernard Daeppen3, Marie Hasselberg21Addiction Info Switzerland, Research Institute, Lausanne, Switzerland; 2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 3Alcohol Treatment Center, Lausanne University Hospital, Lausanne, SwitzerlandPurpose: To investigate how prior-to-injury and usual alcohol consumption relate to time of injury.Patients and methods: The associations between injury time of day and day of week and prior-to-injury (labeled as “acute”) alcohol intake and hazardous usual alcohol consumption (considered from the point of view of both heavy episodic drinking [HED] and risky volumes of consumption) are assessed using interview data from a randomized sample of 486 injured patients treated in a Swiss emergency department (ED; Lausanne University Hospital).Results: Acute consumption was associated with both injury time of day and day of week, HED with day of week only, and risky volume with none.Conclusions: Acute consumption and HED, but not risky volume of consumption, show specific time distributions for injuries. These findings highlight the potential importance of considering the time dimension of an injury when providing emergency care and have additional implications for interventions aimed at influencing the alcohol consumption of injured patients presenting to the ED.Keywords: acute alcohol consumption, volume of consumption, heavy episodic drinking, trauma patients

Background: Child injury mortality and morbidity are a public health concern in European countries and data are scarce. Cross-national efforts are needed to identify high-risk groups, follow trends and assist in establishing European-wide safety legislation. This study investigates fatal child injuries in the home, as compared to those in transport in European countries. Methods: Injury mortality was extracted from the World Health Organization Mortality Database for the years 2002–04. The mortality rate per 100 000 population was calculated by age group for 16 contributing countries, grouped by their economic level of development. Results: Fatal home injuries were highest in children under 5 years of age and then sharply decreased, as opposed to road traffic injuries, which increased with age. The majority of the upper-middle-economy countries tended to have higher home injury incidence rates compared to the high-income countries. The top five injury causes all countries aggregated were drowning/submersion, thermal injuries, poisoning, falls and homicide, all of which account for almost 90% of home injury deaths. Conclusion: Home injuries were the leading cause of injury death in children under 5 years of age in the countries under study and the inequalities found among the countries indicate potential for improvement. Evidence-based interventions exist to prevent these injuries and the barriers to their implementation ought to be determined and addressed.

Injuries are one of the major causes of both death and social inequalities in health in children. This paper reviews and reflects on two decades of empirical studies (1990 to 2009) published in the peer-reviewed medical and public health literature on socioeconomic disparities as regards the five main causes of childhood unintentional injuries (i.e., traffic, drowning, poisoning, burns, falls). Studies have been conducted at both area and individual levels, the bulk of which deal with road traffic, burn, and fall injuries. As a whole and for each injury cause separately, their results support the notion that low socioeconomic status is greatly detrimental to child safety but not in all instances and settings. In light of variations between causes and, within causes, between settings and countries, it is emphasized that the prevention of inequities in child safety requires not only that proximal risk factors of injuries be tackled but also remote and fundamental ones inherent to poverty.

BACKGROUND: Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran. METHODS: This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities. RESULTS: RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country. CONCLUSIONS: The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.

Children's independent everyday mobility can be hindered by fears experienced in their neighborhood. The aim of this study is to assess the prevalence and determinants of such fears among boys and girls in early adolescence, a period when individual freedom is expected to be on the increase. A sample of 7th grade students (age-13 years) in Stockholm County, Sweden, during 2005/06 answered a survey in class (n = 1,008). The relation that gender, housing, family characteristics, individual and peer negative experiences in the neighborhood, parental licensing, and length of stay in the neighborhood have with fear disclosure was assessed through multivariate logistic regression. A total of 60% of the girls and 40% of the boys reported experiencing fears in their neighborhood. Gender differences were significant for all of the most common fears, in particular darkness. When respondents or their friends had been chased, hit, or had something taken from them in their neighborhood, they were more likely to report fear (OR girls 2.3; 95% CI 1.6-4.5; boys 2.8; 95% CI 1.9-4.2). For girls, having one or more parents born outside Sweden was associated with fear. Boys nearly three times more often reported fear if (a) they thought their parents were negative toward adolescent independent mobility in the evening, or (b) they had lived longer than one year in their area. Many young adolescents admitted to experiencing fear in their neighborhood. Fears were more common among girls, and the types and determinants of fear seem to be gender specific. Language: en

Objective: To investigate the relationship between usual and acute alcohol consumption among injured patients and, when combined, how they covary with other injury attributes. Methods: Data from a randomised sample of 486 injured patients interviewed in an emergency department (Lausanne University Hospital, Switzerland) were analysed using the χ 2 test for independence and cluster analysis. Results: Acute alcohol consumption (24.7%) was associated with usual drinking and particularly with high volumes of consumption. Six injury clusters were identified. Over-representations of acute consumption were found in a cluster typical of injuries sustained through interpersonal violence and in another formed by miscellaneous circumstances. A third cluster, typical of sports injuries, was linked to a group of frequent heavy episodic drinkers (without acute consumption). Conclusions: Among injured patients, acute alcohol consumption is common and associated with usual drinking. Acute and/or usual consumption form part of some, but not all, injury clusters.

