Journal of injury & violence research最新文献

Background: Road Traffic injuries (RTIs) are major global health issues, but they have been neglected. RTIs are multi-faceted in nature and, like many injuries, are costly but preventable. Iran has one of the highest rates of deaths due to traffic accidents among middle-income countries. Hence, there is a need for effective and preventive approaches in road safety management. One of the new approaches to road safety is the Vision Zero. The aim of this study was to design a Vision Zero implementation model in Iran.

Methods: This present study was conducted using the qualitative grounded theory approach. Purposive, snowball and maximum variety sampling were used to select participants. In-depth interviews were used to collect data. Grounded theory method was used to analyze the data using Corbin and Strauss method.

Results: In this study, 19 interviews were conducted with 17 participants. Based on data analysis, a total of 4 main categories and 13 subcategories were obtained. According to the participants, the lead agency was recognized as the core category. Other concepts were categorized as causal conditions, intervening conditions, contextual conditions, action/interaction strategies, and consequences.

Conclusions: Establishing a lead agency with inter-organizational coordination through political support and legislation and changing the approach of road safety can be effective in implementing a Vision Zero. Also, improving the safety attitude of the stakeholders and changing their approach through training and advocacy from various organizations related to road safety is effective in creating a lead agency and implementing a vision zero. In addition, in order to implementation of the model, it is very important to pay attention to the economic, political and ethical underlying factors towards human beings.

Background: Fatigue and drowsiness accidents are more likely to cause serious injuries and fatalities than other accidents. Statistics revealed that 20 to 40 percent of traffic accidents in Iran are due to drivers' fatigue. This study identified the most important factors affecting driver injuries in fatigue and drowsiness accidents.

Methods: The Classification and Regression Tree method (CART) was applied 11,392 drivers were in-volved in fatigue and drowsiness accidents in three provinces of Iran, over the 7 years from 2011-2018. A two-level target variable was used to increase the accuracy of the model. First, dataset in each of three provinces was classified into homogeneous clusters using a two-step clus-tering algorithm. Oversampling method was used for imbalanced accident severity datasets. Then, classification was improved by boosting method.

Results: The classification tree reveals that the month, time of day, collision type, and vehicle type were common factors. Also, driver's age was important in female drivers cluster; the geometry of the place and seat belt/helmet usage were important in urban roads cluster; and area type, road type, road direction, and vehicle factor were important in rural roads cluster. Also, the combination of the CART algorithm with oversampling and boosting increased the accuracy of the models.

Conclusions: The analysis results revealed motorcycles, lack of using a helmet or seat belt, curvy roads, roads with two-way undivided and one-way movement direction increased the injury and death of drivers. Collision with fixed object, run-off-road, overturning, falling, and defective vehicles increased the severity of accidents. Female drivers older than 44 years old have a higher probability of fatality. Identifying the factors affecting the severity of driver injuries in such accidents in each province could assist in determining engineering countermeasures and training educational programs to mitigate these crash severities.

Background: To manage life-threatening conditions and reduce morbidity and mortality, pre-hospital's on-scene decision making is an influential factor. Since pre-hospital's decision making is a challenging process, it is necessary to be identified this process. This study was conducted to explore the model of Iranian emergency medical technicians' decision making in emergency situations.

Methods: This study was applied through grounded theory method using direct field observations and semi-structured interviews. Purposeful sampling with 26 participants including 17 emergency medical technicians including dispatchers, physicians of medical directions, managers and 1 representative for court affairs was performed. Interviews were lasted from October 2018 to July 2019. Corbin and Strauss approach, 2015 (open, axial and selective coding) were used to analyze data.

Results: A paradigm model was developed to explain the relationships among the main categories. Decision making in the context of fear and concern was emerged as the core category. Unclear duties, insufficient authorities and competencies as well as lack of enough decision making's protocols and guidelines were categorized as casual conditions. Other important categories linked to the core category were interactions, feelings and "customer focus approach". Action-interaction strategies were taken by Emergency Medical technicians lead to some negative consequences that can threaten clinical outcome and patient safety.

Conclusions: Based on the finding of this study, Emergency Medical technicians' decision making in the context of fear and concern, as the core concept of this model, lead to decrease in quality of the pre-hospital services, stakeholders' dissatisfaction, hospital emergency units' overload, decrease in reputation of the Emergency Medical Technicians, threat to patient clinical outcome and patient safety. To prevent of these negative consequences, facilitation of the Emergency Medical Technicians' on-scene decision making is recommended.

