I have taken Barry’s advice and become a regular reader of Fair Warning. I read a post yesterday titled “After more than a decade and thousands of disfiguring injuries, power tool industry still resisting safety fix” by Myron Levin, with contributions by Lilly Fowler (read the article here: http://www.fairwarning.org/2013/05/after-more-than-a-decade-and-thousands-disfiguring-injuries-power-tool-industry-resisting-safety-solution/). As the daughter of a builder, I am familiar with the extensive variety of injuries that can potentially arise from power tools. I was shocked to learn, however, the enormous number of injuries – many of which are permanent and irreparable – which are caused by table saw blades alone.

Mr Levin refers to a Consumer Product Safety Commission Report which considers the need for a new table saw performance safety standard. It is estimated that over 36,000 table saw injuries each year from 2001 to 2008 required emergency department treatment (which of course excludes those who sought care from primary physicians, or treated their own relatively minor injuries, a common behaviour in rural areas in Australia). Follow-up interviews of 66,900 blade-related injuries sustained by table saw operators which were treated in emergency departments  during 2007 and 2008 revealed the following:

* 31% were aged over 64 years;

* 65.9% resulted in laceration, 12.4% resulted in fractures, 12.0% resulted in amputation, and 8.5% resulted in avulsion (which I learned today is a nice way of saying that a piece of body was ripped off);

* a blade guard was in use in 30.9% of injuries, with consumers removing the guard post-purchase in 75.0% of cases where the guard was absent;

* 7.1% of injured persons were hospitalised (almost double the average 4%  hospitalisation rate for all consumer products);

* the annual total bill for treated blade saw contact injuries was estimated as $2.36 billion (excluding the cost of deaths which were found to occur secondary to the injury).

The existing table saw safety standards were reviewed, with the costs associated with increasing safety were likely to increase the overall purchase price of the table saws. After reading Mr Levin’s article, however, and hearing the harrowing stories of young men who suddenly were looking at their fingers lying on the ground and who had undergone numerous surgeries with further surgery expected to still result in permanent deficits, how can too high a price be put on injury prevention efforts? The injury prevention technology is there.

These are all from recent postings on FairWarning, which, once again I urge you to visit regularly and to support. 

Suicide rate in military rising quickly despite the withdrawal from Iraq and pullback in Afghanistan.Suicide among active-duty troops hit a record of 350 in 2012,  twice as many as a decade before. The suicide rate in the military has caught up to the civilian rate, above 18 per 100,000 people. Although the Pentagon has commissioned numerous reports and invested tens of millions of dollars in research and prevention programs, experts concede they are little closer to understanding the root causes of why military suicide is rising so fast. But an emerging view is that a complex web of factors usually underlie military suicide, including mental illness, sexual or physical abuse, addictions, failed relationships and financial struggles.The New York Times

Top U.S. retail industry group criticizes global pact aimed at improving Bangladesh garment factories.The National Retail Federation said the agreement, which is supported by big European companies, would leave retailers open to legal action and require major funding without providing accountability The five-year contract calls for companies to help pay for fire safety and building improvements in Bangladesh, where a building collapse in April killed more than 1,110 workers. The plan so far covers more than 1,000 of Bangladesh’s 5,000 garment factories, according to IndustriALL Global Union, a Geneva-based group involved in the negotiations. Only two U.S. firms signed: PVH Corp. and Abercrombie & Fitch. The Associated Press

Mexican bus company ordered to halt U.S. operations. The Federal Motor Carrier Safety Administration called the company, Autobuses Zacatecanos, an imminent safety hazard. It operated primarily between Zacatecanos, Mexico, and Los Angeles, but also had occasional trips to Denver, Phoenix and Chicago. FMCSA officials said during a surprise inspection investigators found 34 safety violations, including failing to perform inspections and maintenance repairs and failing to require drivers to follow hours-of service restrictions. The investigation was part of a “Quick Strike” safety program launched last month. In the past three weeks, officials have shut bus companies in Washington D.C., Georgia, Ohio, New York and Utah.Land Line, Commercial Carrier Journal

Editors Note: Apologies if I posted these previously. I wrote them some while ago but discovered them in the Draft folder. So, perhaps second try.

María Seguí Gómez

Our board member has been appointed General Director of Public Health, Drug Dependency and Consumption for the Government of Castilla-La Mancha, Spain. Comment: This is a huge tribute to Maria’s extraordinary talents but a great loss to ECIP, the group she founded only a few years ago.

