You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

SAVIR 2015 Workshop

1 Feb, 15 | by Bridie Scott-Parker

The very interesting workshop, Nurturing a Successful Academic/Early Professional Publishing Career, will be held at the SAVIR 2015 conference in New Orleans next month. The workshop will be held from 4.45pm to 6.00pm in the Oak Alley room, Sheraton Hotel.

Why are we holding this workshop? Because academic environments expect early career professionals to publish for their advancement in their career yet many university programs provide limited opportunities to their students to develop these abilities. The aim of this roundtable is to provide such opportunity for students and early career professionals in an informal setting. In this event, students and early career professionals will be able to closely interact and discuss with editors of leading injury research journals on the issues of identifying the right journal for your manuscript, writing informative abstracts, reporting statistical information, and how to address reviewer comments. This session is aimed at enhancing the capacity on improving the writing skills of early career injury researcher.

There will be two parallel roundtable sessions covering issues related to scientific manuscript preparation and publication. Discussions will focus on the following topics: writing informative abstracts,  how to address reviewer comments, how to identify the right journal for your manuscript, tips and suggestions for overcoming writers block, reporting statistical information: do’s and don’ts, and finally some common mistakes that you see made by researchers when publishing.

The roundtables will be limited to a total of 13 and 12 participants including the discussion leaders. The editorial board will consist of Dr. , Injury Prevention; Dr. Linda Degutis, Injury Prevention, Dr. Guohua Li, Injury Epidemiology; Dr. Frederick Rivara, JAMA Pediatrics; and Dr. Shrikant Bangdiwala, International Journal of Injury Control and Safety Promotion.

Don’t miss out – register for the workshop now!

 

All-terrain vehicles: How do we effectively prevent injury with incomplete injury surveillance data?

23 Jan, 15 | by Bridie Scott-Parker

My very first blog – two years ago this month (!) – was on the topic of injuries sustained when using all-terrain vehicles. Growing up in a rural Australia, quad-bikes were a common and viable option to horses when mustering, checking fences, checking water, setting traps, etc. Since moving to the city as a young adult, and now working in a region that is one of our state’s most popular holiday destinations, I see quad-bikes used for recreation rather than for work. The injury risks for the rider remain the same, however, and I personally find myself attuned to any news reports in which a rollover or other crash had occurred (a couple from Queensland in the last couple of weeks: Three riders one bike; Young boy; Lady rider; some inquest discussions).

Yesterday I came across an article which examined the reporting of quad-bike-related injuries in data collections in New South Wales during 2000-2012. Mitchell, Grzebieta, and Rechnitzer used the World Health Organization (WHO) injury surveillance guidelines as their benchmark. None of the five datasets recorded all of the core minimum data items or the core optional data items. With respect to the core minimum data items, only the injured person’s age and sex was consistently reported, with much variation in the recording of core injury characteristics such as the place of occurrence and the nature of the injury.

Further hampering injury prevention efforts, the Authors note a “general lack of information regarding the make, model, and engine sixe of the quad bike, whether any ROPS, attachments, or loads were affixed to the quad bike or whether any objects were being tow3erd by the quad bike….whether the individual was wearing either a helmet or a restraint was not often collected.”

I have blogged many times regarding the need for quality injury surveillance data – I would argue that at this time, certainly in New South Wales, this appears to be lacking. I agree with the Authors’ call for data linkage – here we have five data collections that could complement each other and could tell us the bigger (albeit fractured and possibly still incomplete) picture.

Source: http://en.wikipedia.org/wiki/All-terrain_vehicle

 

The safety hysteric speaks again

15 Jan, 15 | by Barry Pless

In some circles I am regarded as an injury prevention fascist, safety hysteric, protect the children fanatic, a wuss, or worse. This has come about because I consistently push for more prevention and less risk taking. I am not at all convinced that risk-taking is good for child development, as some would have us believe. Nor am I convinced that having a serious injury with possible life-long (if not life-threatening) consequences builds character, or whatever. But I was not the least bit surprised when I recently came across two newspaper accounts one of which challenged these views. I responded to it but not yet to the other.