Background: Beyond alcohol retail establishments, most business and property types receive limited attention in studies of violent crime. We sought to provide a comprehensive examination of which properties experience the most violent crime in a city and how that violence is distributed throughout a city.

Methods: For a large urban city, we merged violent incident data from police reports with municipal tax assessor data from 2012-2017 and tabulated patterns of violent crime for 15 commercial and public property types. To describe outlier establishments, we calculated the proportion of individual parcels within each property-type that experienced more than 5 times the average number of crimes for that property-type and also mapped the 25 parcels with the highest number of violent incidents to explore what proportion of violent crime in these block groups were contributed by the outlier establishments.

Results: While the hotel/lodging property-type experienced the highest number of violent crimes per parcel (2.72), each property-type had outlier establishments experiencing more than 5 times the average number of violent crimes per business. Twelve of 15 property-types (80%) had establishments with more than 10 times the mean number of violent incidents. The 25 parcels with the most violent crime comprised a wide variety of establishments, ranging from a shopping center, grocery store, gas station, motel, public park, vacant lot, public street, office building, transit station, hospital, pharmacy, school, community center, and movie theatre, and were distributed across the city. Eight of the 25 parcels with the highest amount of violent crime, accounted for 50% or more of the violent crime within a 400-meter buffer.

Conclusions: All property-types had outlier establishments experiencing elevated counts of violent crimes. Furthermore, the 25 most violent properties in the city demonstrated remarkable diversity in property-type. Further studies assessing the risk of violent crime among additional property-types may aid in violence prevention.

Background: The purpose of this study was to analyze the co-occurrence of adult and child abuse based on the reports collected from the Polish police and social welfare institutions.

Methods: The study involved data concerning 468 households in Szczecin (Poland) inhabited by children where acts of violence between adults took place. The presented data refer to the years 2012-2103. The data came from so called Blue Card files, i.e. documents issued by the police and social workers in cases of domestic abuse, providing information about its forms, perpetrators, and victims.

Results: Domestic violence usually occurs between spouses and cohabitees (78%). The perpetrator was usually a man (88%). Violence usually lasted from 1 up to 3 years (30.0%). The most common forms of physical abuse against adults and children included pushing (79.5% of adults, 22.4% of children) and hitting (64.7% of adults, 16.6% of children), and psychologically abusive behaviors were mostly insults (91.9% of adults, 27.5% of children) and criticism (79.1% of adults, 21.5% of children). This work has shown that the longer the psychological abuse between adults lasts, the greater probability is that it will also be used against children. Child abuse is also associated with putting up resistance to the police by perpetrators.

Conclusions: Summing up, in households where violence between adults is observed, actions should be taken to prevent violence against children.

Background: The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS).

Methods: This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay.

Results: With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category.

Conclusions: In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

Background: In recent decades, earthquakes, as natural hazards that caused direct effects both on communities and the chemical industry, produced many Natech events. Natech term is utilizing to describe the technological disasters caused by natural hazards. This study was conducted on the emergency evacuation challenges of residential areas adjacent to a refinery near Tehran based on H2S toxic gas release following a possible earthquake scenario.

Methods: This Research was an applied study at two phases in 2020. In the first phase, a review study was conducted to identify the community's previous experiences on emergency evacuation following Natech events. In the second phase, the challenges of emergency evacuation were analyzed based on the scenario of a possible earthquake and gas release from the refinery.

Results: Due to the high seismic vulnerability of structures in the area affected Natech risk, the total Resident population in this area would be affected simultaneously by an earthquake and H2S gas release in concentration 30 ppm as the result of the earthquake impact on chemical facilities. Emergency evacuation would be inevitable. The existing evacuation places are very unsafe and dangerous due to having open spaces. The nearest suitable evacuation places were found in the north direction for more than 38 % of the exposed population and in the east, west, and south direction for more than 61% of them.

Conclusions: The emergency evacuation challenges were discussed in 4 viewpoints, disrupted or interrupted rescue and firefighting operation, unnecessary evacuation, frequent evacuation, and evacuation behavior. The measures such as revising and updating emergency evacuation maps; public informing, training, preparedness; providing protocols and training for operational and therapeutic response teams; and coordination improvement can help resilience increasing to such disasters.

Background: According to the World Health Organization, occupational injuries are significant health issues globally that affect social lives and economic status. This study aimed to assess the situation of occupational injuries in the Kerman province.

