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Talking about Suicides

15 Apr, 14 | by gtung

The Board of the American Association of Suicidology recently voted to create a new division to represent and recognize individuals who have attempted suicide and survived.  This move seems to be representative of the beginning of a shift in how those involved in suicide prevention view openly talking about and learning from those who have made suicide attempts and survived.  A trend summarized nicely in this NY Times article:

http://www.nytimes.com/2014/04/14/us/suicide-prevention-sheds-a-longstanding-taboo-talking-about-attempts.html?src=xps

Those involved in suicide prevention have taken a cautious approach toward openly talking about or publicizing individual stories about completed suicides and attempts.  The issue of copycat suicides and suicide clusters gives justifiable concern toward publicizing completed suicides but what will be the effect of increased discussion around suicide attempts?

There is optimism around what can be learned from suicide attempt survivors and how those experiences can be used to prevent future suicides.  The website LiveThroughThis.org provides a collection of portraits and survivor stories in an attempt in part to build greater awareness and humanize survivors.

It will be interesting to see how this trend progresses, what is learned, and what impact, if any, it ultimately has on the very real need to develop effective interventions to prevent suicides.

The most popular suicide location in the world

8 Apr, 14 | by gtung

San Francisco’s Golden Gate Bridge looks poised to get a safety net to prevent suicides, something that various people and organizations have been requesting for over 60 years.  Since the Bridge was first opened in 1937 approximately 1,600 people have committed suicide by jumping off the bridge, more than any other location in the world.  In 2013, 46 people committed suicide from the bridge (that authorities know about) and another 118 were talked down or otherwise stopped from jumping by bridge workers.

In May of this year authorities will vote on the installation of a safety net that will be 20 feet below the walkway and is estimated to cost $66 million US dollars.  The proposal seems likely to pass.

http://www.nytimes.com/2014/03/27/us/suicides-mounting-golden-gate-looks-to-add-a-safety-net.html?src=xps

Arguments against installing some type of guard railing or safety net have included concerns about negatively impacting the bridge’s appearance and assertions that suicidal individuals will simply find some other way of committing suicide and therefore a safety net would not actually save lives.  Scientific studies examining means restrictions on suicides clearly indicate that lives will be saved if safety measures are put in place on the Golden Gate Bridge.  In addition, work done by Richard Seiden at UC Berkeley looking at individuals that have been stopped from jumping and those that have survived the jump has revealed that the vast majority (over 90%) do not go on to commit suicide by other means.  All of this research has been summarized nicely by the Bridge Rail Foundation, an organization devoted to installing a safety net and preventing suicides from the Golden Gate Bridge.

http://www.bridgerail.org/lives-can-be-saved/what-science-tells-us

Why has it taken so long when there has clearly been a need for a safety net?  The policy process is complex and it is difficult to say for certain but the media is referencing the recent increase in the number of suicides as motivation.  It can’t hurt that in 2012 the federal government passed legislation making federal funding available for the construction of safety barriers on bridges.  This is an interesting example of the complex interplay of science, misinformation, advocacy, and incentives in policy outcomes of public health consequence.  Too bad it took 60 years.

Balcony collapse – a potential (unseen?) threat to users of all ages

7 Apr, 14 | by Bridie Scott-Parker

Unfortunately here in Australia we have had a number of collapses of the family home balcony, and last month the casualty was a 3 month old baby boy who had been cradled in his mother’s arms moments before the fateful fall (http://www.dailytelegraph.com.au/newslocal/central-coast/death-of-baby-in-niagara-park-balcony-collapse-prompts-building-safety-warning/story-fngr8h0p-1226857651952). Such balcony collapses are by no means unique events here in Australia (e.g., http://www.theaustralian.com.au/news/nation/balcony-collapse-injures-five-people-at-nowra-in-nsw/story-e6frg6nf-1226743237328;  http://www.abc.net.au/news/2013-02-28/seven-injured-in-sydney-balcony-collapse/4544180). I know that in my own experience here in Australia, where the summer can be long, hot and humid, and autumn and spring can mean balmy days continue, the balcony is the perfect place to gather family and friends together.

