Injury Prevention最新文献

Background: Americans increasingly perceive that homes with guns are safer than those without, and physician counselling about in-home firearm safety and injury risks occurs infrequently, despite encouragement from major medical organisations (eg, American Medical Association, American Academy of Pediatrics). Safety counselling that does occur may be limited to gun owners at high risk of injury; however, given the increasing rates of first-time gun ownership in the USA, understanding attitudes toward firearms and firearm safety messaging among persons who may become firearm owners is needed to inform and support continued injury prevention efforts.

Methods: Survey data from a cross-section of firearm owners (n=396) and non-owners (n=551) collected in February 2023 was used to examine differences in perceptions about the safety of firearm households, openness toward firearm safety counselling and comfort with law enforcement compared with physician firearm safety discussions.

Results: Over three-quarters of current and possible future gun owners agreed that firearms make homes safer, compared with just over one-third of non-owners. All three groups favoured law enforcement over physicians for firearm safety messengers and were more comfortable speaking with law enforcement than physicians about firearm safety.

Discussion and conclusion: Public health and injury prevention safety counselling that combines messaging from law enforcement and medical perspectives may be similarly accessible for both current firearm owners and those considering owning firearms in the future.

Background: Suicide is a leading cause of death among adolescents, yet most adolescents who report suicidal ideation do not attempt nor die by suicide. To prevent injury and death, it is thus vital to explore factors potentiating the transition from suicidal ideation to suicidal attempt, especially in high-risk groups like sexual and gender minority (SGM) adolescents. Guided by an "ideation-to-action" framework, we explored risk factors for suicide attempt (ie, "painful and provocative experiences") among adolescents reporting suicidal ideation by SGM status.

Methods: Data were drawn from the cross-sectional 2022 Minnesota Student Survey and restricted to 10 561 adolescents reporting past-year suicidal ideation (52.3% SGM; 47.7% non-SGM). Analyses first assessed prevalence of exposure to painful and provocative experiences (ie, non-suicidal self-injury, adverse childhood experiences, bullying) by SGM status. Then, in multivariable logistic regression models, analyses probed associations between these risk factors and past-year suicide attempt.

Results: Among adolescents reporting recent suicidal ideation, a higher proportion of SGM adolescents reported past-year suicide attempt than non-SGM adolescents (26.7% vs 21.6%, respectively). All examined painful and provocative experiences were more commonly reported among SGM adolescents. In analyses restricted to SGM adolescents, non-suicidal self-injury, sexual abuse by a family member, and bullying demonstrated the largest effect sizes of associations with suicide attempt.

Discussion: Guided by an "ideation-to-action" framework, this research identifies risk factors potentiating suicide attempt in SGM adolescents reporting recent suicidal ideation. Structural and clinical interventions focused on mitigating exposure to painful and provocative experiences may help to prevent suicide among SGM adolescents.

Background: Premature graduation to an adult seatbelt is common and detrimental to optimal crash protection. While there is an existing tool (the 5-step test) to support a parent's decision to graduate their child, its effectiveness is unknown. The aim of this study was to evaluate the 5-step test.

Method: A randomised controlled design was used. Participants were parents of children aged 7-12 years. After exposure to information about the 5-step test or control material, participants assessed belt fit in three seating conditions and 'thought aloud' while making their assessment. Seating conditions provided a good, poor and partially good seatbelt fit based on the child's anthropometry. Participants were also assessed on their knowledge of good seatbelt fit criteria.

Results: Participants exposed to the 5-step test (n=18) had significantly improved their knowledge of the criteria required to achieve good seatbelt with, on average, 1.0 higher score in the 6-point assessment (95% CI 0.23 to 1.7, p=0.012) than those in the control group. There was also a greater percentage of participants in this group (44.4% intervention vs 27.8% control) who made accurate decisions about seatbelt fit, but this difference did not reach significance (OR 2.08, 95% CI 0.52 to 8.34).

Conclusion: The results demonstrate that the 5-step test is effective in improving knowledge but are inconclusive about its effectiveness in promoting accurate decision-making. However, the proportion of participants making accurate decisions in the intervention group remained low. This suggests that parents may require greater assistance than what is currently provided.

Introduction: Road injuries are a leading cause of death in the 5-19 age group and pedestrian school children are a key vulnerable group. However, the road crash risks faced by school children in Malawi remain understudied. This study aims to describe and quantify the prevalence.

