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Non-suicidal self-injury: Another effective avenue of intervention?

15 Oct, 14 | by Bridie Scott-Parker

The 10th of October is World Mental Health Day, and here in Australia a variety of activities helped ensure that mental health was openly discussed during Mental Health Week (5-12 October). As a researcher who works with adolescents, I am interested in their mental health, particularly as it can have pervasive implications for their injury prevention. I thought I would share an interesting article regarding non-suicidal self-injury (NSSI), an intentional injury which unfortunately has been found to be associated with a breadth of other injuries including suicide.

As part of a larger study exploring how adolescents cope with emotional problems, Voon, Hasking, and Martin (2014) explored the role of a number of variables in NSSI amongst a sample of 41 Australian high schools (Time 1 n = 2637 students; Time 2: 12 months post-baseline, n = 2328; Time 3: 24 months post-baseline n = 1984). Lifetime prevalence of NSSI increased over time (8.1% – 10.1%), with adolescents engaging in NSSI typically starting the behaviour aged 12-14 years. Experiencing more adverse life events and high psychological distress increased the risk of the first episode of NSSI, consistent with other research findings that adolescents respond to acute life stress and emotional distress through NSSI. This suggests that adolescents in these tumultuous states could benefit from NSSI-targeted interventions which could prevent NSSI include cognitive reappraisal in particular.

The ripple effect of such support for adolescents in particular could indeed offer another effective avenue of intervention for a breadth of injuries during the developmental period of adolescence and young adulthood.

Pedestrian safety video worth watching

6 Oct, 14 | by Barry Pless

Ted Miller, editorial board member and famed for much else, kindly sent a link to an excellent youtube video that I urge you to watch. I do so because I have long cautioned that pedestrian signals can be dangerous if you assume that cars will always respect them. I plead with my friends, family, and former patients (I am now retired) to always establish eye contact with drivers before assuming that a green light means it is safe for you to cross. This is especially true for elderly folk like me. But it seems youth in particular are often impatient at crossing lights and this video presents one way to keep them from jumping the light. It is very clever and I hope the strategy will be widely adopted. Even then, however, I still recommend eye contact with the nearest driver before stepping onto the road. The video is here: https://www.youtube.com/watch?v=SB_0vRnkeOk&feature=share

Let me know what you think. Just copy and paste the link into your browser. Thanks Ted.

Youth and injury prevention

28 Sep, 14 | by Bridie Scott-Parker

Today’s blog was inspired by a tragedy on our local railway earlier this week. Unfortunately a man was killed after being run over by a train while he was spraying graffiti. Unfortunately this is not the first such death, and it prompted me to trawl PubMed and ‘see what is out there’.

Researchers, practitioners and policy-makers alike a probably well aware that injury is the leading cause of death for adolescents the world over. A search of PubMed using the terms “graffiti” and “injury prevention” did not yield any articles. However, I came across a pertinent article in the most recent Journal of Trauma Nursing in which Ogilvie, Curtis, Lam, McCloughen, and Foster summarise mortality after major traumatic injury for youth aged 16 to 24 years in the Australian Capital Territory (ACT) during the period July 2007 to June 2012. Cases were extracted from the National Coroners Information System and the ACT Level 1 Trauma Centre registry, and 714 cases met the inclusion criteria.

Road trauma was the most common injury mechanism  (58.4% of cases); with self-inflicted violence accounting for 45.8% of the overall ‘violence’ category. High-risk recreation activities also featured, with the Authors recommending “targeting young people involved in multiple risk behaviors”. This is consistent with the approach for which I regularly advocate, and one which is required if we are going to address the senseless loss of young men as they embark on a potentially-lethal activity like spraying graffiti on and around trains.

 

 

 

 

Different questions for more answers?

19 Sep, 14 | by Bridie Scott-Parker

This week I have been pondering the larger issue. You may wonder what brought this on?

I live in Queensland, the Australian state with the dubious title of ‘skin cancer capital of the world’. I was a child of the 70’s. We spent hours in the sun covered in all sorts of oil that smelled great (coconut especially) to see who could get the darkest tan in the shortest time possible. Sleepovers often involved mutual peeling of large segments of skin, which ended up being some sort of weird Silence-of-the-Lambs-esque trophy. Slip, slop, slap was new, and for the social misfits only.

Needless to say in an era of increased awareness of the considerable skin cancer risks of too much sun exposure, I am very proud of the fact that my children have never been sunburnt. Well, I can no longer say this.

One day this week my 14 year-old son returned from a school field trip redder than a tomato, despite his protestations that yes indeed he did wear his hat (it kept blowing off in the wind at the beach, according to his urgent explanation to his very cross mother) and yes indeed he did wear sunscreen (apparently of SPF1 as he was red red red!). As a child who wears glasses, I was particularly concerned about a long day in which the sun’s UV rays were concentrated into his eyeballs. He (unconvincingly) claimed that he wore his sunglasses all day. Even worse – his maternal grandmother had a particularly nasty and aggressive skin cancer cut from her face just one week earlier, so sun protection is very high on our family’s radar at the moment!

