Injury Prevention最新文献

Background: Fall prevention interventions delivered by specially trained emergency medical services (EMS) clinicians in the homes of patients at high risk for falls have been shown to prevent recurrent falls. However, the cost of implementing this 'community EMS' approach to fall prevention is a barrier to widespread adoption. The objective of this study was to assess whether a community EMS fall prevention intervention results in overall cost savings for the healthcare system.

Methods: We performed a cost-effectiveness analysis using a decision-tree model of possible outcomes after an index fall in a simulated population of community-dwelling adults aged ≥65 over a 1-year time horizon. Transition probabilities and costs were obtained through literature review. The intervention, delivered in patients' homes by specialised EMS clinicians, consisted of environmental modifications, fall prevention education, referral to occupational and physical therapy, and coordination with the patient's primary care physician. We compared the mean healthcare expenditures per patient among those receiving and not receiving the fall prevention intervention.

Results: The intervention would result in a net cost savings of $964 per patient compared with no intervention, with an incremental cost-effectiveness ratio of -$22 174 per fall prevented (lower cost and more effective). Holding other variables constant, the programme would remain cost-saving if the effectiveness decreased to a 26% reduction in falls or the programme cost increased to $1634 per patient.

Conclusions: In this economic modelling analysis, a multifactorial fall prevention intervention delivered by community EMS was cost saving to the healthcare system. Healthcare payors should provide financial support and reimbursement for these programmes.

Objectives: To predict beachgoer decision to enter the water at a high-energy surf beach, in southwest France.

Methods: We built a unique multidisciplinary database combining data collected by an on-site beachgoers survey, weather stations, marine buoys and tidal reconstruction. Human, weather and meteocean factors were considered as potentially predictive of beachgoer behaviour. We employed a logistic regression analysis to predict beachgoers' decision to enter the water on any given day at a high-energy recreational beach.

Results: We demonstrated that both environmental and human factors influence a beachgoer's decision to enter the water. Daily mean wave height and daily mean insolation duration were significant predictors at the p<0.001 level, while age, place of residence and self-confidence in swimming out of a rip current were significant at the p<0.05 level or higher. Beachgoers were more likely to enter the water on sunny days with lower waves. Younger individuals, those living outside the Landes département, and those who declared themselves to be 'confident' or 'uncertain' about their ability to swim out of a rip current expressed a higher propensity to enter the water. Our model has an accuracy, F-Score, precision and recall of 71%, 73%, 86%, 79%, respectively.

Conclusions: Beachgoer exposure on any given day can ultimately be predicted by coupling our model with beach attendance models. This would allow for the design of rescue and preventive operations on days with high expected exposure. While models based solely on environmental factors can be used to forecast beach risks, incorporating human factors into the model provides valuable insight for crafting prevention messages. In this regard, lifeguards could engage more actively with beach users to deliver appropriate safety messages.

Background: Rip currents are the leading coastal hazard on Australian beaches and a significant contributor to coastal drowning. This comprehensive study explored the long-term epidemiology and exposure-based mortality rates of Australian rip current drowning deaths, with the purpose of informing rip-related education efforts to reduce coastal drowning risk.

Methods: A retrospective descriptive analysis of rip current drowning deaths between 1 July 2004 and 30 June 2023 was conducted, and rip current involvement was determined using data triangulation methods (incident narrative, beach imagery and expert opinion). Temporal trends were examined using Joinpoint regression, while Australian population and coastal participation data were used to calculate mortality rates.

Results: 407 rip current drowning deaths were identified (21 deaths/year); an exposure-based mortality rate of 0.11/1 million coastal visits. Incidents predominantly involved males (85%), 20-34 years (38%), occurred in regional/remote areas (59%) and in the presence of others (80%). For every rip current drowning death, an estimated 2449 people were rescued by someone else and 8171 individuals self-rescued.

Discussion: Despite small reductions in the rate of rip current drowning among males, little overall progress has been seen in attempts to decrease the mortality burden. Future efforts will require an expanded approach, beyond traditional means.

Conclusions: Rip currents remain a significant public health threat and the number one coastal hazard contributing to preventable mortality along Australia's coastline.

Implications for public health: Improved rip current education approaches, development and evaluation are needed to direct effective messaging to at-risk groups.

Context: Falls from beds are a leading cause of unintentional injuries in infants under 1 year of age. While most cases result in mild outcomes, the potential for severe injuries, such as skull fractures or intracranial haemorrhages, exists. Despite the prevalence of these incidents, no systematic review has focused specifically on injuries from bed falls in this specific age.

Objective: To evaluate the risk and severity of injuries caused by falls from beds in infants under 1 year of age through a systematic review.

Data sources: We searched in PubMed, Embase, Cochrane Library and Lilacs Scielo for studies published between 1984 and December 2024.

Study selection: We included observational studies that reported injuries from falls from beds in infants under 1 year.

Data extraction: We extracted the relevant data from the included study details, recruitment setting, study design, sample size and outcome measures. We conducted a quality assessment using the Newcastle-Ottawa Scale.

