Injury Prevention最新文献

Objective: Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesise evidence examining intervention effects of person-focused interventions for risk assessment and prevention in LTCFs in order to identify evidence-based practices in LTCFs.

Methods: We included three databases (Ovid-Medline, CINAHL and EMBASE) to identify original research from 2007 to 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. From the initial search, we identified 988 articles. Following the removal of duplicates, title and abstract screening, and full-text review against inclusion/exclusion criteria, 20 studies remained for analysis. Then, we conducted a narrative synthesis to summarise the included studies.

Results: Identified evidence-based interventions for fall prevention include (1) exercise programmes (eg, high-intensity functional exercise, aerobic exercise, short stick exercises, etc); (2) multifactorial programmes; and (3) other interventions (eg, lavender olfactory stimulation). Outcomes of included studies included the number of falls, fall rate, risk of falls and fear of falls before and after interventions.

Conclusion: Overall, most studies reported significant effects of person-focused interventions in LTCFs. Available evidence supports that well-designed person-focused interventions can reduce falls and fear of falls for individuals in LTCFs.

Background: There is a rising burden of severe and fatal outcomes resulting from button battery exposures (ingestions or insertions). We summarised current evidence following button battery exposures in children and provided pooled prevalence estimates for key clinical characteristics, complications and risk estimates for predictors.

Methods: MEDLINE, Embase and Scopus databases were searched up to 19 May 2023. Included studies described complications of button battery exposures in children aged <18 years and reported prevalence data, an OR estimate or allowed OR calculation. Random effects models were used to estimate pooled estimates and event rates.

Findings: Forty-four articles (3125 children) were included in the analysis. Battery exposures were more common in males (59%) and young children. For ingestions, batteries were most often located in the stomach (43%). Mucosal damage (46%) and oesophageal stricture (10%) were the most common complications. Most (60%) children were asymptomatic at presentation. When symptoms were present, vomiting (26%) and dysphagia (18%) were the most common. Duration of ingestion to removal increased the likelihood of any complication; OR 3.71 (95% CI 1.11 to 12.42) for ≥10 hours and 5.12 (95% CI 1.79 to 14.67) for ≥12 hours. Battery diameter ≥20 mm was associated with any complication OR 4.34 (95% CI 1.16 to 16.27) and oesophageal location OR 18.66 (95% CI 6.99 to 49.82). Death was associated with oesophageal impaction OR 15.52 (95% CI 2.40 to 100.27). For insertions, nasal septal perforation was the most common complication (13%).

Interpretation: Button batteries are a potentially fatal domestic hazard particularly for young children. Increased prevention efforts through safer battery design are needed to mitigate this risk.

Background: Research is scarce on unintentional femur fractures in children under 2 years of age, with many studies focusing on intentional injuries in this age group. This cross-sectional observational study aimed to characterise unintentional femur fractures in very young children evaluated in emergency departments and reported to a nationally representative database involving consumer products.

Methods: Emergency department visits in children with a femur fracture, under 2 years of age, from 2017 to 2021 were queried from the National Electronic Injury Surveillance System. Case narratives were reviewed to assess eligibility criteria and to create novel variables in addition to those included in the dataset.

Results: An estimated 8891 children under age 2 in the USA were treated for femur fractures related to a consumer product or part of the home environment from 2017 through 2021 (95% CI 6900 to 10 881). The highest incidence was during 2020 (2138; 95% CI 1392 to 2883). Femur fractures most often involved furniture (3155; 95% CI 2201 to 4108), while some involved items specifically designed for babies. Falls on stairs contributed to an estimated 1584 femur fractures (95% CI 1031 to 2137), most often when someone fell while carrying the child. More than half of these fractures resulted in hospitalisation.

Conclusion: Caution should be used when leaving babies around certain household items, even those that may seem safe or designed for babies. Stairs and furniture are significant household hazards even before children become mobile.

Background: Too little is known about the effectiveness of efforts to prevent firearm violence. We evaluated California's Armed and Prohibited Persons System (APPS), which identifies legal purchasers of firearms who have become prohibited persons and seeks to recover all firearms and ammunition to which they have access.

Design and methods: This cluster-randomised pragmatic trial was made possible by APPS's expansion from a small pilot to a continuing statewide programme. We included 363 California cities, allocated to early (n=187) or later (n=176) intervention in blocks stratified by region within the state, and within region by population and violent crime rate. The study period began 1 February 2015; region-specific end dates ranged from 1 May 2015 to 1 February 2016. Analysis was on an intention-to-treat, difference-in-difference basis using generalised linear mixed models and generalised estimating equations with robust SEs. The population-level primary outcome measures were monthly city-level counts of firearm-related homicides, robberies and aggravated assaults. The primary model was adjusted for stratification variables; city-level population, population density, socioeconomic status and firearm purchasing; year; and month.