Methods: In this cross-sectional study, all occupational injuries registered in the Department of Cooperatives Labor and Social Welfare of Kerman Province were investigated during 2012-2016. Data were retrieved from an institutional database, including the official institutional software reports of Cooperatives Labor and Social Welfare occupational inspectors. The study used ArcGIS 10.3 software to prepare the geographical distribution of the cumulative incidence of occupational injuries on the map for each city. Data were analyzed using SPSS software.

Results: A total of 2228 subjects with a mean age of 34 years and a mean work experience of 4.5years were injured during 5 years. 73.2% of them were married. 96.4% of them were Iranian, and 61.3% had insurance. The most number of injuries occurred in the construction industry, fractures being the typical outcome of the injuries. The most injured organ was the hands. Kerman has the highest number of injuries with 804 cases. Incidence rates ranged was 93 to 138 cases per 100,000 people in 5 years. The highest cumulative incidence rates of accidents occurred in Zarand and Kahnuj, respectively, in 5 years.

Conclusions: Despite the decrease in occupational injuries in recent years, it is a severe problem in Kerman province. Occupational injuries cause irreparable damages to human resources, and it, directly and indirectly, imposes costs for the family and the government. Therefore, considering safety in occupational environments to prevent occupational injuries should be a priority in planning.

Background: Road traffic injuries (RTIs) have been eighth leading cause of death in the world and second leading one Iran in 2018. Every year, a large number of motorcycle RTIs lead to deaths and disabilities due to non-compliance with traffic rules and the traditional design of the streets and routes in Dezful, Iran. This study aims to pursue two goals: identifying the legal and environmental factors affecting motorcycle RTIs, and prioritizing effective strategies in reducing number of motorcycle RTIs in Dezful, Iran.

Methods: A mixed method approach was used in this study. In the qualitative phase, focus group meetings using key informants were used to identify the effective factors and in the quantitative one a matrix was used for prioritizing effective strategies in preventing motorcycle RTIs.

Results: 45 basic codes related to legal factors and 8 basic codes of environmental factors were derived from the focus group meetings. Six main legal factors and 3 main environmental factors were prioritized as the most effective strategies to reduce motorcycle RTIs. The legal factors with the highest score were: making visible: obstacles, motorcycles and pedestrians and motorcyclists using colors and stickers or glossy stickers, further monitoring and training of riders' license issuance schools, seriousness in enforcing the laws and dealing legally and seriously with violators, continuous marking of roads and streets, random check of motorcycle riders' license, and construction of public parking lots in crowded zones. The environmental ones were: identifying places where traffic signs are covered with trees, and reporting through the 137 call center, identifying and reporting shoulderless and hazardous roads by municipality, and Identifying and reporting accident-causing potholes through the 137 call center.

Conclusions: All organizations and stakeholders involved in reducing motorcycle RTIs, should take benefit from different recommendation - i.e. education & awareness, law enforcement and legal actions, environmental actions, collaborations, partnerships, and lobbying, and research.

Background: In the U.S., drowning is a leading cause of death for toddlers. One important layer of protection against submersion injuries and fatalities is parent or caregiver supervision. The aims of this study are to explore current supervisory behavior of caregivers, determine how caregivers view com-mon supervision distractions, like cell phones and grilling, and identify what factors shape the quality of supervision that is given when swimming with their toddler at a swimming pool.

Methods: This cross-sectional study used the MTurk online platform to survey 650 caregivers of toddlers (1-4 yrs old) about their supervision behavior, their drowning knowledge, their perceptions of arm's reach supervision, the water competency of their toddler, and other background information. Regression analysis was used to identify factors that predicted report-ed supervision behavior.

Results: The average supervision behavior score for caregivers indicated an attitude between neutral and disagreement with allowing distractions for themselves while supervising their toddler in a swimming pool. High water safety knowledge and positive perceptions of arm's reach supervision were the biggest predictors of attentive supervision behavior. Having a home pool, higher education level, and believing their toddler had greater water competency were predictive of less attentive supervision behavior.

Conclusions: Results suggest that supervision behavior while toddlers are in a swimming pool may be inade-quate. Low water safety knowledge and attitudes about what constitutes quality supervision are related to pool supervision behavior and changing these may reduce drowning risk. Caregivers should be encouraged to not reduce supervision as their toddlers gain water competency and if they have a home pool.