After a lengthy – and at times loud – discussion about the need to look after his skin particularly in our climate, and that now he is growing up he needs to start taking care of his own health (yes, he did agree that having Mum attend the field trips with him would be embarrassing, and yes, it would definitely harm his reputation with the opposite sex), I started to think about injury prevention more generally.

Initially I had tried to identify the predictors of risk as a way to intervene: what about this field trip contributed to him being sunburnt? Like most injury prevention researchers, we want to know what contributes so we can ameliorate or eliminate it altogether. According to him, hat, check; sunscreen, check; sunglasses, check. Then I started to think about it a different way. What about this field trip helped him be less-sunburnt? What protected his classmates from sunburn (if indeed, as I hope, some managed to avoid the sun’s wrath)?

Maybe as injury prevention researchers we should be spending more time considering what helps to minimise risk, not only what increases risk. I think these ‘different questions’ will lead to more answers in the long term. Think big picture!

Medical marijuana laws associated with decreased fatal opioid overdoses in the US

8 Sep, 14 | by gtung

Really interesting paper published by Bachhuber and colleagues recently in JAMA Internal Medicine looking at the association between medical marijuana laws and opioid analgesic overdose in US states from 1999-2010.

http://archinte.jamanetwork.com/article.aspx?articleid=1898878

They found an association between states with medical marijuana laws and decreased fatal opioid overdoses. To be exact, a 24.8% decrease in fatal opioid overdoses in medical marijuana states compared to nonmedical marijuana states. The authors were careful to point out that their analysis did not highlight a potential mechanism of action but they did discuss the potential that the use of medical marijuana to manage pain by those patients that might have otherwise used some or more opioids may have contributed to the decreased overdoses.

The findings from this study are especially interesting given the continued rise of opioid overdose deaths and the ongoing experiment with both medical and recreational marijuana in the United States. Additional research needs to be done in this area including all of the potential impacts (good and bad) of recreational marijuana in what seems inevitably to be the increasing number of states to legalize it.

Children and injury prevention

8 Sep, 14 | by Bridie Scott-Parker

I read an interesting article recently, in which the authors explored the burden of sport- and exercise-related injury in children aged 14 years or less. The frequency, years lived with disability, bed-days, and direct hospital costs were explored for  non-fatally injured, hospital-treated children treated in a private or public hospital in Victoria (Australia) over a seven-year period. Finch, Wong Shee, & Clapperton (see http://bmjopen.bmj.com/content/4/7/e005043.full) note a significant increase in the burden of injury, including a 29% increase in injury over the seven-year timeframe.

Whilst personally I have reservations regarding the authors’ approach of comparing the burden of traffic-related injuries during the same period (related to my belief that injury prevention researchers can inadvertently ‘muddy’ the injury prevention burden and thus intervention focus, particularly when it may appear to those outside of injury prevention that the injury mechanisms, and therefore the injury prevention social and financial resources, are in ‘competition’ with each other; and, unrelatedly, exposure to each mechanism of injury could not be determined), some interesting findings were drawn. For example, traffic-related injury fell by 26% during the same period, with sports injury accounting for three times as many years lived with disability, 1.9 times as many hospital-bed days; and 2.6 times as much hospital costs.

I particularly liked the statement, as noted by the authors,  that “When non-fatal disability resulting from injuries is taken into consideration along with the mortality burden, injuries are shown to be an even more important health problem.” Whilst obtaining accurate records regarding injury can be problematic (including but not limited to accuracy and completeness of information, linkages of databases, and non/specificity of injury mechanisms), it is only with these figures do we have an understanding of the nature and magnitude of any injury. This information is of utmost importance for effective intervention.

Engagement appears the key

25 Aug, 14 | by Bridie Scott-Parker

Regular readers of the Injury Prevention blog will be well aware with my obsession with engagement. Traditionally, injury prevention – such as in road safety – focuses on the “Three E’s” of Engineering, Enforcement, and Education. I think that Engagement is the fourth, often-forgotten, essential “E”, albeit it can be very tricky to actually manage, and manage effectively.

I was interested to read the engagement experiences of a team of Australian colleagues who trialled an online injury surveillance program in 78 community sports clubs in five football leagues (see http://www.injepijournal.com/content/1/1/19). I have previously blogged regarding injuries in sports such as football, and in particular related to concussion, and this and similar contact sports continue to be of interest to injury prevention researchers, practitioners, and policy-makers. As such, community-based injury surveillance can help everyone from persons in injury prevention to those actually on the sports field. While Ekegren et al note that 44% of the 78 clubs targeted for the intervention actually adopted the program, overall only 23% of the clubs implemented the program by recording injuries in the online program in 2012, and 9% maintained the program by recording injuries in 2013.

Barriers included personal factors like a lack of importance being placed on injury surveillance; socio-contextual factors such as staff shortages/changes, injury underreporting, lack of leadership/support for reporting injuries; and system factors included technical issues, data requirements, time to input data, and adjusting to a new online reporting system. Notwithstanding these barriers, facilitators include recognition that injury surveillance is important and is part of the trainer’s role (personal factors); association with a simultaneous injury prevention program (socio-contextual factors); and ease of use (system factors).

