Injury Prevention最新文献

Background: Childhood bullying can result in serious injury. Our objective was to compare bullying victimisation and perpetration of school-aged youth from 2018 to 2022 in different households: foster care, kinship care and birth families. A second objective examined correlations between bullying and adverse childhood experiences, child gender, age and race while stratifying by household type.

Methods: The 2018-2022 samples of the National Surveys of Children's Health were used. Bullying victimisation and perpetration were reported by caregivers and ranged from none, yearly, monthly to weekly or daily. Adversities include parental separation, death or incarceration; witnessing or experiencing violence; living with an adult with a substance problem or severe mental illness; or racial discrimination. Pearson χ² and ordinal logistic regression models were used.

Results: Pre-COVID-19, 69% of foster youth were victimised compared with 44% of kinship and 48% of birth-family youth, and 57% of foster youth perpetrated compared with 21% of kinship and 20% of birth-family youth. During COVID-19, the relative risk of both victimisation and perpetration flipped between groups: 25% of fosters were victimised compared with 34% of both kinship and birth youth, and 24% of fosters perpetrated compared with 35% of kinship and 33% of birth youth. In 2022, younger foster youth were at a higher risk of victimisation and perpetration, while males were at risk of perpetration.

Discussion and conclusions: Foster youth are at high risk for victimisation and perpetration compared with youth living with kinship or birth families. Results indicate that prevention efforts in school settings may be the most effective.

Introduction: A high burden of unintentional fatal drowning has been reported in low- and middle-income countries. However, little is known about unintentional drowning in Indonesia.

Methods: This population-based retrospective cohort study analysed unintentional drowning data for Indonesia sourced from The Global Burden of Disease Study 2019. Estimates of trends, mortality rates, incidence rates, years lived with disability (YLDs) and disability adjusted life years were generated.

Results: A decline in unintentional drowning mortality rates was observed, with an average annual mortality rate of 2.58/100 000. Males were 1.81 (95% CI 1.79 to 1.84) times more likely than females to unintentionally drown. Average annual mortality rates were highest among the under-5 age group (9.67/100 000) and 70 and over (5.71/100 000 for males; 5.14/100 000 for females). Distributions of drowning deaths vary depending on region, with mortality rates higher in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara regions.

Discussion: While a decline in drowning mortality rates in Indonesia was identified between 2005 and 2019, mortality rates for unintentional drowning remained high among children under 5 years, the elderly population and those residing in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara, warranting further focused attention.

Conclusion: A downward trend in the rate of unintentional drowning deaths in Indonesia is observed from 2005 onwards, with risk variation based on age, gender and region. The findings highlight the importance of addressing drowning as a cause of premature mortality and health system burden in Indonesia, including through enhancing drowning data collection systems and identifying drowning risk factors.

Background: Drowning is the leading cause of death among children in rural Bangladesh. While survival swimming for children ages 6 years and above is recommended in low-income and middle-income countries, research into the long-term retention of survival swimming skills is absent.

Methods: The retention of four survival swimming skills, including swimming for 25 m, floating/treading for 30 s, reach rescue skills and throw rescue skills, was observed among those trained under the SwimSafe programme more than 10 years ago. Information about the practice of survival swimming skills among SwimSafe graduates and whether they recommended such lessons for others was also collected through surveys. A multistage sampling strategy was used. Descriptive statistics on the retention of survival swimming skills and other variables and ORs from logistic regression analysis were reported.

Results: A total of 3603 SwimSafe graduates were observed. The retention of swimming and floating/treading skills was 88.4% and 89.7%, respectively, and that of swimming and floating/treading skills combined was 84.2%. While 87.7% of the graduates retained reach rescue skills, the retention of throw rescue skills was lower (71.9%). Approximately 60.6% of the graduates retained all four survival swimming skills. The majority of the graduates (70.3%) rarely practised swimming following graduation. Overall, 61.7% of the graduates recommended other children to learn survival swimming skills.