 

The first was in Canada’s National Post (NP). It was written by its editorial board who were prompted by a municipality’s ban on tobogganing on certain hills. That action was based in part on the work of Dr. Charles Tator, a renown pediatric neurosurgeon and founder of ThinkFirst Canada. Tator’s study revealed huge risks of a ‘catastrophic injury’ from tobogganing. (http://www.tandfonline.com/doi/abs/10.1080/17430437.2011.614787?journalCode=fcss20#.VLapHsZpwyE) To be specific, his research found that over 4 years tobogganing had the fourth highest chance of grave risk, exceeded only by diving, snowmobiling, and parachuting. In that time frame about half of the serious injuries involved the head and one quarter the spine. This placed tobogganing among the most dangerous of all recreational activities. Tator made it clear that he was not suggesting that tobogganing be banned or regulated, but he did urge greater caution.But the lawyers for the municipality fearful of liability suits had other ideas.

 

In contrast to the ill-informed NP editorial board, a wiser and more responsible health reporter, Andre Picard, argued that tobogganers should not have to “pay for ‘liability chill.” He acknowledged that tobogganing is a “high-risk” activity but that the risks can easily be reduced. He added, “What is more difficult to contain is the voracious appetite of personal injury lawyers and the financial fearfulness of cash-strapped municipalities.” He went on to write, “In fact, while helicopter parents and overly cautious public health officials often get blamed when ridiculous bans on tobogganing, road hockey, skateboarding and the like are instituted, the real culprit is a torts system that has lost touch with reality.” As Picard summarized, “risks can be reduced by improving control and better head protection”. Importantly, he also quoted Drs. Tator and Francescutti (former Canadian Medical Association president) who asserted that “municipalities should provide information on how to ride safely rather than block off popular hills”.

 

In contrast, in its infinite wisdom, the National Post editorial that bordered on ridiculing Tator and which encouraged many commentators to contribute their mostly foolish and irresponsible views. (The link to the editorial is http://news.nationalpost.com/2015/01/05/national-post-editorial-board-the-freedom-to-toboggan/) Only a few commentators, (including, ironically, the editors themselves), acknowledged that the community had an obligation to remove dangerous obstacles, etc. I was disgusted with the tone and content of the piece and posted this comment. Undoubtedly, as is true for most letters I write to editors, it will do little except make me feel a bit better.

 

“It is hard to imagine why a supposedly responsible editorial board of a respected paper should ridicule the important message Dr. Tator issued. For the editors to make the comparison with car crashes is entirely inappropriate and ironic because I assume they have no problem with laws that regulate how cars are used! Similarly the comparison with personal responsibility with feeding grizzlies is simply embarrassing. Surely even Post editors would agree that at the very least the community shares the responsibility to prevent injuries of all kinds; that it is not simply up to the individual. That is why grizzlies don’t wander freely and communities notify snowmobilers that lakes are half frozen. This is a disgusting editorial that comes close to ridiculing one of Canada’s leading neurosurgeons and one of the few who makes a huge effort to keep people out of his operating room. Praise, not mockery, is the morally correct response and the editors owe Dr. Tator and their readers a huge apology.”

 

To which “John Smith” (??) wrote: “@barrypless – your angst is what is ridiculous. Are you Dr. Tator’s houseboy? Be thankful for writers and editors that don’t kneel down and kiss the ring of someone with a bit of fame and are willing to question their statements. And yes, it is up to the individual. Grow something in that mansack.”

 

Then, just as I was getting ready to post this blog, I came across a report from the Irish Times based on an editorial in the BMJ that criticized rugby’s “tribal, gladiatorial culture”. (Note: European rugby is not the same as American football). The editorial describes the rugby culture as one that “sees parents, coaches and schools encouraging excessive aggression and playing on when injured.” As the author, a paediatric neurosurgeon, Michael Carter wrote, “Anyone who has spent an hour picking skull fragments out of the contused frontal lobes of a teenage rugby player is entitled to an opinion on the safety of youth rugby.”

 

One possible solution offered by Carter is that the age of contact rugby be increased to 12 years. He noted, however, that a 14-year-old sustained three head injuries in one game and speculated that the increased interest in rugby is related to it becoming a professional sport. That has lead to a preference for hulk-like players. These problems seem similar to those now experienced by the National Football League in the US. Carter called attention to New Zealand’s approach to the issue which entails “teaching people how to play the game safely and correctly. “

 

The BMJ editor, Fiona Godlee, added: “Let’s call the current state of monitoring and prevention of rugby injury in schools what it is: a scandal. It needs urgent remedy before more children and their families suffer the consequences of collective neglect.”

 

My reaction is, “Right on, Fiona!” (although I doubt if more monitoring will help much). To my surprise and pleasure, so far most of the Responses in the BMJ have been supportive and constructive. Eventually, however, I expect we will hear some vociferous ‘risk-is-good’ voices but somehow I doubt that their owners would accept a spinal cord injury if risk-taking continues to be encouraged.