Results: Out of 297 initially identified studies, three met inclusion criteria, comprising a total of 2034 infants under 1 year of age. Most falls resulted in minor or no injuries. Warrington et al reported <1% of cases leading to concussion or fractures. Samuel et al identified two cases of intracranial haemorrhage and linear skull fractures without intervention. Kolulu et al observed significant injuries, including skull fractures and cerebral contusions, in 10.2% of infants.

Conclusions: Falls from beds are frequent in infants under 1 year, with most resulting in minor outcomes. However, serious injuries occur in around 5% of infants below 1-year old, emphasising the need for prevention strategies and clinical guidelines for managing post-fall assessments. Further research is required to refine understanding and improve prevention and management practices.

Prospero registration number: CRD42024626255.

Background: Structural weakness may occur within bicycles (eg, during manufacture or impact) and may result in sudden failure and serious injuries. While some indicators of structural weakness may be detected by visual inspection, others require more advanced non-destructive tests. Available research is yet to adequately examine bicycle riders' awareness and experience of the structural weakness in bicycles, or their knowledge and use of testing methods.

Methods: An online cross-section survey of 298 bicycle riders was conducted to address these knowledge gaps.

Results: 11.4% of respondents had experienced at least one crash that they suspected was due partly to structural weakness, with just over half resulting in injury and just under half involving costs greater than $A500. About 25% of respondents had a component replaced because of 'failure during normal use'. More than one third did not think it was necessary to test for indicators or weaknesses when buying a used bicycle, or after a crash. Testing was most likely following motor vehicle collisions and for bicycles with carbon components. Visual inspection was the most reported form of testing and only 42% of respondents reported being aware of any non-destructive methods of testing.

Discussion and conclusions: 11.4% of respondents had experienced at least one crash that they suspected was due partly to structural weakness, with just over half resulting in injury and just under half involving costs greater than $A500. About 25% of respondents had a component replaced because of 'failure during normal use'. More than one-third did not think it was necessary to test for indicators or weaknesses when buying a used bicycle or after a crash. Testing was most likely following motor vehicle collisions and for bicycles with carbon components. Visual inspection was the most reported form of testing, and only 42% of respondents reported being aware of any non-destructive methods of testing.Results suggest that structural weakness in bicycles is fairly common while awareness of the issue, and methods of testing for it, is limited. Public education about when and how to test for weakness (eg, after any crash), and improvement in production standards and quality assurance, may reduce injuries due to bicycle failure.

Background/aims: Understanding how injury mechanisms, demographics and neighbourhood characteristics differ based on injury location can improve data-driven injury prevention efforts. Our objective was to describe the association between mechanism of injury (MOI), patient age, neighbourhood characteristics and home and injury location discordance.

Methods: We performed a retrospective, multicentre study of children transported by emergency medical services to 15 trauma centres in the county trauma registry from 2010 to 2021. Home-injury discordance (discordance between home and injury zip code) and neighbourhood opportunity discordance (more than one level difference across Childhood Opportunity Index (COI) levels) were trended by age and MOI. COI discordance by home COI for each MOI was also explored.

Results: Among 13 020 paediatric traumas, home-injury discordance occurred in 48% of injuries, and was highest in sports/recreation (72%) and motorised travel (69%). COI discordance (27% overall) was frequent in sports/recreation (34%) and rarer in assault (22%). Assault and assault and motorised travel injuries occurred closer to home and with less COI discordance.

Conclusion: Unique patterns of injury risk and COI discordance by home COI level demonstrate that injury prevention efforts may require differential focus on factors affecting residents versus visitors of a neighbourhood depending on the MOI.

Background: Xylazine, a veterinary sedative and analgesic, has emerged as a novel adulterant in the US illicit drug supply, frequently co-occurring with fentanyl. This study examines trends in fentanyl-xylazine overdose death rates from 2018 to 2023.

Methods: This serial cross-sectional study examined death certificates from the CDC WONDER database to identify International Classification of Diseases, 10th Revision codes for overdose deaths likely coinvolving fentanyl (T40.4) and xylazine (T42.7 or T46.5). Crude mortality rates per 100 000 were calculated overall and by sex, race/ethnicity, US Census Divisions and state to examine demographic and geographical trends.

Results: Fentanyl-xylazine deaths increased from 99 in 2018 to 6020 in 2023. Crude mortality rates rose from 0.03 (95% CI 0.02 to 0.04) to 1.80 (95% CI 1.75 to 1.84) per 100 000. In 2023, rates were higher among males than females (2.63 (95% CI 2.55 to 2.71) vs 0.99 (95% CI 0.93 to 1.03) per 100 000), and higher among black than white individuals (3.21 (95% CI 3.04 to 3.38) vs 1.86 (95% CI 1.80 to 1.92) per 100 000). The Middle Atlantic and New England Census Divisions had the highest regional rates at 5.72 (95% CI 5.49 to 5.95) and 4.32 (95% CI 3.99 to 4.65) per 100 000, respectively.