BACKGROUND:: Acute alcohol consumption has been reported to be an important risk factor for injury, but clear scientific evidence on issues such as injury type is not available. The present study aims to improve the knowledge of the importance of alcohol consumption as an injury determinant with regards to two dimensions of the type of injury, namely the nature and the body region involved. METHODS:: Risk relationships between two injury type components and acute alcohol use were estimated through multinomial and logistic regression models based on data from 7,529 patients-among whom 3,682 had injury diagnoses-gathered in a Swiss emergency department. RESULTS:: Depending on the type of injury, between 31.1% and 48.7% of casualties report alcohol use before emergency department attendance. The multinomial regression models show that even low alcohol levels are consistently associated with nearly all natures of injury and body regions. A persistent dose-response effect between alcohol levels and risk associations was observed for almost all injury types. CONCLUSIONS:: The results highlight the importance and consistency of the risk association between low and moderate levels of acute alcohol consumption and all types of injury. None of the body regions and natures of injury could pride on absence of association between alcohol and injury. Public health, prevention, and care implications are considered. Language: en

OBJECTIVES: The study examines the relationship between country of birth, socioeconomic position, and the risk of being injured as a young car driver. METHODS: The study consists of a nationwide follow-up of young people in Sweden in which individual census records on country of birth and household socioeconomic position were linked to the Hospital Discharge Register so as to identify subjects' road traffic injuries (RTIs) as car drivers. Multivariate analyses were conducted using Cox regression, with hospital admission due to RTI as car driver as the dependent variable. RESULTS: There are no significant differences in injury risks between foreign-born and Swedish-born drivers, but clear socioeconomic differences were found. Young drivers from manual worker families have 80% higher risk for RTIs compared to drivers in families with salaried employee parents (RR 1.83, CI 1.63-2.05). CONCLUSIONS: The results do not support the idea that type of country of origin constitutes a significant marker of risk level for RTI as novice car driver. On the other hand, the results reconfirm that, in Sweden, the risk of RTI among young drivers from different socioeconomic backgrounds varies. Language: en

In many developing urban settings, economic growth and motorization are coupled with increasing rates of road traffic injuries (RTIs). By highlighting typical sites and circumstances at/in which car crashes occur, more specific targets for prevention can be identified. The study is based on police data for a 1-year period and covers the Chaoyang District, the biggest district of Beijing City. Focus is placed on crash patterns and their distribution by types of road and areas. Both fatal and non-fatal crashes are considered (n=754). In the main, the crashes occurred in relatively favorable driving circumstances (e.g., sunny weather, flat and straight roads, asphalted roads, and good traffic signals and road markings). They were also quite evenly distributed over time of day, day of week and season. Five crash patterns were highlighted, of which three were strongly associated with specific areas and four with specific types of road. The study supports the idea that type of road and RTI severity or pattern are closely related. It contributes to the development of context-relevant prevention measures aimed at reducing road crashes and minimizing their consequences and also supports safe planning of the road traffic environment.

The study examines whether there are socioeconomic differences among young motorcycle drivers (aged 16-25) involved in road-traffic injuries with regard to age and injury severity.Nationwide retrospective register-based cohort study.Subjects born in 1970-1972 were extracted from the Swedish Population and Housing Census of 1985 (n = 334,070). Individual records from the 1985 census were linked to police-reported data and hospital-based data for the period 1988-1995 on the basis of a search for each subject's first registered road-traffic injury as a motorcycle driver (n = 2034). Information on household socioeconomic group was taken from the Swedish census of 1985. Two categories of crash severity were analysed (minor injury and severe/fatal injury), based on assessments of the police and according to length of hospitalization.Incidence of motorcycle injury varies considerably according to age of driver, reaching a peak at the age of 17. The greatest differences in injury risk between socioeconomic groups are present when their members are aged 17-19. At the age of 18, subjects belonging to low socioeconomic positions run a risk of injury occurrence 2.5 times higher than those belonging to the highest socioeconomic category. Young drivers in lower socioeconomic groups have higher odds for both minor and severe injuries than their counterparts in the highest socioeconomic group, but there is no further increase for the latter.The study demonstrates how crucial the first years of driving are in relation to injury, and how wide the gap is in terms of socioeconomic differences at these ages, suggesting that this is the most appropriate time for intervention.