The Missing Link

13 Jan, 15 | by Barry Pless

In the spring of 1988 I had the honour to serve as the Felton Visiting Professor in Melbourne, Australia. Giving 7 or 8 lectures in 5 days while jet-lagged proved to be a huge ordeal and I don’t think I made a great impression. No, that is not entirely accurate: I was a great hit when I gave an after-dinner speech because most of the audience and I were well ‘into our cups’ (inebriated). In spite of my shortcomings, I left Melbourne with many good ideas.

 

One of these was that we needed to create an injury surveillance system in Canada. My motivation was that this would provide a far more accurate picture of the magnitude of the injury problem we faced. Naively, I thought that when ER data were added to mortality data policy makers would be sufficiently impressed to take action. Although this never happened, the creation of that system (later called the Canadian Hospitals Injury Reporting and Prevention Program (or CHIRPP) may have been one of my most noteworthy accomplishments. It began with m the huge task of persuading the federal deputy health minister all of its importance and the need to support it financially, I also had to persuade all the pediatric ER directors that it was a good idea. Part of what sold the idea to both parties was that this would a collaborative effort between industry, the hospitals, and the government.

 

The industry part involved persuading Hewlett Packard Canada (HP) to donate a desktop computer to each of the 10 children’s hospitals to enable data entry at the ER by a coordinator who was paid by Health Canada. At the time HP was the main supplier of mainframe computers for all children’s hospitals so this was not a tough sell. Basically, CHIRPP involved presenting a form to parents of an injured child to complete while they were waiting to be seen. However, the basic idea that made CHIRPP and it’s Australian predecessor (the National Injury Surveillance and Prevention Program) different – and presumably better then other ER-based systems – was the inclusion of a free text field on the forms where parents were asked to describe “what happened”.

 

As the well-publicized launch date drew nearer, I begin running through a mental checklist of all the items that needed to be in place to make the system work as planned and all that could go wrong. About one week before the actual launch, I discovered that there was, in fact, something I had overlooked: a missing link. Can you guess what it was?

 

Here is a hint: remember that everything hinged on parents filling out one side of the carefully designed reporting forms. It’s true that on the reverse side the treating physician was supposed to enter basic details about the injury and treatment but I was not foolish enough to assume that most physicians would actually do so. We foresaw this problem and arranged for this task to be performed by a paid coordinator based on the medical record. Far more critical was ensuring that parents provided the information we needed, especially the open text field describing ‘what happened’. Generally most parents were given the forms but still something was missing. What was it?

 

If you guessed pencils, you deserve a gold star on your workbook. We had wrongly assumed that most parents had a pencil with them. But we did assume that the ER had enough pencils lying around to fill the need and it never occurred to us that many parents would forget to return them. So we needed a large supply on a regular basis.

 

With little time left I managed to persuade Buros Canada – one of the largest pencil suppliers – to donate large numbers of golf pencils to each hospital each month. They agreed but only if all were sent to one address which turned out to be ‘my’ hospital, the Montreal Children’s. We, in turn, somehow managed to distribute them to all the other hospitals. I honestly don’t know or don’t remember how this problem was solved after I was eased out of my position as CHIRPP’s founder, but somehow it was and the system has survived.

 

Last word: No, in case you were wondering,  providing more accurate (i.e., much larger) numbers has still not persuaded politicians to provide appropriate funding for injury prevention in Canada.

Reference: Mackenzie S, Pless IB. CHIRPP: Canada’s principal injury surveillance program. Inj Prev. Sep 1999; 5(3): 208–213.

Surfing and injury prevention

8 Jan, 15 | by Bridie Scott-Parker

As a Queensland-er, I must confess that I feel a little remiss as I cannot surf. In fact, I am pretty sure I would fall off a surfboard on the sand, let alone try and stand on a surfboard in an ever-moving ocean! I appreciate and admire the skills required, however, to not only stand up, but to actually stand up for any period of time. As an injury prevention researcher during the peak of our summer season and annual holidays, I was interested to see a recent publication exploring the nature and magnitude of injuries sustained during surfing. Woodacre, Waydia and Wienand-Barnett summarised the self-reported injuries sustained during 2012 for 130 surfers from the UK. Having seen surfers and surfing incidents first-hand, I was unsurprised to see that head injuries featured most commonly, cuts and lacerations were the most common injury type, and that surfers reported most often colliding with their own boards. My interest was peaked!