Conclusion: The majority of the SwimSafe graduates retained swimming and floating/treading skills for over 10 years despite minimal practice. Retention of throw rescue skills was lower. Therefore, refresher training and awareness campaigns focused on survival swimming skills are recommended.

Objectives: There has been extensive debate in the USA as to how laws regulating the carrying of concealed firearms affect crime and public safety. This study examines whether US state laws making it easier for civilians to obtain permits to carry concealed handguns in public increase defensive gun uses against violent threats and attacks in public.

Methods: We used National Crime Victimization Survey data from 39 metropolitan statistical areas (MSAs) in the USA over a 19-year period (1986-2004) to examine whether laws making it easier for civilians to obtain concealed carry permits are linked to higher levels of defensive gun use against violence in public spaces of metropolitan areas. Bivariate χ² tests and multivariate logistic regression models (controlling for actor and situational characteristics) were used with 7196 public incidents to examine whether the likelihood of the victim using a gun against an attacker(s) varied based on the type of concealed carry law in the MSA at the time of the incident.

Results: The prevalence of self-defensive gun use in this sample was not clearly related to the passage of permissive gun carrying laws. Although defensive gun use was more common in MSAs with permissive gun carrying laws, this difference was not consistently related in magnitude or statistical significance to the passage of those laws or the length of time they had been in effect.

Conclusions: Permissive concealed carry permit laws do not produce evident increases in self-defensive gun uses against crime in public locations.

Introduction: Emergency department patients presenting with non-fatal suicidal behaviour face elevated risk of suicide and all-cause mortality, but the extent to which this has changed over time is unknown. This study tracked trends in mortality risks faced by emergency department patients presenting with deliberate self-harm and suicidal ideation in California.

Methods: Using statewide linked emergency department and death data, we estimated 2010-2016 trends in suicide and all-cause mortality among emergency department patients with either deliberate self-harm (n=111 658) or suicidal ideation (n=162 959). We also calculated average annual percent changes in age-adjusted mortality rates and compared these to the general California population.

Results: Deliberate self-harm and suicidal ideation patients' age-adjusted suicide rates decreased by approximately 5% per year during the study period; however, their all-cause mortality trends were flat. In the general California population, suicide rate trends were flat while all-cause mortality slightly declined.

Conclusions: Suicide mortality unexpectedly declined among self-harming and suicidal patients presenting to California emergency departments. Additional research is needed to understand the reasons behind this decline and inform quality improvement efforts for suicide prevention in hospital settings.

Background: In 2020, Maryland had the fourth-highest opioid overdose mortality rate in the USA. We describe substances identified in postmortem toxicology screening and designated as cause of death (COD) for overdose decedents in Maryland, including specific combinations of substances designated as COD.

Methods: We performed a retrospective analysis of N=5442 adult overdose decedents (ie, manner of death unintentional or undetermined) in Maryland between January 2020 and December 2021. Overdose mortality data from the State Unintentional Drug Overdose Reporting System. Substances were categorised into five major categories: opioids, alcohol, psychostimulants, sedative-hypnotics and psychotropic drugs. Opioids were further divided into prescription opioids (eg, oxycodone, methadone, tramadol) and illicit opioids (eg, illicitly manufactured fentanyl (IMF), heroin).

Results: Opioids were present in 93% of cases and designated as COD for 92%. IMF was the predominant opioid designated as COD (82% of cases), whereas heroin was COD in only 3%. Psychostimulants, predominantly cocaine, were present in 48% of cases and designated as COD in 41%. Opioids alone were COD in 39% of cases, opioids and psychostimulants in combination were COD for 27%, followed by opioids and alcohol (9%), opioids, alcohol and psychostimulants (6%), and opioids and sedative-hypnotics (4%).