The study examines whether there are socioeconomic differences between young adult car drivers involved in road-traffic crashes with regard to crash-injury severity and crash circumstances. Differences in social patterning based on socioeconomic position (SEP) of origin and of destination, and also the effect of gender, are considered. Subjects born in 1970-1972 were extracted from the Swedish Population and Housing Census of 1985 (n = 329,716). Individual records from the 1985 census were linked to road-traffic data for the period 1988-2000 on the basis of a search for each subject's first police-registered road-traffic crash as a car driver (n = 12,502). Information on household socioeconomic group was taken from the census of 1985, and data on completed education at age 28-30 were gathered from Sweden's Register of Education. Two categories of crash severity were analysed (minor/no injury and severe/fatal injury), and also five crash circumstances (based on a classification of five crash descriptors). Both crash severity and crash circumstances are unequally distributed across social groups among young adult drivers. Social patterning is more pronounced for severe injuries/fatalities, and is consistently so across crash circumstances depending on SEP of destination, particularly for males. Socioeconomic differences are more pronounced for crash circumstances characterised as front-on and overtaking collisions and for single-vehicle crashes (43% of total crashes). In conclusion,the excess risk of young drivers from lower socioeconomic groups is consistent over crash severity but more pronounced as severity increases and for certain crash circumstances.

The aim of this study is to explore the manner in which different measures of original socioeconomic position (SEP) influence road traffic injuries (RTIs) among young car drivers in Sweden. The study consists of young people age 16-23. Subjects were taken from the Swedish Population and Housing Census of 1990 (n=727,995), and followed up by a search for cases of injury to car drivers in Sweden's National Hospital Discharge Register over the years 1991-96 (n=1,599). Household SEP was measured using social class, education, and disposable income. Relative risks were estimated by Poisson regression and population attributable risks were computed for each measure of SEP. Children of unskilled workers, of the self-employed, and of farmers, as well as children of parents with compulsory education only showed an increased risk of injury as car drivers compared to children in the highest socioeconomic group and children of highly educated parents. By contrast, level of household disposable income was found not to vary with RTI among young drivers. Twenty-five percent of the injuries could be avoided if all young people had the injury rate of the highest socioeconomic group, and 29% if all young people had the injury rate of those with highly educated parents. The reduction of risk differences based on household SEP calls for consideration of factors related to both differential exposure and differential susceptibility, which may be addressed in driver education.

Problem and Objective Studies focusing on the socioeconomic distribution of fall injuries among children are few and show mixed results. Previous studies are mainly area-based and no studies have investigated the relationship between family socioeconomic position and subgroups of fall injuries. The current study examines whether socioeconomic position affect the risk of having fall related injuries of different types. Method This population-based cohort study links Swedish national register data for a cohort of 1 544 047 individuals born between 1977 and 1991. Individual records from the 1985 census were linked to the National Hospital Discharge Register for the period 1998–2004. Fall injuries requiring hospitalisation were recorded (n=38 529). Logistic regressions were used to measure the effect (odd ratios) of socio-economic position on eight subgroups of fall injuries (based on external codes, ICD-10). Results An analysis of all types of fall aggregated (W00-W19) showed no significant differences between young people from different socioeconomic groups. However, analyses of subgroups of falls showed that children of manual workers had significant higher odds of having injuries related to falls from playground equipment (OR 1.35 (1.21 to 1.50), stairs (OR 1.48, CI 1.30 to 1.69), trees (1.36 (1.17 to 1.58) and falls from buildings (OR 1.38 CI 1.18 to 1.60). On the other hand, children in lower socioeconomic groups had significantly lower odds for sport related falls compared to children of parents who are intermediate- and high level salaried employees. Conclusion This study indicates that when falls are split into subgroups the effect of low socioeconomic position can be both protective and aggravating.