A quick Google Scholar search, and I came across a number of other interesting surfing-injury papers that you may also care to read. Nathanson, Haynes and Galanis examined the self-reported injuries sustained by 1348 surfers, again finding that cuts and lacerations were the most common injury type, and that most injuries emerged from collisions with the surfer’s own board. Taylor, Bennett, Carter, Garewal and Finch examined injuries sustained by Victorian surfers, similarly finding that cuts and lacerations were the most common injury type, and collisions with surfboards and other surfers were the main injury mechanism. Taking a different approach, Nathanson, Bird, Dao and Tam-Sing examined the medically-treated injuries sustained during competitive surfing, reporting a 2.4 times greater risk of injury when surfing larger waves and 2.6 times greater risk of injury when surfing over hard surfaces such as rocks and reefs.

So what does this mean for injury prevention? In my case, it means that I won’t be taking up surfing! For those who do surf, however, how can the research findings help keep them safe? Sunshine has suggested a number of treatment options and harm minimisation strategies, such as rubber surfboard nose covers. Woodacre and others acknowledge that helmets – which can prevent serious head injuries – are unlikely to be used by surfers as head injuries are a relatively uncommon occurrence. I am interested to hear other’s experiences, and tips for injury prevention.

Hope for future gun control

28 Dec, 14 | by Barry Pless

Last week was the anniversary of the horrific Newtown shootings. That was when I saw an item on Mother Jones that prompted this posting. That item described the work of Moms Demand Action for Gun Sense in America (MDA). This group was founded after the Newtown massacre and it has had several important victories, largely by following the example of Mothers Against Drunk Driving (MADD). It aims to change the gun culture in America, just as MADD did in the 1980s when driving while intoxicated was still taken for granted. Thirty years ago most Americans saw drunk-driving deaths as “a problem you had to live with.” MADD helped to redefine them as crimes. It put pressure not on political leaders and on the liquor industry by “turning a spotlight on kids who had been killed.”

 

Some years ago I served on the National Board of MADD Canada. Today I am convinced that the strategies MADD used are equally well suited for MDA’s vital mission to bring to bring some sanity to the gun scene in the US. Largely, those strategies focus heavily on the wise use of the media, and nowadays, the web, combining human interest stories with solid statistics. In each case the major focus is politicians and all successes are brought to the attention of the media. MDA now has over 200,00o members, a sizeable war chest, and has joined forces with other influential groups such as Bloomberg’s ‘Mayors Against Illegal Guns.’

 

 So far MDA has persuaded some restaurant chains, internet companies, and retailers to oppose lax gun laws. They must be on the right track because they have elicited strong responses from many gun rights activists. MDA members and leaders have been called “Bloomberg’s whores,” “thugs with jugs,” and far worse. They get menacing phone calls and see violent images posted online.

 

 When Sandy Hook failed to bring about substantial changes in gun laws MDA focused on corporations like Starbucks where guns were being ‘openly carried’. Moms response was to urge members to “#SkipStarbucks” and post pictures of themselves having coffee elsewhere. Starbucks changed its policy after Facebook posts resulted in a petition with over 40,000 signatures. Other similar successes offer hope that large-scale changes in attitude will come before the next massacre.

 

 One experienced Washington lobbyist stated, “Changes to the culture are more important than legal changes in some ways. This sends a message that having guns everywhere makes people uncomfortable, which goes directly against the gun lobby’s agenda—to normalize having them everywhere.”

 

 

 

 

Preventing clothing-related burns in children

16 Dec, 14 | by Bridie Scott-Parker

Burn injuries are dreadful for any person of any age, but arguably they are most horrific for our most vulnerable: children. In Australia as in many other countries, we have mandatory standards which regulate the design and labelling of children’s nightwear. Having grown up in a rural area where we heated our house (our melted marshmallows and burnt our toast) via an open fireplace, I am well aware how quickly clothing can catch fire. Therefore preventing these injuries is of vital importance. To prevent, we must understand, therefore I was pleased to see an interesting article by Harvey, Connolley and Harvey (see http://www.ncbi.nlm.nih.gov/pubmed/25435488).