Conclusions: IMF is, by far, the leading cause of overdose in Maryland. For more than one-quarter of decedents, opioids and psychostimulants in combination were COD. Specific drug combinations have implications for public health surveillance and harm reduction efforts to keep people who use drugs safer from a volatile drug market and potential fatal overdose.

Introduction: This study examined the effectiveness of three physical environmental roadway interventions (enhanced crossings, speed humps, and turn traffic calming) in preventing crashes involving pedestrian and cyclist injury and mortality in New York City.

Methods: We examined crashes that occurred within a 100-foot radius of intervention and control sites from 2015 to 2019. We used a staggered difference-in-difference design to estimate the association between each intervention type and pedestrian and cyclist crash outcomes.

Results: Estimates for enhanced crossings and speed humps included the possibility of no association with crashes, but estimates for turn traffic calming interventions showed reduced odds of crashes involving pedestrian injury by 16% (OR 0.84, 95% CI 0.74 to 0.95) and crashes involving pedestrian fatality by 80% (OR 0.20, 95% CI 0.08 to 0.47). When stratifying by street segment length as a proxy for areas with high speeding risk, turn traffic calming treatments appeared to be most effective at intersections connected to long street segments.

Discussion: Turn traffic calming may substantially reduce crash risks for pedestrians. Municipalities can prioritise this physical environmental intervention, especially at turns near long street segments, as a low-cost intervention with substantial public health impact.

Objectives: To identify risk factors associated with falls in older people in rural China.

Methods: A prospective cohort study was conducted across 27 villages in the rural areas of Ningxia, China. After excluding individuals younger than 60 years, a total of 758 out of the initial 822 participants were ultimately included for the collection of baseline information. Participants were followed up through telephone calls or face-to-face interviews at 3rd, 6th and 12th months following the baseline investigation. The Cox proportional hazards regression model was used to examine risk factors of falls.

Results: A total of 758 participants underwent baseline information surveys, and all samples were included in the Cox model analysis. The study found that being woman (RR=1.879, 95% CI: 1.313 to 2.668), smoking (RR=1.972, 95% CI: 1.238 to 3.143), use of painkillers (RR=1.700, 95% CI: 1.226 to 2.356) and higher systolic blood pressure (SBP) (RR=1.081, 95% CI: 1.013 to 1.154) were associated with higher risk of falls among the elderly in rural China. After excluding those who were lost to follow-up or deceased, 738 participants completed the follow-up. There were 341 men (46.2%) and 397 women (53.8%), with an average age of 66.8±5.0 years. The fall rate in study area was 23.8% during the follow-up period.

Conclusions: The fall rate among the elderly in rural China was higher than other areas. Our findings revealed that being woman, smoking, medication usage, elevated SBP and people with a higher body mass index were risk factors for developing falls.

Introduction: Suicide is a leading cause of death among Native American youth and adolescents in the USA. A myriad of factors have been correlated with risk for suicide ideation (SI)/suicide attempt (SA), including historical trauma; however, accurate measurement of historical trauma has been inconsistent.

Objective: To examine the association of family history of a negative mandatory boarding school experience with SI and SAs.

Methods: An anonymous online survey was conducted with 288 Native youth aged 15-24 years from the Fort Peck Reservation in Montana. Multinomial regression was applied adjusting for other known risk and protective factors of SI and SAs.

Results: Thirty-five percent reported past SAs and 15% reported ideation without prior attempt. Of the 129 (45%) reporting a family history of mandatory boarding school experiences, 28% perceived the experience as positive while 22% as negative. After adjusting for risk and protective factors, both SI and SAs were associated with a family history of negative mandatory boarding school experiences (adjusted OR (AOR)=4.8 and 4.3, respectively) and polydrug use (AOR=3.6 and 2.3). SAs were also associated with post-traumatic stress disorder (AOR=2.6) and depressive symptoms (AOR=3.6).

Conclusion: The association between family history of negative mandatory boarding school experiences and SI and SAs implies that culturally responsive interventions are needed to reduce the intergenerational impacts of historical trauma.