Kate Carr

Kate Carr became President and CEO of SafeKids Worldwide on October 2, 2011. Previously Carr was Managing Director and Chief Development Officer of Malaria No More, a nonprofit organization. She was also President and CEO for the Elizabeth Glaser Pediatric AIDS Foundation from 1998 – 2005.  Comment: Welcome to the world of injury prevention, Ms Carr.

Gary Smith

The work of Gary Smith, director of the Center for Injury Research and Policy in New Mexico, is highlighted in a warm report.  www.medpagetoday.com Smith has pediatric and public health training and over many years has proven to be an effective advocate.  His most recent contribution relates to falls from high-rise windows but as the piece notes, his interests are wide-ranging and include: choking, furniture tip-overs, bath and shower slips, bunk bed crashes, cheerleading falls, gymnastics accidents, bumps from cribs and playpens, and problems on the playground.” Believing that “We know what works, we just need to apply it” he helped establish the hospital Center. Comment: What is there not to like in this laudatory report?  The title! “Accidents Leading Cause of Death in Kids”. I am still convinced that using the term ‘accidents’ (as the writer, not Smith, does) makes it much harder to achieve our goals. I wonder if any readers still agree?

Herb Simpson

The Governors Highway Safety Association’s (GHSA) most prestigious award, the James J. Howard Highway Safety Trailblazer Award, was presented posthumously to Dr. Herb Simpson for his outstanding contributions to the field of highway safety through his groundbreaking research. Dr. Simpson’s work was instrumental in identifying hard core drunk drivers as a significant contributor to highway fatalities and helped pioneer the concept of graduated driver licensing (GDL), among many other contributions.

Gerald Waters

The Traffic Injury Research Foundation (TIRF) announced that this year’s Sweedler Award recipient was Gerald Waters, a road safety advocate from New Zealand. After Waters lost a friend to a repeat drunk driver, he wrote to the Justice Minister asking for a review. He then appeared before a parliamentary select committee and spoke of the need to do more to address recidivist drunk drivers.  Although not an academic, he wrote a paper ‘The Case of Alcohol and Other Drug Treatment Courts in New Zealand’ highlighting the connection between drugs, alcohol and crime and emphasized the value of alcohol interlocks as part of the solution.

On several occasions in the past I have moaned about the undue emphasis placed on the Journal Impact Factor (JIF) while accepting that wisely or otherwise, many Universities and Faculties that should know better rely on it for judging a candidate’s suitability for promotion, tenure, etc.  As a consequence, many authors on the cusp of such important academic milestones are determined to publish in journals with high impact factors even when other journals may be more appropriate. Gradually, it seems, the balance is swinging in a direction that puts the IF in better perspective.

A group of journal editors issued a Declaration on Research Assessment (DORA) that was recently publicized in Science News.  The so-called San Francisco group agreed that the JIF  has become ‘an obsession in world science. Impact factors warp the way that research is conducted, reported, and funded.’ The DORA statement  ’makes 18 recommendations for change  to reduce the dominant role of the JIF in evaluating research and researchers and instead to focus on the content of primary research papers, regardless of publication venue.’

Today’s declaration is timed to coincide with editorials in many scientific journals.  The signatories are an impressive group of top ranking journal editors. A complete list of signatories to date is athttp://www.ascb.org/SFdeclaration.html. Importantly, they are not just editors of ‘also-ran’ journals.  As the article notes, “There are number of citation ranking systems today, but the oldest and most influential is the so-called “two-year JIF” devised by Eugene Garfield in the early 1950s.” The article continues, “Even though the JIF is only a measure of a journal’s average citation frequency, it has become a powerful proxy for scientific value and is being widely misused to assess individual scientists and research institutions, say the DORA framers. The JIF has become even more powerful in China, India, and other nations emerging as global research powers.’ The San Francisco declaration cites studies that outline known defects in the JIF, distortions that skew results within journals, that gloss over differences between fields, and that lump primary research articles in with much more easily cited review articles. Further, the JIF can be “gamed” by editors and authors, while the data used to compute the JIF “are neither transparent nor openly available to the public,” according to DORA. The statement goes on to explain: “Since the JIF is based on the mean of the citations to papers in a given journal, rather than the median, a handful of highly cited papers can drive the overall JIF, says Bernd Pulverer, Chief Editor of the EMBO Journal. “My favorite example is the first paper on the sequencing of the human genome. This paper, which has been cited just under 10,000 times to date, single handedly increased Nature’s JIF for a couple of years.”