Overloading of balconies, poor maintenance and shoddy workmanship at the time of construction has been suggested as contributing to their collapse, however I would suggest that much of the threat is indeed unseen by the user. I have never inspected a balcony or deck prior to standing on it, and I would not know what I should be looking for if I did try to inspect it. There are numerous tips for home-owners with decks and balconies which have the potential to cause injury if they collapse (e.g., see http://www.archicentre.com.au/publications/archicentre-blog/629-check-the-deck), however as a visitor, I am unlikely to know if the home-owner is aware of these tips, let alone if they have acted upon them.

Recent collapses have sparked a call for tighter rules by the Australian Institute of Architects (http://www.abc.net.au/news/2014-04-01/architects-say-up-to-12000-decks-at-risk-of-collapse/5359072). “Up to 12,000 balconies and decks across Australia could be at risk of potentially deadly collapse”.

Gino Andrieri, of Maurice Blackburn Lawyers representing the Diefenbach family (their baby girl died in 2010 after her father’s foot fell through a rotted floorboard in the rented home’s deck), stated “It’s a hidden trap because from the outside there are no significant visual indicators of the danger.” The Queensland coronial recommendations include:

  • Mandatory decks, verandas and balconies inspections;
  • Wood rot and termite activity be considered an emergency repair;
  • Real estate agents must record and act on tenants’ complaints.

In addition, Professor Roy Kimble (Royal Children’s Hospital, Brisbane), recommends decks and balconies be given a maximum load rating.

 

Low speed vehicle run-over incidents remain in the spotlight

31 Mar, 14 | by Bridie Scott-Parker

PubMed abounds with articles exploring the epidemiology of low speed vehicle run-overs (e.g., doi: 10.1136/ip.2010.030304; 10.1111/jpc.12188; 10.1111/wvn.12014; 10.1136/injuryprev-2013-040932; 10.1186/1471-2458-14-245; 10.1186/1471-2458-14-245). The devastating consequences of low speed vehicle run-over incidents has led to a plethora of suggested intervention and ‘tips’ for parents and others interested in child and infant injury prevention (for example, http://www.kidsafewa.com.au/drivewaysafety.html; http://www.safekids.org.nz/index.php/page/driveway-run-over-kit-locations; http://www.keepyourchildsafe.org/child-safety-book/child-driveway-accidents.html). In addition, after-market reversing cameras are available for purchase, and many new cars now come with this option as a standard feature.

Despite these resources, low speed vehicle run-overs continue to occur and they are not an isolated phenomenon unfortunately. Examples are commonly found in the news media (e.g., in Australia earlier this month: http://www.theherald.com.au/story/2153058/baby-hospitalised-after-being-run-over-in-driveway-by-4wd/). In New Zealand, a news report summarising a recent tragedy finished with a summary of 7 other driveway deaths (see http://www.stuff.co.nz/national/9879675/Child-run-over-in-driveway-dies). Similar events are also summarised in an article reporting a 2013 tragedy in Texas (see http://www.theeagle.com/news/local/article_55db2af5-f68b-5344-9e00-60c79f109c6a.html).

So how do we progress in preventing injury to our most vulnerable? Are parents and other caregivers unaware of the potentially-devastating injuries that can be sustained in the family driveway, thus suggesting that education is the key? Or is engineering, in the form of barriers and mandatory cameras, the solution? I would argue that a multilevel approach is needed, and is needed urgently. I welcome your ideas!

 

 

 

Sharing Data Collection Instruments

27 Mar, 14 | by Brian Johnston

In the April 2014 issue, I highlighted a new service from SAVIR and  SafetyLit - a searchable repository of injury-related data collection instruments.

In follow-up correspondence, Kavi Bhalla points out that the injuries group in the  global burden of disease study had also compiled a collection of  instruments with questions related to measuring injury incidence.

Interested? You can find it here.

 

 

When you run, does it matter what you wear on your feet?

21 Mar, 14 | by Caroline Finch

Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)

The British Journal of Sports Medicine (BJSM) Volume 48, Issue 5 includes several papers relating to joint stability and its relationship to musculoskeletal injury. Verrelst et al. show that hip and thorax joint stability, as measured by range of motion, can contribute to the development of tibial (shin) pain in female physical education students. Gehring et al. demonstrate that mechanical ankle instability is related to the mechanism behind ankle sprains in “close-to-injury” scenarios in a lab-based study.

