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Work-related traumatic brain injury

29 Oct, 14 | by Bridie Scott-Parker

Traumatic brain injury (TBI) can occur through various mechanisms, including violence and car crashes, but the mechanism of TBI I am focusing upon today is through a work-related injury. As a wife and mother, I know that I want my husband to return from work at the end of each shift in relatively the same condition as when he left for his shift, albeit a little more grubby! You can understand my alarm, then, as I read an article by Chang, Ruseckaite, Collie and Colantonio which explores the epidemiology of 4186 husbands, wives, mothers, fathers, sisters, brothers, sons, daughters, aunts, uncles, grandparents and grandchildren who did not come home from work in the same state as they went to work.

The Authors examined the TBI workers’ compensation claims during the period 2004-2011 in the Australian state of Victoria, identifying clear gender differences in the experience of TBI. To illustrate, male employees were considerably more likely to sustain a TBI (nearly 64% of claims were male), which may reflect the difference in occupations apparent across the claims (males worked predominantly as tradesmen/technicians, machinery operators/drivers, and labourers; females as professionals/scientific/technical services and community/personal service workers).

TBIs were incurred most commonly by being struck by/against an object (53%), falls (24%), assaults/violence (13%) and car crash (7%), with struck by/against accounting for a greater proportion of female TBI, and assaults/violence and car crashes accounting for a greater proportion of male TBI. Interestingly, most falls for males were found to occur from a height, whilst females were more likely to fall from the same level. Notwithstanding this, the proportion of falls increased for both genders with increasing age. For TBI victims who claimed lost-work-time,  the TBI resulted in an average of 219 days of work disability, at a claim cost of $96,343 on average. Males were more likely to be hospitalised, and for longer, with commensurate greater TBR-associated costs.

What does this mean for intervention? While a gradual downward trend in TMR was observed throughout the measurement period, particularly for males, as a wife with a husband who operates a very large machine and is at risk of a TBI during every work shift, I want to be sure that everything is being done to keep him – and other workers – safe. This means safe policies and practices in government regulations, workplace conditions, company management, and by him and his offsiders. It means regular equipment maintenance, including equipment repair, and the provision of personal protective equipment in addition to fully-functioning guards on the machine and rails on the catwalk. It means reasonable work expectations and management of customer demands, particularly as his company operates 24-hours a day to meet the demands of a 24-hour society. It means support at work, including through risk management and rehabilitation in case of injury. It means responsibility for safety at all levels, from government, to managers, to those on the coalface. It means a culture of safety, not a culture of shifting the blame if something does go wrong and someone is injured. It means learning from the past -for the present and the future – including learning from epidemiological studies such as Chang et al.

Let’s keep our workers safe, and for reasons beyond the negative impact upon the employer’s hip pocket.

 

Taking the good with the bad: bike helmet website

22 Oct, 14 | by Barry Pless

I recently came across a website that managed to be both impressive and depressing. The link is http://www.cycle-helmets.com/index.html

I have no idea how old it is or even, precisely, who is responsible for it. What is impressive is that it includes a massive amount of data on bicycling, bike helmet use, and helmet legislation for several countries, but principally for Australia. Some of the data are presented as graphs and others in tables. The amount of work that must have gone into assembling all this is staggering. I somehow suspect it has not been updated recently but it is still worth a visit if you are looking for any statistics related to these topics.

So why did I find it depressing? Simply because the commentary and text make it clear that all this effort is intended to discredit and oppose helmet legislation. Clearly, nothing I read convinces me that the data well support their opposition but to be fair, this is a far site better than the usual diatribes unsupported by anything remotely ‘scientific’.

For the record, I am not convinced helmet legislation discourages cycling or even if it does, the effect is short-lived. More importantly, as I have argued elsewhere and repeatedly, I am also not convinced that casual cycling, by children or adults, can do much to enhance cardiac fitness or reduce obesity. By casual cycling I mean trips of a few kilometres, by children or adults, to and from school or work, at a pace much slower than racers or couriers. In other words, the kind of recreational bicycling that is typical or average.

But even though I remain unhappy about the goals of this website, I must admit it is well done and exhaustive. And, for the most part, it seems that the data are accurate, even if they are consistently misinterpreted.

PS – At the very end I found this note: 

This website is maintained by Chris Gillham, a print/radio journalist and web designer based in the West Australian capital of Perth.
The site has been on the internet since 2000 and the accuracy of its data has never been challenged by relevant authorities. All information on the site is sourced to academic and government reports.

 

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/

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