“The Journal Impact Factor (JIF) was developed to help librarians make subscription decisions, but it’s become a proxy for the quality of research,” says Stefano Bertuzzi, ASCB Executive Director, one of more than 70 institutional leaders to sign the declaration on behalf of their organizations. “Researchers are now judged by where they publish not by what they publish. This is no longer a question of selling subscriptions. The ‘high-impact’ obsession is warping our scientific judgment, damaging careers, and wasting time and valuable work.”

The SF declaration urges all stakeholders to focus on the content of papers, rather than the JIF of the journal in which it was published, says Bertuzzi, “The connection is flawed and the importance of the finding as reflected by the light of a high JIF number is often completely misleading, because it is always only a very small number of papers published in a journal that receive most of citations, so it is flawed to measure the impact of a single article by this metric. Great papers appear in journals with low JIFs and vice versa.”

One of the four editors of Traffic who signed DORA, Michael Marks acknowledges that the group realized that the scientific world has been using impact factors inappropriately. “Initially our gut reaction was to blame the JIF itself but it’s not the JIF’s fault,” says Marks. “It’s our use of the JIF that’s the problem.”

DORA’s 18 recommendations call for sweeping changes in scientific assessment, says Drubin. They will hopefully lead to “a change in the culture where people will choose the journals that they publish in not on the prestige but on the fit. Is the format correct? Is the audience correct? Does the editorial board have the appropriate expertise?”  Editors note: This is long overdue. I hope the DORA insurrection succeeds.

On May 14, 2013 the National Transportation Safety Board (NTSB) in the United States released a report titled, “Reaching Zero: Actions to Eliminate Alcohol-Impaired Driving.” 

http://www.ntsb.gov/doclib/reports/2013/SR1301.pdf

 The National Transportation Safety Board is a legislatively mandated independent federal agency that is charged with, among other things, making recommendations related to transportation safety.  The NTSB report is substantial and it notes that alcohol-impaired driving remains a major safety issue in the United States with close to one-third of all highway fatalities associated with alcohol.  The report makes a number of recommendations to U.S. states that include the following taken directly from the report.

• Reduce the per se blood alcohol concentration (BAC) limit for all drivers,
• Conduct high-visibility enforcement of impaired driving laws and incorporating passive alcohol sensing technology into enforcement efforts,
• Expand the use of in-vehicle devices to prevent operation by an impaired driver,
• Use driving while intoxicated (DWI) courts and other programs to reduce recidivism by repeat DWI offenders, and
• Establish measurable goals for reducing impaired driving and tracking progress toward those goals.

The recommendation that seems to have already garnered the most attention is the recommendation to lower state blood alcohol concentration limits to 0.05g/dl.

http://well.blogs.nytimes.com/2013/05/14/cracking-down-on-drinking-and-driving/?src=xps

The current standard that exists in all U.S. states is 0.08g/dl while most developed countries have a 0.05g/dl standard.  Not surprisingly, there appears to be strong resistance to the 0.05g/dl BAC recommendation from the beverage industry.  A representative from the American Beverage Institute was quoted in the following article as saying, “Moving from 0.08 to 0.05 would criminalize perfectly responsible behavior” and “further restriction of moderate consumption of alcohol by responsible adults prior to driving does nothing to stop hard-core drunk drivers from getting behind the wheel.”

http://www.nytimes.com/2013/05/15/us/legal-limit-drunken-driving-safety-board.html?hp

And a representative from the Beer Institute was quoted as saying, “…we strongly encourage policymakers to direct their efforts where we know we can get results: by focusing on repeat offenders and increasing penalties on those with BAC of (0.15) or more.”

http://www.cnn.com/2013/05/14/us/ntsb-blood-alcohol/index.html?c=homepage-t

Scientific research on the topic summarized in the NTSB report however, clearly supports the assertion that moving to a 0.05g/dl BAC standard would save additional lives.

It will be interesting to see how responsive the states are to the NTSB’s recommendations.  In an effort to help motivate the states, the NTSB also recommends that some type of incentive grants be offered to states if they adopt the best practice recommendations including the 0.05 g/dl BAC standard.