But it is two papers that highlight the multidimensional nature of risk factors associated with running injuries that particularly caught my eye – especially for their discussions of footwear.

One paper (by Theisen et al.) involved a double-blind randomised controlled trial of 247 runners allocated to either wearing shows with either a soft or a hard midsole. Although, it has been argued previously that runners, especially those with pronated feet, should wear shoes with more stability around the midsole to prevent injuries, this study found no difference in running related injury risk in the two groups over 5 months. The study did find that runners with higher body mass index, a previous injury history and a higher mean running session intensity were more at risk of injury. In contrast, runners who had been a regular runner over the previous 12 months and those who participated in other sports were protected from injury risk.

So if the type of shoe makes no difference, do you even need to wear running shoes?

A review of barefoot running, including its association with injury risk, by Tam et al. , is timely given much popular media attention given to the supposed benefits of this form of running. Unfortunately, for the proponents of barefoot running, the authors conclude that not enough research has been undertaken to date to confirm whether barefoot running is an effective injury prevention strategy. Whilst they argue that there are some benefits to barefoot running, these are likely to be experienced only by runners who have acquired technique adaptations to allow them to run this way properly. For other runners, barefoot running might exacerbate other factors associated with running injury such as poor technique, kinetic and kinetic factors associated with the biomechanics of running, etc.

Taken together, these papers highlight, once again, that the cause of sports injuries – particularly those of a musculoskeletal and/or overuse nature, – is highly multifactorial. Injury prevention for sports such as running will require the development of new strategies that are holistic and consider the modification or control of several risk factors at once. Given this complexity, the implementation of individual preventive measures is unlikely to be beneficial if they are do not consider the broader set of causal mechanisms that could influence injury risk – whether they be internal to the runner (e.g. injury history or personal biomechanics) or external to them (such as environmental, training load factors).

 

Caroline Finch is an injury prevention researcher and Head of the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Federation University Australia located in Ballarat, Victoria, Australia. She specialises in two areas: (1) sports injury surveillance and research methodologies and (2) implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and the Statistical Editor for Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.

 

If coaches are to deliver sports safety programmes, they need to be taught the HOW not just the WHAT

20 Mar, 14 | by Caroline Finch

Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)

There is irrefutable evidence that injury prevention efforts will only work if the people they are intended for, such as sports participants, actually adopt them (e.g. Finch, 2006). More recently, however, it has become recognised that whether or not they do so, depends on the influence of significant others or specific delivery agents, such as the coaches who organise and deliver training sessions for the athletes they are responsible for (e.g. Finch et al. 2011).

Most athletes only do what their coaches ask them to do during training sessions; nothing else. This becomes a problem for injury prevention if the coaches do not know how to delivery safety programmes to their players. It also reinforces the need for targeted coach education to ensure they are fully informed and equipped to deliver training programs.

The British Journal of Sports Medicine (BJSM) Volume 48, Issue 5 includes an article from my own research team (White et al.) on exactly this topic. We asked coaches from a popular team sport in Australia to tell us what would most encourage them to deliver sports safety programmes. The coaches were generally supportive of safety programmes but were less interested in knowing the rationale behind the composition of those programmes. But, most importantly, they also told us two main things:

  • they need to know that other coaches are already doing it (so it CAN be done)

AND

  • they want to learn from prominent coaches who are already doing it about how they are doing it (i.e. HOW it is done).

To adequately skill-up the workforce of coaches who could deliver safety programmes in sport will require improved coach education that focusses as much on “exactly how do I implement safety programmes” as on “what programmes should I be delivering”.

I would not be surprised at all for this to also apply to the training of any sort of professional for the delivery of safety programmes in all injury prevention contexts.

 

Caroline Finch is an injury prevention researcher and Head of the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Federation University Australia located in Ballarat, Victoria, Australia. She specialises in two areas: (1) sports injury surveillance and research methodologies and (2) implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and the Statistical Editor for Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.