The authors examined the clothing-burn-related hospitalisation data for the entire state of New South Wales from 1998-2013 inclusively, and report the following clothing-related burn statistics:

* 18% of burns were nightwear-related (despite our mandatory legislation)

* exposure to open flame the most common mechanism (open fire, cooking)

* 25% of clothing-related burn hospitalisations occurred amongst children aged 5-14 years

* nightwear-related burns decreased by approximately 7% per year, compared to other clothing (reduction of approximately 2% per year)

* accelerant use was reported in 27% of cases

Whilst difficulties with coding data in official records were identified, which leads to underestimation of the clothing-related burns burden for all persons, including children, the authors note the reduction in burns as a result of the mandatory legislation introduced in 1987. Further legislative efforts targeting all clothing, and education of parents and extended family members regarding clothing-related burns risk for children is also recommended, and these findings can help us all in our injury prevention efforts as we keep safe over the festive season.

Engagement: The fourth ‘E’ in injury prevention

4 Dec, 14 | by Bridie Scott-Parker

Regular readers of the Injury Prevention blog will know what a keen advocate I am for the fourth ‘E’ in injury prevention: Engagement. I firmly believe that engagement is vital to transforming and translating education, engineering and enforcement efforts into real world advances in injury prevention. I know that in the domain of my own research and injury prevention efforts – young driver road safety – that young drivers want to be engaged with, and talked with, not TALKED AT and TOLD WHAT TO DO. Think about yourself as a teen – did that work with you? Providing such agency is the first sure step in making inroads in their safety, increasing their ownership and investment in injury prevention efforts and outcomes.

So you can understand how pleased I was when I saw a recent Scandinavian Journal of Caring Sciences article by Latimer, Chaboyer, and &Gillespie in which hospital patient perceptions regarding prevention and treatment of pressure injuries were explored. I particularly liked their closing comment that “If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners.”. I would argue that this should be extended to all injury prevention strategies, and that patient/target participation should not only be considered, it should be an essential component.

 

High school start and finish times

26 Nov, 14 | by Bridie Scott-Parker

High school start and finish times can be a controversial topic! A quick search of school start and finish times in Queensland, Australia, my home ground, sees a range of start times generally between 8.20-9.00am, and a range of finish times generally between 2.30-3.30pm.

High school start and finish times can be controversial indeed if you have more than one child in more than one school. I know that as a parent that I spent a number of years juggling kids and different start and finish times, and when schools suggest changing these times a media furore can erupt. Such was the case when, for various reasons, my son’s high school moved the finishing time from 3.00pm to 2.30pm (thus the start time moved also), resulting in the adjoining primary school moving their students’ finishing time from 3.00pm to 2.40pm.

So, if you are not a parent juggling kids with different school start and finish times, why are school start and finish times so interesting? Because there appears to be a mounting body of evidence that these times have considerable implications for injury prevention.

The November edition of the Journal of Clinical Sleep Medicine contains an article by Vorona, Szklo-Coxe, Lamichhane, Ware, McNallen, and Leszczyszyn in which the road crash rates for teens attending early-start schools were compared to teens attending later-start schools in Virginia, US. Teens in early-start counties had a significantly higher crash rate, with crash peaks coinciding as expected with the earlier times that students commute to and from school. It is noteworthy that adult crash rates and traffic congestion did not differ between the counties with an early start and the counties with the late start, further validating the importance of the research findings.

I also came across a webpage for a “non-profit organization dedicated to healthy, safe, equitable school hours“, which summarises the experiences of 43 US states that have moved their start times from early starts (e.g., 7.30am) to later starts (e.g., 8.30am), including the impact upon their students. I must say that as a parent of teens, who often feels like she needs to get a hose to spray water on them so that they actually drag themselves out of bed in the morning, I found such early start times shocking.

We know adolescents experience different sleep needs than children and adults, and that sleep deficits can have a pervasive impact psychologically, physiologically, and – I would argue – socially. The dialogue regarding sleep times needs to consider this pervasive impact if we are to protect some of our most vulnerable community members.

 

 

 

 

 

 

Ending men’s violence against women

24 Nov, 14 | by Bridie Scott-Parker

Tuesday 25 November is White Ribbon Day in more than 60 countries around the world. Visit the Australian online resource to find out more about this inspiring campaign which is a male led Campaign to end men’s violence against women. The mission of the campaign is to make women’s safety a man’s issue too. The campaign works through primary prevention initiatives involving awareness raising and education, and programs with youth, schools, workplaces and across the broader community. A great systemic approach!

 

 

Injury Prevention blog

Injury Prevention

News, notes and discussion of topics relevant to injury prevention science and practice. Visit Site

Latest from Injury Prevention

Latest from Injury Prevention