Now that I have your attention with my alliterative title, I wanted to draw your attention to a review article in The New England Journal of Medicine.

This year readers of the Injury Prevention blog have been invited to read further regarding injuries arising from such mechanisms as gun violence, transportation, and domestic violence. The review article succinctly explores the burden of injury more broadly, considering both intentional and unintentional injuries. The enormous projected burden of these injuries is highlighted, particularly as a result of road crashes and self-harm.

The Authors next address injury prevention, emphasising the need for both legislative and non-legislative approaches to the problem. This is followed by a discussion of what is needed to minimise the impact and extent of these injuries – a very interesting read indeed for a road safety researcher such as myself.

The Authors conclude with “The Way Forward”,  in which they suggest the next steps needed in injury prevention and remediation. Again the theme of inaccurate and incomplete data rears its ugly head, a pervasive problem about which I have previously blogged. Notwithstanding the innumerable issues associated with such data deficiencies, at the most basic level is the need to adequately represent the magnitude of an injury problem as a vital first step in securing research and intervention funds to address the injury problem.

I recommend you read more at http://www.nejm.org/doi/full/10.1056/NEJMra1109343.

This week, Flaura Winston of the University of Pennsylvania shared the news post of the first ever media campaign regarding violence against women in the Kingdom of Saudi Arabia (KSA). The campaign features a veiled woman with a bruised and blackened eye, and is entitled “Some things can’t be covered.” The campaign is sponsored by the Saudi Arabian charity, the King Khalid Foundation and appears to be trying to raise awareness of violence again women. (Link to view the advertising campaign: http://www.adweek.com/adfreak/ogilvy-creates-saudi-arabias-first-major-ad-campaign-condemning-violence-against-women-14904).

Violence against women is a global social and public health issue. Intimate partner violence, blogged by Bridie earlier this year, is the most frequent type of violence against women with a high prevalence around the world (e.g., see the World Health Organization’s fact sheet at http://apps.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf). For instance, a ten country study including 24,000 women showed that the prevalence of ever experiencing intimate partner violence ranges from 13% and 61% (Countries included: Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Thailand, the former state union of Serbia and Montenegro, and the United Republic of Tanzania). The fact sheet identifies that essential steps towards tackling violence against women include, but are not limited to, the legislation, its enforcement and developing asupport system. It indicates that the mass media “edutainment” campaigns are pivotal in raising public awareness as well as guiding the victimized women to seek support.

Violence against women is not uncommon in KSA (Link to Saudi Media: http://www.saudigazette.com.sa/index.cfm?method=home.regcon&contentid=20130430163665). The survey by the National Family Safety Net showed that most Saudi women were unaware of their rights (Link: http://english.alarabiya.net/en/News/middle-east/2013/04/28/Saudi-Arabia-launches-first-anti-domestic-violence-campaign.html). KSA is a traditional society where women have fewer opportunities to contribute in economic and political activities. According to the World Economic Forum, the KSA is ranked at 131^st out of 135 countries on the gender parity index (Link: http://www3.weforum.org/docs/WEF_GenderGap_Report_2012.pdf). Samar Fatany, a Saudi columnist and women rights’ advocate, pointed out that societal factors could make it difficult for Saudi Women to report violence against them.

These issues have caught the attention of the Saudi Government, which is now pursuing reforms to give more voice to women in the political system. For instance, women have now been given the right to vote and run for office in municipal elections to be held in 2015. This year, thirty women were given the membership of the country’s highest legislative body. The current media campaign, which has a focus on violence against women, reiterates that women issues are now a priority for the Saudi government. Editor: Given the traditional nature of the KSA society, it will be interesting to see whether this campaign leads to increased momentum in the country’s efforts to address violence against women such as by facilitating the creation of a reporting and support system for abused women.

Contributions: Junaid Bhatti, Bridie Scott-Parker, and Gregory Tung.

The controversy-riddled state government in Queensland, Australia, has decided to allow segways to travel on footpaths, infrastructure which until now has been out of bounds to all but pedestrians and children bicyclists. Consistent with bicycle legislation, segway riders will be required to wear helmets. In addition, they must not exceed the soon-to-be mandated speed limit of 12 km/hr (read more at http://www.couriermail.com.au/news/queensland/state-government-relaxes-bike-helmet-rules-for-people-who-must-wear-religious-headwear/story-e6freoof-1226626808441), however they can travel up to 20 km/hr and the penalty associated with violating this Police-enforceable limit is not known.