Preventing overuse, not just acute and traumatic, injuries matters in youth sport

19 Mar, 14 | by Caroline Finch

Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)

Readers of this journal would be fully aware of international definitions of injury based on the energy-exchange causation theory proposed by early injury researchers such as Haddon. Such definitions have led much prevention research to focus on acute traumatic injuries only. In this work, injury has been defined as any physical complaint that is caused by the inability of the body’s tissues to maintain its structural and/or function integrity following a transfer of energy to the body (e.g. from an impact, sudden movement, repeated force, etc.). For acute and traumatic injuries, this inability to withstand the energy transfer is manifested within a relatively short period following the inciting event. For this reason, studies analysing medical presentations for injury, especially at emergency departments and hospital settings, has provided a strong epidemiological basis to underpin preventive research, including in sport.

In the context of sports participation, however, injury prevention depends just as much upon the ability of the athlete’s body to tolerate repeated exposures to injury risks whilst remaining active in sport. Therefore, it is not just injuries associated with acute events that are problematic. Overuse injuries, that are not associated with a single inciting event and with symptom onset developing over time, also occur. As an example in other contexts, this has previously been reported in this journal by Wilkinson et al in the context of British infantry injury rates, for which only 83% of all injury diagnoses were associated with traumatic inciting events.

The British Journal of Sports Medicine (BJSM) Volume 48, Issue 4 recognises the importance of overuse injuries in youth sports, through its publication of a position statement from the American Medical Society for Sports Medicine on this important topic. There has been a general trend over recent years for increasing amounts of high-intensity training and competition in sport to be undertaken by youth, especially by those motivated to pursue careers in sport. However, such activities, when not balanced with appropriate physical load management and skill development, can lead to high rates of overuse injuries.

The Overuse Injuries and Burnout in Youth Sports position statement emphasises the following strategies to prevent overuse injuries:

  • Limit the amount of training undertaken, both in terms of actual time spent and its intensity. It is important that young athletes also have adequate periods of rest between sporting episodes, to allow their bodies to recover fully.
  • Preparation for sporting activity is important and both age-appropriate strength training and resistance training is important to help prepare the young athlete’s body for the physical challenges.
  • Proper supervision of training and sports preparation programs for young athletes should be provided.
  • As youth athletes are still maturing physically, it is possible that associated changes in their biomechanics could make them more prone to injury. When the sporting activity involves equipment, it is important that it is checked regularly to ensure it still fits properly and is of the right size.

There is sometimes the perception that overuse injuries are not very severe, because people with them rarely report to hospitals for treatment. However, even in children, they often take longer to recover from than acute injuries and they can significantly affect quality of life over some time. Importantly, they most certainly prevent children from participating in sport and other physical activities, thereby denying them the overall benefits of participating in an otherwise active lifestyle.

 

Caroline Finch is an injury prevention researcher and Head of the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Federation University Australia located in Ballarat, Victoria, Australia. She specialises in two areas: (1) sports injury surveillance and research methodologies and (2) implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and the Statistical Editor for Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.

Safety defects in GM cars: the role of industry and government

16 Mar, 14 | by Barry Pless

This is verbatim from an article in the New York Times, via Lombardo. When we think about injury prevention we must never lose sight of the major role government has to play, especially when ensuring the safety of dangerous products. One of the most dangerous, in my view, is the automobile.

“What we do know is that for more than a decade G.M. did not act on significant evidence of the flaw, and only last month did it recall 1.6 million affected cars. The National Highway Traffic Safety Administration missed warning signs from accident data and consumer complaints, too.  Federal laws on auto safety weren’t sufficient to prevent and cure this hazard, and they should be toughened….”

Under a 2000 federal law, carmakers must inform the agency about claims of possible defects that led to serious injury or death, and the agency is required to make public a summary of that information. But often, many of the details are kept secret to protect proprietary information. That should change. Disclosing more information, including detailed accident data and the service bulletins automakers send to their dealers, would increase the chance that researchers and consumer advocates would spot problems regulators missed….

“It is unrealistic to expect cars to roll off assembly lines free of all flaws. But it shouldn’t take a decade to identify and fix major defects.”

See http://www.nytimes.com/2014/03/15/opinion/a-defective-auto-safety-system.html?emc=edit_tnt_20140314&nlid=37926955&tntemail0=y&_r=0

Physical activity promotion has nothing to gain from injury prevention! Fact or Fiction?