Findings: Allocation groups were well balanced on baseline characteristics and implementation measures. In adjusted models, allocation to early intervention was not associated with statistically significant differences in any primary outcome measure; these findings were robust to multiple sensitivity analyses. There was some heterogeneity across regions.

Conclusions: The APPS intervention directly affects a very small percentage of the population, limiting its potential for population-level effects. Individual-level analyses may provide a better estimate of the intervention's effectiveness.

Trial registration number: NCT02318732.

This essay establishes a conceptual framework to understand how direct, secondar and community exposures to gun violence converge to influence population health. Our framework asserts that persistent gun violence in structurally disadvantaged communities enacts broad consequences for mental, physical and behavioural health, operating as a key driver of racial and socioeconomic health disparities. We discuss the applications of this framework for research and improved data collection with a focus on establishing timely and accurate measures of gun violence alongside individual and community health measures. We then address the policy implications of the framework, emphasising the need for long-term, institutional investment in gun violence prevention and intervention, survivor service provision and evidence-based policies at all levels of government.

Background: Consumer product-related genital injuries in females across all age groups are understudied. Existing research focuses primarily on paediatric populations. We aimed to determine characteristics, trends and predictors of hospitalisation.

Methods: The National Electronic Injury Surveillance System database was queried for female genital injuries from 2013 to 2022. We stratified our population into four age groups (<18, 18-34, 35-54, >54 years). Automated text matching and manual reviews were employed for variable extraction. χ² tests and logistic regression were conducted, accounting for survey design and weights.

Results: 9054 cases representing a national estimate of 252 329 injuries (95% CI 188 059 to 316 599) were identified. Paediatric injuries were most common (61%) and seniors had the highest hospitalisation rates (28%). Falls were common in paediatric (51%) and senior (48%) groups, whereas self-induced and topical application injuries were more frequent among adults aged 18-34 and 35-54. Injuries predominantly involved playground equipment and bicycles in children, razors and massage devices in adults aged 18-34 and 35-54 and household structures in seniors. Hospitalisation increased over the decade from 7% to 9%; significant predictors of hospitalisation were Asian race (OR=3.39, 95% CI 1.83 to 6.30), fractures (OR=7.98, 95% CI 4.85 to 13.1) and urethral injury (OR=3.15, 95% CI 1.30 to 7.63).

Conclusions: Our study identifies distinct patterns in female genital injuries across ages. In the paediatric cohort, injuries are often linked to playgrounds and bicycles. For adults, grooming products are frequently implicated. Seniors commonly suffer injuries from household structures such as bathtubs. These patterns may inform discussions on tailored preventive strategies.

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.

Objective: Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum.

Methods: We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death.

Results: From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment.

Conclusion: Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention.

Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.

Objectives: This study examined trends in the frequencies and rates of deaths associated with unintentional injuries in sport and recreation in Québec, Canada, for the period January 2006-December 2019.

Methods: In this descriptive retrospective study, data were extracted from the database of the Bureau du coroner du Québec. Incidence rates were calculated using participation data from the Étude des blessures subies au cours de la pratique d'activités récréatives et sportives au Québec (ÉBARS) and Canadian census population data. Poisson regression was used to investigate changes in death rates over the 14-year period by estimating incidence rate ratios.

Results: There were 1937 unintentional injury deaths and the population-based death rate was 1.72 per 100 000 person-years. The participation-based rate was 1.40 per 100 000 participant-years, considering the 24 matching activities in both ÉBARS' editions. Using both population-based and participation-based denominators, separate analyses consistently showed declining death rates in non-motorised navigation and cycling. Deaths related to all-terrain vehicles, snowmobiles, swimming, cycling, motorised navigation and non-motorised navigation activities accounted for 80.2% of all deaths. Drowning was documented as a cause of death in 39.3% of all fatalities. Males represented 86.8% of all deaths, with males aged 18-24 years and 65 and over having the highest rates.

Conclusion: The death rates of unintentional injury deaths associated with non-motorised navigation and cycling declined, from January 2006 to December 2019. The characteristics and mechanisms of drowning deaths and fatalities that occurred in activities associated with higher death frequencies and rates need to be further investigated.