Injury Prevention最新文献

Objectives: Older adults living in long-term care facilities (LTCFs) are at high risk for falls. Interventions to prevent falls and fall-related injury in this population may be individual-level or system-focused interventions. However, relatively little attention has been given to research on system-focused interventions. This scoping review seeks to synthesise previous studies on the effects of system-focused interventions for fall prevention in LTCFs.

Methods: We searched Ovid-Medline, CINAHL and Embase databases from 2007 to 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. We conducted a narrative synthesis to summarise findings from the included studies.

Results: In the initial search, 403 studies were identified and underwent title and abstract screening resulting in 116 articles retrieved for full-text review. 20 studies were included in the final data extraction. System-level fall prevention interventions evaluated in LTCFs include (1) multicomponent and multidisciplinary programmes, (2) environmental adaptations, (3) technological adaptations, and (4) staff education and training programmes. 11 out of 17 included quantitative studies reported significant effects of system-focused interventions to reduce falls in LTCFs.

Conclusions: This scoping review reveals the effectiveness of system-level fall prevention strategies in LTCFs. Enhancing training, customising tools and fostering a supportive leadership culture are vital for improving fall prevention practices in LTCFs.

Background: Femoral shaft fractures tend to be rare among children; however, these injuries are the most common major paediatric injuries treated by orthopaedic surgeons. The purpose of this study is to characterise the demographics and mechanisms of femoral injury associated with consumer products in the age group treated with spica casting, children 6 months to 6 years, to identify areas for injury prevention.

Methods: Data from 2012 to 2021 were obtained from the National Electronic Injury Surveillance System maintained by the Consumer Products Safety Commission, documenting emergency department visits for unintentional injuries associated with consumer products. Narrative descriptions were analysed to identify common factors in the injury events such as location, products and mechanisms of action.

Results: From 2012 to 2021, the estimated incidence of femur fractures was 23.5 cases per 100 000 children with no significant difference in yearly frequency. The most common mechanism of injury was a fall with the most frequent fracture sources being bed/bunk beds (16.1%), floor (slips/falls, 9.7%) and trampolines (9.7%). Most fractures occurred at the patient's home (58.4%). The incidence of injury outside of the home and frequency of fractures involving play structures/trampolines increased with age.

Conclusions: The incidence and demographic characteristics of paediatric femur fractures associated with consumer products have remained consistent over the past 10 years. As home was the most common location of fracture, prevention of femur fractures should focus on caregiver education around high-risk sources of fracture (bed, stairs and trampolines) and manufacturers should consider design alternatives that discourage potential misuse.

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.

Objectives: There is a lack of evidence on interventions to improve the safety of cycling use in low- and middle-income countries. We investigated the impact of road design and traffic characteristics on the fatality risk of bicyclists.

Methods: Our study population is the road sites in the peri-urban areas of New Delhi, India. We used a retrospective, population-based case-control study design. We identified 50 case sites (road locations) where a fatal cycle crash had occurred over a 3-year period. For control sites, we intercepted and interviewed three cyclists at each case site, mapped their route to the crash location using Google Maps and selected one random location on each of those routes as controls. We recorded traffic and road design characteristics at the case and control sites. We used a logistic regression model to estimate ORs of site characteristics.

Results: We found a strong effect of the presence of U-turns on the likelihood of a bicycle fatality, with an OR of 4.4 (95% CI 1.8, 11.5). This effect is robust against multiple sensitivity analyses. We found that the volume of cars is associated with an increased likelihood and that of motorcycles with a reduced likelihood of bicycle fatalities.

Conclusions: Our results indicate that the presence of U-turns is a strong risk factor for bicycle fatalities in Delhi. Given the strong evidence of their impact on the safety of bicyclists, their construction should be discontinued in zones of high bicycle presence.

Objectives: Intentional fire or burn-related deaths are rare in the USA compared with some countries, but do occur, and our knowledge of their epidemiology is limited. The objective of this study is to epidemiologically describe fire or burn-related deaths resulting from violence, including victim and suspected perpetrator characteristics and incident circumstances.