Engagement to reduce barriers and maximise benefits appears essential, and expertise and guidance in engagement appears to be a definite need in the realm of injury prevention across all domains of injury. In my own area of young driver road safety, I and others struggle to engage one key partner: parents. Perhaps learnings from one domain can help other domains, and information sharing is vital.

Texting laws reduce traffic fatalities

7 Aug, 14 | by gtung

Quick post here to highlight a nice study authored by Alva O. Ferdinand and colleagues at the University of Alabama at Birmingham that examined the impact of state texting laws on motor vehicle fatalities in the United States. I came away with two important findings from the study. First, primary enforcement (which means that officers can stop someone for only texting) texting bans were associated with a 3% decrease in traffic fatalities. Second, primary texting laws targeting teens were associated with an 11% decrease in traffic fatalities in that group. Given the tremendous variation that exists among the US states, including many states that have no texting restriction, this study provides important evidence to advance these laws. Links to the study and related media coverage below.

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.301894

http://www.washingtonpost.com/blogs/govbeat/wp/2014/08/01/texting-bans-work-they-cut-teen-traffic-deaths-by-11-percent-study-finds/

Domestic violence

4 Aug, 14 | by Bridie Scott-Parker

Blog readers are well aware of my passion for conferences – the immeasurable benefits that can arise from presenting, networking, developing and maintaining collaborations, and sparking ideas, just to name a few. So today I won’t talk at length about the wonderful experiences I had last month as I spoke at a conference in Paris, then at another conference in Krakow. I will talk, however, about domestic violence.

Whilst in Europe, I had no idea that a verdict had been handed down in a local murder trial which has grabbed our attention since the victim’s disappearance more than two years ago (see http://www.brisbanetimes.com.au/queensland/gerard-badenclay-found-guilty-of-murdering-wife-allison-badenclay-20140715-ztdon.html). I also had no idea of the insidious nature of the domestic violence, inflicted upon the victim, which emerged during the trial and has insipired a variety of responses including efforts to start a dialogue around the unacceptability of domestic violence  (eg., see http://www.couriermail.com.au/news/queensland/tragedy-of-allison-badenclay-inspires-cousin-to-set-up-online-antidomestic-violence-site/story-fnihsrf2-1227006310512?nk=e46ae81c51bf6c72de6319e37bb46706).

It is easy to lay blame and cast judgement in such circumstances. Some will lay blame at the perpetrator’s feet. Others will lay blame at the victim’s feet. Hindsight is frequently 20/20, and laying blame may not help those in a similar situation. Rather, is there a way we can break the victim/perpetrator dynamic by understanding the victim’s perspective, with the ultimate goal of supporting the victim to extricate themselves from this situation?

A recent article by Taket, O’Doherty, Valpied, and Hegarty (see http://www.ncbi.nlm.nih.gov/pubmed/24925714) summarised the interview responses of 254 women who had experienced intimate partner violence. Interestingly, as noted by the authors, “The sample of women was extremely diverse in terms of their experience of abuse, including those still actively working to improve the relationship; those who were staying in the relationship and could not see how it could change; those working to stay safe in the relationship while they worked out how to leave; those in the process of ending the relationship and sorting out finances, housing, and custody of children (if applicable); and those who had ended the relationship but were still experiencing abuse and/or were dealing with the physical or psychological effects of abuse.” Participants shared a range of experiences and advice relating to what they value – and do not value – from their family and friends, including instrumental, informational, emotional and companionship support.

I was particularly touched by their concluding statement: “Notably, women value both support that is directly related to abuse and support related to other areas of life.” How can I help?

Gangs, Violence, and a Flood of Migrant Children

11 Jul, 14 | by gtung

There has been a tremendous amount of media attention in the United States on what is described as a flood of migrant children illegally crossing the US-Mexico border. Statistics referenced in a recent NPR article estimate that more than 50,000 unaccompanied children have been detained by US border patrol in the last eight months.

http://www.npr.org/2014/06/20/323657817/from-a-stream-to-a-flood-migrant-kids-overwhelm-u-s-border-agents

Much of the US media coverage has also emphasized a belief of migrant children and their families that they can receive political asylum or that there are other mechanisms in place that will allow them to stay in the US once they cross. What is also starting to get more media attention are the factors pushing migrant children to take the risk of traveling long distances alone in hopes of making it into the US. A recent New York Times article does a nice job of describing the fear of gangs and violence in some Central American cities and the role it plays as a driver of the recent flood of migrant children to the US border.

http://www.nytimes.com/2014/07/10/world/americas/fleeing-gangs-children-head-to-us-border.html?src=xps

The severity of the gang and violence problem portrayed in some Central American cities in the NYT article is shocking with some city blocks described as empty and other significant internal displacement because of gangs. I can understand taking the risks of trying to make it into the US if faced with these issues. What is less clear to me is what should be done to address the gang issues that are pushing so many children to leave their homes. And then there is the heated and ongoing debate in the US about what steps if any the US should take in responding to the issue.

Greg

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