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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

Hot ash burns – are we making progress?

6 Jul, 14 | by Bridie Scott-Parker

One of the best parts of being able to blog for Injury Prevention is being able to reflect upon my own experiences (personal and professional) as I learn about the research of other injury prevention researchers. I suppose today’s blog has left me feeling a little frustrated, however, that maybe we aren’t making as much progress as we could be.

This morning I came across a paper summarising the hot-ash burns experience of 50 children in Western Australia in 2011 and 2012 (see the research of Martin, Rea, McWilliams, and Wood at http://www.ncbi.nlm.nih.gov/pubmed/24280525), and this immediately led to the resurfacing of a memory from my own childhood.

As a young child (I was maybe five or six years old) I was shocked to hear that one of my friends, neighbours and best playmates had been seriously hurt during a camping holiday with her family. They had been camping, and just like every previous camping holiday, she had walked through the sand at the beach with her older brothers. The problem was that this sand was used to put out the fire which was used to cook the family’s dinner the previous night. Next day, it was if the fire hadn’t been extinguished in any way, and she sustained very serious burns to her feet.

that examined the exact same problem (eg., http://www.ncbi.nlm.nih.gov/pubmed/18182906; http://www.ncbi.nlm.nih.gov/pubmed/18789590), and made similar injury prevention recommendations.

More needs to be done if we are going to gain traction in the prevention of hot ash burns in our most vulnerable, our children.

The Benefits of Aggressive Play

27 Jun, 14 | by gtung

Is aggressive play or roughhousing something that models and facilitates violent behavior or are there benefits and if so, what are those benefits? A recently story on NPR summarizes some of the research that highlights the potential benefits of roughhousing , even forms that involve pretend violence.

http://www.npr.org/blogs/ed/2014/06/25/325218402/what-kids-can-learn-from-a-water-balloon-fight

I found the reported potential benefits of roughhousing fascinating. To get a more comprehensive list you will have to read the article and the literature but two that really got me thinking where that aggressive play and roughhousing (1) helps children learn how to resolve conflicts and regulate aggressive impulses and (2) is associated with higher first-grade academic achievement in kindergarteners.

My understanding of what might be driving some of the benefits of aggressive play (synthesized from the article) is that it creates an environment where children have to navigate complex, dynamic, and fast moving and conflict ridden social situations while regulating their own emotions.  It makes sense to me that there might be many benefits from this.

The question is where is the line (or is there a line) where this type of play, especially pretend violence, might facilitate more violent behavior in real life?

Data linkage: overcoming a potential injury prevention obstacle

23 Jun, 14 | by Bridie Scott-Parker

I am not an expert in data linkage, nor am I up to the challenge of linking various data sources, however I am acutely aware that NOT linking data is a huge obstacle for injury prevention. Without the base information which is provided by data linkage, we (and by we I am referring not only to my injury prevention researchers, practitioners and policy-maker colleagues; I am also referring to politicians, the media and others who state ‘the facts’ and control the research funds) struggle to gain accurate insight into the injury we are all working to prevent.

However, data linkage is not as simple as merging two data files (although, having said that, merging two data files is not always straightforward either!). For the uninitiated, there are a number of approaches which can be used, each with their own advantages and disadvantages. Irrespective of the data linkage method utilised, there may be additional problems which relate to the quality of the data linked, such as data completeness, accuracy and scope.

Not only are there problems in linking data files, and difficulties related to the data itself, there are also pitfalls and perils associated with actually accessing the data files. Researchers must traverse the tricky waters that are the essential paperwork of Human Research Ethics Committees. With the exception of a National Ethics Application Form, virtually every Australian injury-prevention-related institution (research and medical) uses their own Ethics form(s) and has their own mandates regarding the Ethics and research practice and process.

I hope you are not disheartened by the story so far…. Indeed, to help place the potential data linkage obstacle in perspective, Mitchell, Cameron and Bambach discuss these various issues in detail in their recent publication “Data linkage for injury surveillance and research in Australia: perils, pitfalls and potential” (see http://www.ncbi.nlm.nih.gov/pubmed/24890486).  The authors close with a recommendation for “better accessibility and use of existing data collections for injury research” as vital steps in our injury prevention pathways.

Injury prevention and the musician

16 Jun, 14 | by Bridie Scott-Parker

It doesn’t seem right that something so beautiful as music can cause terrible, enduring pain for the creator.

Miss Imogen Scott-Parker preparing for a concert

Miss Imogen Scott-Parker preparing for a concert

Sharing my home with an aspiring concert pianist (a busy young lady who has also spent years studying violin, harp, and classical voice) means I have seen first hand just what can happen through overuse, incorrect practice, or simply through not knowing what the consequences may be. She has also shared stories of the pain experienced by fellow musicians as they commit themselves – quite vigorously at times – to perfecting their craft. Such injuries can have devastating, long-term consequences, with permanent conditions meaning a change in career may not be a choice, rather the only option.

My daughter commenced her tertiary studies this year, and pleasingly one of her classes covered how to practice ‘smart’, so that less time was spent fixing more problems, thus minimising exposure to potential injury. If injured, the students were advised to cease practice immediately and to notify teachers of any discomfort and pain in particular. Students were also provided with contact details for a physiotherapist who specialises in music-related injury management.

Consistent with this advice, my daughter mentioned to her instrumental teacher that she was experiencing pain whilst practising certain pieces of music for lengthy periods. Her teacher strongly counselled her to immediately cease all practice, including typing (which is fundamentally the same movements as playing a piano), and allow her wrists, her thumbs, and her little fingers time to recuperate. Her teacher is mindful that she has relatively small, young hands (she is 15 years old) and is playing quite challenging repertoire.

Given my first-hand exposure to the realm of injury in music, I had a look through some recent publications. If you are interested, here are some interesting papers: Rickert, Barrett and Ackermann have produced a two-part series exploring injury in the orchestral environment (see http://www.ncbi.nlm.nih.gov/pubmed/24337034 ; http://www.ncbi.nlm.nih.gov/pubmed/24925177); Chan, Driscoll, & Ackermann examined the usefulness of triage services for professional orchestral musicians (http://www.ncbi.nlm.nih.gov/pubmed/23506482); and the reframing of the injury-prevention issue of likening musicians to athletes was an interesting read (http://www.ncbi.nlm.nih.gov/pubmed/24225525).

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