Methods: This cross-sectional study uses National Violent Death Reporting System data from 2003 to 2020 to examine violent fire or burn-related deaths among individuals of all ages. Analyses include the following case types: (1) fire or burn-related injuries were immediate, underlying or antecedent cause of death; (2) death resulted from arson; or (3) weapon used was categorised as 'fire or burns'. Precipitating circumstances were examined by manner of death (ie, suicide, homicide or undetermined intent) using χ² tests, with p values of <0.05 indicating statistical significance.

Results: Among 4395 victims, most were male (64.6%), non-Hispanic white (60.8%) and 20-64 years (72.7%). Deaths by suicide were most common (38.9%), followed by homicides (32.6%) and undetermined deaths (28.5%). Current mental health (53.4%) and substance use problems (15.0%) were common among suicide deaths. One-half (49.8%) of homicide deaths were precipitated by another crime and 19.5% were related to intimate partner violence.

Conclusions: The prevalence of mental health and substance use problems among suicide victims underscores the urgency for targeted prevention strategies and timely interventions. Stressors, such as interpersonal conflicts and financial problems, may contribute to fire or burn-related violent deaths.

Background: Every year, thousands of people from Latin America and the Caribbean are migrating to the USA. Policy-makers have argued that US firearms are fuelling violence in these countries and are contributing to migration. The objective of this article is to examine the proportion of immigrants from Latin America and the Caribbean arriving at the US border who have previously been threatened with a firearm. This article further explores sociodemographic factors associated with the likelihood of previous firearm-related threats, whether those threats are associated with post-traumatic stress disorder, as well as the reasons behind those threats.

Methods: Data were obtained from a survey of migrants recruited at the southern US border from March 2022 to August 2023. To be selected, respondents had to be 18 years of age or older, had to speak English or Spanish and come from a Latin American or Caribbean country. We used descriptive statistics and a logistic regression.

Results: We analysed 321 cases. Roughly, 48% of respondents reported previous firearm-related threats. Males and respondents coming from Honduras, Venezuela and El Salvador were more likely to report previous firearm-related threats. There was a strong association between previous firearm-related threats and signs of post-traumatic stress disorder. Most threats occurred during robberies or extortions, but other threats were perpetrated by authorities, to prevent crime reporting, or by intimate partners.

Conclusion: Understanding the violence, particularly firearm-related violence, experienced by those migrating to the USA from Latin America and the Caribbean could help guide policy discussion and actions.

Background: Multiple anonymous reporting systems (ARS) have been implemented to prevent school violence and improve school climate. This study examines the facilitators and barriers to implementation and the role and usability of the Say Something Anonymous Reporting System (SS-ARS).

Methods: 10 qualitative interviews with key staff and administrators from intervention schools in the Miami-Dade County School District were conducted between July and December 2020. Using a thematic framework analysis of interview transcripts, we identified major themes related to the SS-ARS.

Results: Students used the SS-ARS to report issues related to violence, mental health and substance use. The SS-ARS provided training and safe reporting channels, enabling prompt responses from administrators. Successful anonymous reporting system implementation requires ongoing training for students and personnel, a multidisciplinary response team and integration into a comprehensive school safety effort.

Conclusion: Our study highlights key facilitators and barriers to implementing ARS in schools, offering three takeaways for practitioners: (1) include ongoing training for students and personnel, (2) establish a multidisciplinary team to respond to reports and integrate ARS into a comprehensive safety effort and (3) encourage reporting on a range of concerns. Interviews were conducted with school personnel, with findings primarily reflecting their perspectives, thereby limiting the ability to generalise the findings to students. Although conducted in schools within Miami-Dade County, an urban US county, the findings may be relevant for practitioners implementing ARS or similar initiatives in educational settings globally, given the ubiquity of violence and mental health issues among adolescents.