Discussion and conclusions: The sharp increase in fentanyl-xylazine deaths, particularly among black individuals, highlights both the growing infiltration of xylazine into the illicit drug supply and persistent structural disparities in addiction treatment. Addressing this escalating epidemic requires routine toxicological testing for xylazine and expanded access to trauma-informed care, harm reduction services and interventions such as naloxone, opioid agonist therapies and wound care.

Objectives: Work-related injuries are only partially captured for older workers in the USA, likely due to low sensitivity of traditional data sources, such as workers' compensation, to capture non-fatal incidents. Using claims from Medicare, the primary health insurance of most US adults after age 65, we identified and described work-related injuries among Medicare enrollees aged 65 years and older.

Methods: We identified injury claims from 2016 to 2019 Medicare inpatient and outpatient claims for aged 65+ Medicare fee-for-service enrollees. We then identified work-related injury claims using ICD-10-CM external cause codes and employment-related and workers' compensation codes used in Medicare claims processing. We calculated annual rates of work-related injuries among aged 65+ Medicare fee-for-service enrollees. We described demographics, injuries and their mechanisms, and healthcare encounter characteristics of Medicare enrollees with work-related injuries.

Results: From 2016 to 2019, the average annual rate of work-related injuries was 27.6 per 100 000 Medicare fee-for-service enrollees aged 65+. Injury claims were most often for outpatient emergency department (ED) visits (58%), followed by non-ED outpatient visits (20%) and hospitalisations (19%). Falls, transportation and machinery-related mechanisms of injury each accounted for approximately 20% of injuries.

Conclusions: Using the mechanism of injury, employment-related and workers' compensation codes, Medicare claims can be used to identify work-related injuries. Most work-related injuries appear in outpatient settings, although hospitalisations involve the most extensive care. Future research should validate and expand these methods, drawing on the depth of information in Medicare claims data to explore costs and health outcomes of work-related injuries in older populations.

Background: There is a knowledge gap regarding the potential roles that socioeconomic status (SES), race and ethnicity may play in the associations between alcohol use and injury risk. This study aimed to examine these factors as potential effect modifiers in the relationship between heavy episodic drinking (HED) and unintentional injury mortality.

Methods: We used mortality-linked data from the 1997-2018 US National Health Interview Survey. We performed survey-weighted Cox proportional hazards models to evaluate the effect modification of education, income, race and ethnicity on the relationship between the frequency of HED and motor vehicle and other unintentional injuries mortality.

Results: 559 442 participants were included, with 772 motor vehicle fatalities and 2003 other unintentional injury deaths. Our cohort study found no significant interaction effect between SES, race and ethnicity, and HED on motor vehicle fatalities. For other unintentional injury mortality, we identified a significant interaction effect between low education and HED once or more per month (HR 2.75, 95% CI 1.38 to 5.49). Similarly, we found a significant interaction effect between low income and HED once or more per month (HR 1.84, 95% CI 1.02 to 3.34). Finally, both Black and Hispanic participants exhibited a higher risk of other fatal unintentional injuries at varying frequencies of HED compared with White participants.

Conclusions: Our results emphasise the importance of considering SES, race and ethnicity in understanding the complex interplay between alcohol consumption and unintentional injury mortality. Understanding subgroup-specific dynamics is crucial for formulating targeted interventions to address disparities and enhance public health outcomes.

Background: While previous studies have investigated the risk factors contributing to drowning risk-taking behaviours in adolescents, whether peer risk-taking behaviours influence this relationship remains uncertain. This study explored the potential relationship between peer risk-taking behaviours and adolescent drowning risk-taking behaviours while examining whether drowning risk perceptions play a moderating role in this relationship.

Methods: A national survey of 7485 adolescents in China was conducted using three scales: the Drowning Risk-Taking Behaviours scale, the Peer Risk-Taking Behaviours scale and the Drowning Risk Perceptions scale. Pearson's analysis was employed to identify the correlations and hierarchical regression to examine the moderating role of drowning risk perceptions.

Results: Peer risk-taking behaviours promoted adolescent drowning risk-taking behaviours (β=0.428, t=45.384, p<0.001). The interaction between peer risk-taking behaviours and susceptibility to drowning and seriousness of drowning reduced adolescent drowning risk-taking behaviours (β=-0.175, t=-18.576, p<0.001; β=-0.189, t=-20.802, p<0.001, respectively). The interaction between peer risk-taking behaviours and benefits of swimming skills also reduced adolescent drowning risk-taking behaviours (β=-0.227, t=-24.858, p<0.001), whereas the interaction between peer risk-taking behaviours and perceived barriers did not (β=0.012, t=1.242, p>0.05).

Conclusions: Peer risk-taking behaviours are an important risk factor for adolescent drowning risk-taking behaviours, whereas an individual's drowning risk perceptions serve as a protective factor that negatively moderates the relationship between the two.