Methods: We performed an observational study from July to December 2022. Data were collected through a knowledge, attitudes and practices survey, mobility survey, school-zone speed and pedestrian observations and star ratings for schools' assessments in six schools in Blantyre.

Results: We surveyed 2466 students aged 12-16 and conducted safety assessments in the areas around these schools. Among surveyed children, 134 (5.4%) and 732 (29.7%) had been involved in a crash or 'near-miss' in the last 6 months. Receipt of road safety education in the past was not associated with involvement in a crash. 63.4% of vehicle observations were above the standard 30 km/hour safe speed limit, and star ratings from 2 to 5 stars.

Discussion: Despite receipt of road-safety education, road crashes continue to affect students walking to school. Improvement of road markings, signs and pedestrian crossings is a key intervention to improve safety across all schools. Modest infrastructural improvements are required to raise star ratings to at least three in study sites.

Conclusions: Improving road safety for school children in Malawi requires targeted action focusing on ground truth assessments. Enhanced road safety awareness and practices at designated crossings, reduced speeds and improved infrastructure are potential targets.

Background: The International Classification of Disease Injury Severity Score (ICISS) provides an efficient method to determine injury severity in hospitalised injury patients. Injury severity metrics are of particular interest for the tracking of road transport injury rates and trends. The aims of this study were to calculate ICISS using linked morbidity and mortality datasets and to compare predictive ability of various methods and metrics.

Methods: This was a retrospective analysis of Admitted Patient Data Collection records from New South Wales, Australia, linked with mortality data. Using a split sample approach, design data (2008-2014; n=1 035 174 periods of care) was used to derive survival risk ratios and calculate various ICISS scales based on in-hospital death and 3-month death. These scales were applied to testing data (2015-2017; n=575 306). Logistic regression modelling was used to determine model discrimination and calibration.

Results: There were 12 347 (1.19%) in-hospital deaths and 29 275 (2.83%) 3-month deaths in the design data. Model discrimination ranged from acceptable to excellent (area under the curve 0.75-0.88). Serious injury (ICISS≤0.941) rates in the testing data varied, with a range of 10%-31% depending on the methodology. The 'worst injury' ICISS was always superior to 'multiplicative injury' ICISS in model discrimination and calibration.

Conclusions: In-hospital death and 3-month death were used to generate ICISS; the former is recommended for settings with a focus on short-term threat to life, such as in trauma care settings. The 3-month death approach is recommended for outcomes beyond immediate clinical care, such as injury compensation schemes.

Background: Over decades, governments have enacted policies and legislation mandating strategies to reduce the incidence and severity of all-terrain vehicle (ATV)-related injuries. We performed a systematic review to determine the efficacy of laws and policies in reducing these injuries.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 articles from the peer-reviewed literature were systematically selected. Associations between legislation/policy and changes or differences in injury numbers, rates or severity were queried.

Results: Data were available to examine age restrictions or child/youth-directed safety measures, use of helmets and vehicle-specific/engineering policies. Legislating age restrictions was associated with limited paediatric injury reduction in five of nine studies; sustained efficacy may require concurrent socialisation through media or regulated riding environments. Mandated helmet use was associated with reduced ATV-related mortality in five of six studies. However, the concurrent presence of other safety legislation precludes concluding the efficacy of helmet laws, alone. Legislation targeting vehicle design/engineering is limited, as are studies of their efficacy. A US federal decree for large-scale vehicle-related and industry-related changes was associated with a brief but dramatic decrease in ATV-related deaths; this reversed once the decree was lifted.

Conclusions: With the possible exception of helmet legislation, many laws aimed at reducing ATV-related injuries demonstrate little association with actual injury reduction. Most target changing individual behaviours and may be unsuccessful due to personal perceptions of low risk of injury. Enacting policies directed to industry, to address design and engineering interventions that can reduce risk during operation of these products, is more likely to result in substantive and sustained change.

Background: Falls in older age pose a major public health concern, with unclear urban-rural patterns of falls mortality in China. This study examines the trends of late-life falls mortality in urban and rural China over a 35-year period.

Methods: Falls mortality data were sourced from China's National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modelling to estimate age, period and cohort effects on fall-related mortality from 1987 to 2021. Net drift, local drift, longitudinal age curves and period relative risks were also calculated.

Results: The age-standardised falls mortality in older age showed a long-term trend of initial decline prior to 2003, followed by a steep increase thereafter, with notable distinctions between urban and rural patterns. The rise in rural populations, particularly among older males, was more conspicuous. In rural areas, the decline in falls mortality diminished with age, contrary to the urban trend. Falls mortality increased with age in both urban and rural older populations, peaking in the group aged 85-89. The period effect curves of falls mortality in urban and rural areas both approximated a U-shaped pattern while there were minor variations in early cohorts.