Objectives To determine the predicting effect on youth suicide of prior episodes of injuries of various intent (ie, inter-personal and self-directed violence, unintentional and undetermined intent) and the extent to which any association is influenced by family socioeconomic status. Methods A nationwide register-based cohort study was conducted covering all Swedish subjects born between January 1977 and December 1991 (N=1 616 342, male/female ratio=105). The cohort subjects were followed up from January 1998 to December 2003, when aged 726 years. Poisson regression and the likelihood ratio test (CI 95%) were used to assess the age-adjusted effect of hospitalisation for injuries of various intents on youth suicide and its effect once adjusted for family sociodemographic and social circumstances. Results Each set of exposures independently and significantly predicted suicide mortality. Being hospitalised for self-inflicted injuries or injuries of undetermined intent was associated with a risk of suicide 36–47 times that of subjects never hospitalised in the period under study (95% CI 28.36 to 45.58 and CI 26.67 to 83.87 for self-inflicted injuries and for events of undetermined intent, respectively; overall p Conclusion Youth suicide is predictable not only by prior suicide attempts but even by prior exposure to injurious assaults and unintentional injuries leading to hospitalisation, regardless of family socioeconomic status.

Background Road traffic crashes are a major cause of death and injury, especially in low and middle-income countries (LMICs). Improvements in prehospital trauma care can help minimise mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in LMICs with a high rate of RTIs such as Iran. The aim of current study was to explore barriers to and potential facilitators for providing effective prehospital trauma care for RTI victims in Iran based on the experience and perception of prehospital trauma care professionals. Methods This study conducted using a grounded theory approach. Participants of the study were 15 prehospital trauma care professionals. The data collected via indepth interviews and were analysed using the constant comparative method. Results Seven categories emerged through data analysis: (1) administration and organisation, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organisations, (6) laypeople and (7) infrastructures. The lack of interaction and common understanding was identified as the core category. Moreover, a conceptual model was developed based on the categories. Conclusions According to the findings, improving the interaction within the current prehospital trauma care system and building a common understanding of the role of the emergency medical services were identified as the key issues for developing an effective prehospital trauma care system in the country.

Objective: Most studies on alcohol as a risk factor for injuries have been mechanism specific, and few have considered several mechanisms simultaneously or reported alcohol-attributable fractions (AAFs)-which was the aim of the current study. Method: Data from 3,592 injured and 3,489 noninjured patients collected between January 2003 and June 2004 in the surgical ward of the emergency department of the Lausanne University Hospital (Switzerland) were analyzed. Four injury mechanisms derived from the International Classification of Diseases, 10th Revision, were considered: transportation-related injuries, falls, exposure to forces and other events, and interpersonal violence. Multinomial logistic regression models were calculated to estimate the risk relationships of different levels of alcohol consumption, using noninjured patients as quasi-controls. The AAFs were then calculated. Results: Risk relationships between injury and acute consumption were found across all mechanisms, commonly resulting in dose-response relationships. Marked differences between mechanisms were observed for relative risks and AAFs, which varied between 15.2% and 33.1% and between 10.1% and 35.9%, depending on the time window of consumption (either 6 hours or 24 hours before injury, respectively). Low and medium levels of alcohol consumption generally were associated with the most AAFs. Conclusions: This study underscores the implications of even low levels of alcohol consumption on the risk of sustaining injuries through any of the mechanisms considered. Substantial AAFs are reported for each mechanism, particularly for injuries resulting from interpersonal violence. Observation of a so-called preventive paradox phenomenon is discussed, and prevention or intervention measures are described. Language: en

STUDY OBJECTIVE—To investigate if there are socioeconomic differences in road traffic injuries among Swedish children and adolescents, and if this applies to the same extent to all categories of road users. To assess the modification effect of gender of child. DESIGN—A closed population-based cohort study based on the Swedish Population and Housing Census of 1985. Individual census records are linked to Sweden's National Hospital Discharge Register (1987-1994). SETTING AND SUBJECTS—All children aged 0-15 years in 1985 (approximately 1.5 million subjects) were monitored for five categories of road traffic injuries over eight years, and divided into seven socioeconomic groups on the basis of parental socioeconomic status. Odds ratios and population attributable risks were computed using the children of intermediate and high level salaried employees as reference group. MAIN RESULTS—The injury risks of pedestrians and bicyclists are 20% to 30% higher among the children of manual workers than those of intermediate and high level salaried employees. Socioeconomic differences are greatest for injuries involving motorised vehicles—that is, moped, motorcycle and car. If all children had the same rate as children in the reference group, the rate for all groups would be 25% lower for moped riders and 37% lower for car drivers. CONCLUSIONS—Socioeconomic differences in road traffic injuries are substantial for both boys and girls. Socioeconomic injury-risk differentials increase when young people use motorised vehicles. Keywords: traffic exposure; injury; health inequality