14 Mar, 14 | by Caroline Finch

Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)

The British Journal of Sports Medicine (BJSM) Volume 48, Issue 3 is devoted to physical activity promotion and “Exercise as Medicine”. However, as the deliberately provocative title of this particular cross IP-BJSM Blog indicates, there is nothing in any of the papers in this particular BJSM issue that links injury prevention to physical activity promotion. Even a paper on how the built and social environment influences people choosing inactive lifestyles, ignores the extensive literature on how to make such settings safer and more useable because injury hazards are removed. So could it be that the title of this blog is true. But I would challenge any reader of this blog to provide evidence to support such a stance. Given the lack of papers directly related to injury prevention in this particular BJSM issue to discuss, I am going to take this opportunity to explain why this aforementioned fact is, in fact, fiction.

As long ago as 2003, separate Editorials by Ray Shepherd I and Marshall & Guskiewicz in Injury Prevention argued for the importance of linking promotion of exercise/physical activity (PAP)  to injury prevention (IP) to ensure that health and fitness goals. Even earlier, I published a paper that outlined the nexus between physical activity promotion and injury prevention. These are not the only commentaries to have discussed the links between the two, but I am left wondering why there remains such a gap. Which sector, physical activity promotion or injury prevention, benefits the most from the gap?

At its most basic, on a per exposure basis, sports (including exercise, fitness, physical activity) related injuries only occur when people participate in such activities. By definition, and if nothing is concurrently done to actively encourage safe participation, more people being encouraged to be physically active (by physical activity promoters) means that more people will be exposed to the risk of injury (even if small). And more people will present with injuries needing medical treatment or with lifelong disability outcomes.

Ok – this may be good for injury prevention professionals because we have larger numbers of cases to document, prevent and treat. But it also seems to me that this scenario is a WIN (for PAP) -WIN (for IP)  for both physical activity promoters (because more people will be active) and for injury/injury prevention professionals (because there are more injuries for us to deal with). But it would also lead to increased burden on our medical delivery systems due to the need to deal with injury management and repair. Injury prevention could prevent this poor population health outcome.

We also know that many people who are injured have to stop their physical activity for some time to recover and a significant number do not return to their pre-injury activity levels. This is, in a sense, a LOSS (for PAP) – WIN (for IP) scenario because fewer people will remain active, but there will still be lots of injuries and injury consequences to deal with. Moreover, an increasingly larger number of people will not take up physical activity because they are fearful of injury. Reductions in physical activity levels at the population level will lead to an increased chronic disease burdens that will need to be met by our healthcare systems. Still not being proactive about sports injury prevention, will mean that fewer people remain active.

Overall, it seems to me that the physical activity and sport promotion sector has much more to lose from ignoring injury prevention strategies than we do the other way around. By not incorporating injury prevention principles as standard practice into their activates, and by continuing to largely ignore the injury prevention literature around issues that are directly relevant to supporting and enabling physically active populations, there is every likelihood that injury rates and their public health burden will increase whilst participation rates will stabilise or further decline.

It is clearly a myth that “Physical activity promotion has nothing to gain from injury prevention”. If we injury prevention professionals are doing our jobs properly, there should be fewer injuries for us to concern ourselves with, not more of them. In essence, over time, we should be doing ourselves out of a job. We should be sharing our injury prevention strategies with the physical activity promotion professionals, especially those operating at the broad population level.

Is it the injury prevention or physical activity promotion professionals who are most to blame for the two not to be linked?

From one viewpoint, it could be argued that many of the current physical activity promotion and “Exercise is Medicine” activities are doing everything possible to ensure that this outcome is not achieved. They do not even mention “injury risk” or “safety strategies” in many of their resources and programs. But equally, it could be that the injury prevention sector is not doing enough to engage with those who are most concerned about other health issues and so have not convinced them of our integral relevance to them.

No matter the reason for not currently linking the two health promotion issues, it seems to me that there will be plenty of sports and physical activity related injuries for me and my colleagues to keep on preventing for a very long time! BUT even I can see that this is NOT a good thing for the health of all.

 

Caroline Finch is an injury prevention researcher and Head of the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Federation University Australia located in Ballarat, Victoria, Australia. She specialises in two areas: (1) sports injury surveillance and research methodologies and (2) implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and the Statistical Editor for Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch.

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