Background: There is consensus on the need and ability to address firearm injury risk in healthcare settings; however, the lack of education for healthcare professionals hinders the implementation of evidence-based firearm injury and mortality prevention strategies. The objectives of this study are to develop, disseminate and evaluate education for team members to facilitate implementation in emergency departments METHOD: Two-tiered education was developed in partnership with stakeholders and disseminated to the healthcare team, covering evidence-based screening and interventions for firearm access and violence risk. The implementation, development and dissemination strategies followed the framework used for systemwide Screening, Brief Intervention and Referral to Treatment implementation for substance use. Team members who screened patients for firearm injury risk received screening education and team members meeting with patients who screened positive received intervention education. Participants completed surveys to evaluate the education and learning objectives.

Results: Across three emergency departments from March 2021 to May 2022, 267 team members completed screening education. Key takeaways reported by 173 participants were how to screen (24.9%), the 5L's of Firearm Safety (19.7%) and the prevalence of firearm injury (11.0%). Participants still had questions about workflow, resources and safety. 34 of 67 (50.7%) intervention education participants completed the postsurvey. 100% were confident they could screen, 79% were confident they could provide brief interventions and 88% were confident their site could implement firearm injury prevention strategies.

Conclusion: Tiered education for firearm injury prevention screening and intervention achieved learning objectives and facilitated programme implementation. Education increased knowledge and confidence regarding firearm injury risk screening and its importance in healthcare settings.

Introduction: In 2021, among all age groups, falls ranked as the third leading cause of unintentional injury death in the USA. Unlike fatal data, which rely on death certificates as the gold standard, there is not a gold standard for non-fatal data. Non-fatal falls data are often based on insurance claims or administrative billing data. The purpose of our study is to compare three claims databases to estimate rates of unintentional fall-related hospitalisations in 2019, the most recent year of available data across the three sources.

Methods: Three databases were used to produce incidence rates of fall-related hospitalisations for the year 2019: (1) Merative MarketScan research databases, (2) Centers for Medicare and Medicaid Services (CMS) data and (3) Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. Inpatient falls were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes. Incidence rates per 100 000 people were then produced across all three datasets by payer type. Unadjusted incidence rate ratios were estimated with corresponding 95% CIs.

Results: There were wide disparities among fall rates between the three datasets by payer type. HCUP had the highest rate of falls among Medicare (1087.6 per 100 000) and commercial enrollees (74.7 per 100 000), while CMS had the highest rates of falls among Medicaid enrollees (148.0 per 100 000).

Conclusions: This study shows wide variation in fall hospitalisation rates based on the claims data used to estimate rates. This study suggests that database selection is an important consideration when determining incidence of non-fatal falls.

Background: Road traffic injuries are the leading cause of death in children. Parents' health literacy (HL) is closely related to child safety, especially for the young children. This study aimed to develop an intervention-oriented parent HL scale: Parents' Health Literacy Scale on Preventing Road Traffic Injuries (PHLS-PRTIs).

Methods: We developed the scale including four parts: (1) definition and conceptualisation of PHLS-PRTIs; (2) domain and item development; (3) instrument construction; and (4) psychometric property validation. 685 parents participated in process of development (n=333) and validation (n=352). Cronbach's α and test-retest correlation were used to assess reliability. Content validity and construct validity were used to assess validity.

Results: The scale consisted of five domains (access, understand, belief, communication and use) and 16 subdomains. The Cronbach's α for each domain and the whole scale was 0.85, 0.70, 0.87, 0.80, 0.79 and 0.85, respectively. The test-retest reliability was acceptable (intraclass correlations >0.70). Content validity was good (item-level content validity index >0.79, average of the scale-level content validity index >0.80, kappa >0.74). For construct validity for domain understand, χ²/df=1.723, p=0.009, standardised root mean square residual (SRMR)=0.0404, root mean square error of approximation (RMSEA)=0.045, Comparative Fit Index (CFI)=0.942, Tucker-Lewis Index (TLI)=0.910; and for the other four domains, χ²/df=1.840, p<0.001, SRMR=0.043, RMSEA=0.049, CFI=0.958, TLI=0.952.

Conclusions: PHLS-PRTIs was developed and validated by a rigorous process, providing a tool for community doctors to measure parents' HL on child road traffic safety and develop targeted health education interventions.