Conclusions: China has experienced a consistent rise in late-life falls mortality in recent years. Notably, there are significant urban-rural disparities in age, period and cohort effects of fall-related mortality among older adults. Rural residents, males and older age groups have potential higher fatal-falls risk. Targeted strategies should be implemented to prevent late-life falls.

Background: In 2015, California passed AB 71 to create a state-wide Use of Force Incident Reporting Database (URSUS) to tabulate law enforcement-reported encounters that resulted in serious bodily injury, death or discharge of a firearm. We use these data to analyse encounters that resulted in fatal and non-fatal civilian injuries in California between 2016 and 2021.

Methods: We performed a retrospective review of URSUS from January 2016 to December 2021. The main outcomes were the number of law enforcement encounters that involved civilian serious bodily injury or death and encounter-level characteristics.

Results: URSUS recorded 3677 incidents between 2016 and 2021 resulting in 942 civilian fatalities and 2735 instances of serious civilian injuries. Injury rates were highest for civilians who identified as Hispanic (1.80 injuries per 100 000 population) or black (5.17 injuries per 100 000 population). Injuries involving a firearm were usually fatal (58.9% fatality rate; 1471 injuries), while non-firearm incidents were more likely to result in serious injuries (4.2% fatality rate; 2929 injuries). We did not find statistically significant trends in rates of civilian injuries per 100 000 population.

Conclusion: Rates of law enforcement-related injuries were highest for Hispanic and black civilians in California between 2016 and 2021 and firearm-related injuries were overwhelmingly fatal. The URSUS database represents an important effort by law enforcement agencies to collect information on injuries and fatalities resulting from law enforcement encounters. Given similar databases exist in fewer than half of states, additional legislative efforts are needed to improve systematic national data collection on these encounters.

Background: Suicide remains a major public health problem, and firearms are used in approximately half of all such incidents. This study sought to predict the occurrence of suicide specifically by firearm, as opposed to any other means of suicide, in order to help inform possible life-saving interventions.

Methods: This study involved data from the Minnesota Violent Death Reporting System. Models evaluated whether data beyond basic demographics generated increased prediction accuracy. Models were built using random forests, logistic regression and data imputation. Models were evaluated for prediction accuracy using the area under the curve analysis and for proper calibration.

Results: Results showed that models constructed with social determinants and personal history data led to increased prediction accuracy in comparison to models constructed with basic demographic information only. The study identified an optimised 'top 20' variables model with a 73% chance of correctly discerning relative incident risk for a pair of individuals. Age, height/weight, employment industry/occupation, sex and education level were found to be most highly predictive of firearm suicide in the study's 'top 20' model.

Conclusions: The study demonstrated that the use of a firearm in a death by suicide, as opposed to any other means of suicide, can be reasonably well predicted when an individual's social determinants and personal history are considered. These predictive models could help inform many prevention strategies, such as safe storage practices, background checks for firearm purchases or red flag laws.

Background: The Gun Shop Project aims to reduce firearm suicide and is widely implemented in the USA, yet little is known about the core firearm business practices and behaviours that might contribute to preventing firearm suicide.

Methods: Owners or managers of all firearm businesses identified as participants in Colorado's Gun Shop Project were invited to respond to a questionnaire. Data collection occurred from March to May 2021. Analyses included unweighted descriptive statistics with CIs and Pearson χ² tests for categorical associations.

Results: 54 firearm businesses participated (response rate: 28%). Under half reported practices that are Gun Shop Project core aspects (range: 14%-45%). 22% of businesses frequently engaged customers on the importance of safe firearm storage in suicide prevention while 26% had denied a firearm sale and 14% had assisted with temporary secure storage in the past year with customers perceived to be in suicidal crisis. However, high proportions reported willingness to engage in these behaviours if a customer was in crisis: 74% were willing to refuse a sale of a firearm or ammunition, 70% were willing to discuss temporary secure storage options and 70% were willing to direct customers to mental health services.

Conclusions: This study suggests that efforts to continue educating and involving firearm businesses may have an impact on the adoption of organisational suicide prevention practices and behaviours. Ongoing efforts are needed to understand core components of Gun Shop Project to inform standardised recommendations for effective firearm business practices that prevent firearm suicide.