The reaction to the announcement has been mixed. Queensland Transport Minister Scott Emerson encouraged tourism venture operators in popular areas like the Gold Coast and Brisbane’s South Bank to capitalise on these changes. Queensland Police endorsed the Minister’s announcement, with plans to trial segway use by officers. Road safety and injury prevention researchers at the Centre for Accident Research and Road Safety – Queensland highlighted the mounting evidence that segways are dangerous to the rider (who have received fractures and serious head injuries, see http://www.ncbi.nlm.nih.gov/pubmed/20889236), particularly if they are inexperienced. Segways are also dangerous to slower-moving, unprotected pedestrians (including the elderly who are also more frail and vulnerable to injury). The Pedestrian Council of Australia emphasised the burgeoning epidemic of obesity, citing segways as a barrier to the healthier option of walking.

Segways are very quiet and weigh in excess of 35 kilograms, therefore collisions with pedestrians are likely to result in injury. In addition, segway riders have been found to require over 2 metres to safely negotiate the device around a pedestrian (see http://trid.trb.org/view.aspx?id=848782), suggesting that shared paths are not the optimal solution for all users. Moreover, tourists characteristically meander across paths, stopping at random intervals to photograph their surroundings – perhaps the target audience is going to be the most vulnerable one?

By now most readers will have learned about the horrific collapse of a factory in Bangladesh killing hundreds of low-paid workers and injury many others. The owner has been arrested and that seems logical. But equally logical it seems to me, is to hold the authorities responsible for workplace safety responsible. I see this as a general paradigm for injury prevention: Most countries have governmental bodies with responsibility for various aspects of public safety. If they fail to do their job in an acceptable manner and people are killed or injured, why should they not be held criminally or civally responsible?  Coming at this from another angle, if it could be established that on a systematic basis a government body fails to remedy dangerous intersections, for example, then a principle in much of western law called ‘mandamus’ may kick in. This, as Wikipedia explains, is “a judicial remedy — in the form of an order from a superior court, to any government subordinate court, corporation, or public authority — to do (or forbear from doing) some specific act which that body is obliged under law to do (or refrain from doing) — and which is in the nature of public duty, and in certain cases one of a statutory duty.”  In the American legal system it must be a judicially enforceable and legally protected right before one suffering a grievance can ask for a mandamus. A person can be said to be aggrieved only when he is denied a legal right by someone who has a legal duty to do something and abstains from doing it.”  My general point is that if we are trying to prevent injuries by setting examples of what could happen, I believe we must consider not only those directly responsible, in this case the factory owner who added to the structure without permission, but also the relevant government body that should have prevented this from happening.

As one report (in the Washington Post (WP) notes)  Bangladesh’s ‘deadliest industrial accident” was built without proper permission on unstable land. (But how, I ask, can a structure emerge without permission?)  Ironically, because this factory and others like it make cheap goods for Western retailers, there is some scrutiny of work conditions by some importers. The WP states that “At least two garment factories at Rana Plaza had passed international labor and safety standard audits under a European trade organization that addressed specific safety concerns at the factories but didn’t assess the stability of the building that housed them.”  A  senior official with the municipal agency that oversees building safety in the greater Dhaka area said the building ”did not receive planning permission.” “It could and should have been demolished.” In fact permission was obtained from the mayor who had no authority to give such consent. It appears that because of the boom in the garment industry,  ”Hundreds of factories in this area have been built with local council permission.”  Canadian retailer Loblaw Cos. said workers in the complex were making clothes for its Joe Fresh clothing line but that its factory-monitoring system doesn’t check for building construction or integrity. The company plans to expand the scope of its factory audits.

So, why no action against government departments? As the WSJ explains, “Labor-rights activists said laws remain weak and implementation uneven in a country where factory owners, many of whom are also local politicians or members of Parliament, maintain political clout. At least 33 members of the current Parliament own garment businesses.”  There are repeated instances of MPs linked to the garment industry blocking stricter legislation.” Bottom line: Bangladesh had adequate laws governing the safety of buildings, but those laws weren’t properly implemented, and, I add, they make no provision for holding government departments legally responsible for failing to do what it is mandated to do.