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harm reduction

Happy International Women’s Day 2017!

8 Mar, 17 | by Bridie Scott-Parker

Today is International Women’s Day 2017, and while each and every one of us has our own experiences relating to this year’s theme, I thought I would share with you my own recent reflections on how I have been Bold for Change. I was honoured to share my experiences at the Graduate Women Queensland Sunshine Coast Branch International Women’s Day Breakfast last Saturday, and in preparing for this event – as any good researcher would proceed – I leapt into my homework activity and asked Google for definitions of “bold”. While some were rather risqué, I found some definitions with which I sensed a strong affiliation, and I shared some of my good, and less-good, life experiences around these definitions.

  1. Confident and courageous, daring and brave. Regular readers of the blog, and anyone who knows me beyond my peer-reviewed publications, will know that I have had more than my share of physical challenges. It never ceases to surprise me that, on a weekly basis at a minimum, I encounter someone who is surprised to see me working, mothering, contributing to my local community or the global community more generally. Yes, staying at home and resting all day would definitely be the easy thing to do, but I do not seem have the gene that allows me to do this! I was also brought up by a confident and courageous, daring and brave mum (and dad) who encouraged me from the cradle to leave my small farming community and move to the capital city and gain a degree, something girls are NOT supposed to do. I see my own daughter being confident and courageous, daring and brave, doing the same, and it reinforces that I (and my mum) have done the right thing, and I couldn’t be more proud of both of them.
  2. Not hesitating in the face of rebuff, or to break rules of propriety. Kudos again is needed for my mum (and dad) for raising a strong-willed (I prefer ‘tenacious and resilient’, while my husband is more likely to use ‘stubborn and pig-headed’) daughter, who is living the family motto of leave-the-world-better. Sometimes this means that there will be rebuff, and sometimes this means breaking rules of propriety. So be it. I am confident and courageous, daring and brave, and I WILL leave the world better.
  3. Not afraid to speak up for what she believes, even to people with more power.  Change will not happen unless people – women! – who are confident and courageous, daring and brave, and who do not hesitate in the face of rebuff and do not hesitate to break the rules of propriety are not afraid to speak up for what they believe. Others may have more power, but to me that means that others can join me in tireless quest to prevent injury among our most precious, our children. I have worked very hard through my studies, and my life post-PhD, and through these efforts (and experimentation with my own children!) have developed, implemented, and evaluated some highly innovative projects. Change not only requires bold thinking, but bold actions, so I walk-the-walk, not just talk-the-talk.
  4. Not afraid of difficult situations. Every day is an opportunity to learn: you might learn something about yourself, about another, or about something as lovely as a pet cat or dog. I am a big fan of reframing and looking at the positive of any situation, no matter how dire. A difficult situation is a fantastic opportunity to learn, and not only can you learn to manage difficult situations, you will also learn from these difficult situations, by being confident and courageous, daring and brave, and speaking up. It’s important however to remember to listen, and to talk with, not just talk at or be talked at. Everyone likes to be talked with 🙂
  5. Willingness to take risks. I am willing to take risks. I have been in a medication trial, and being number 23 in a world’s first double-blind study was scary, particularly when there was a massive list of potential side-effects, including death, and I had two small children, a husband and a mortgage. I have also taken many risks during my studies and in my post-doctoral life by treading a less-conventional path, and indeed I prefer to live life generally as an open book. Life is much simpler that way. Doing this has required me to be confident and courageous, daring and brave; to speak up; to not be afraid of difficult situations; and to be willing to take risks. I take educated risks, however, and use all my nous, research skills, and social supports to take every step to help these risks translate into injury prevention, whatever my endeavour.
  6. A final message?  Whether you are a woman on International Women’s Day, or someone who shares the planet with a woman on International Women’s Day (or indeed any other day), you can make a difference and you can prevent injury, by being bold for change 🙂

Pondering the peanutabout…..

5 Jan, 17 | by Bridie Scott-Parker

I read the StreetsBlogUSA post Study: Diagonal Intersections are Especially Dangerous for Cyclists today with great interest, for a number of reasons that I thought I would share with you.

Firstly, there is no doubt that cyclists are a vulnerable road user group, and that particular segments of road are more problematic for cyclists. The research cited in the post pertains to an Injury Prevention publication which examined, in-depth, police reports of 300 car-cyclist crashes in the New York city area , and the police templates to record crash-pertinent information across the US. Innovative research which approaches a known problem from novel perspectives helps to provide additional pieces for the jigsaw puzzle that we seek to solve, and this research was an intriguing read indeed.

Secondly, the research revealed that some road configurations appeared to increase crash risk (i.e., we want to reconfigure these roads), and that the safest option in the most problematic circumstances was to separate the motor vehicle from the vulnerable cyclist. The ‘solution’ for cyclist safety can be a highly contentious issue, particularly here in Australia in which the motor vehicle has traditionally – through necessity – dominated our vast landscape, and as health and other benefits become apparent, cycling is gaining traction. Indeed, Cadel Evans, arguably Australia’s most celebrated cyclist, has tried to bring clarity to this divisive issue; stating that

I don’t think we should separate the two, because most people who ride a bike also have a car. In the end, they’re public roads for everyone. It’s a privilege to use roads; not a right.

 We have to respect everyone who’s using them, whether they’re driving a car, bus, tractor or truck, or riding a bike or are a pedestrian. We have to respect each other’s privilege and safety.”

in response to the question “What do you say to drivers who think cyclists don’t belong on the road?

Thirdly, the innovative solution of the peanutabout helps speak to ideas beyond the cyclist themselves – this is consistent with systems thinking which argues that safety (in this case, cyclist safety) emerges from a complex web of actions and interactions among a breadth of stakeholders who play a role in the larger safety system (e.g., in the case of my own research interests, an application of systems thinking in the young driver road safety). Given we are more than half way through the Decade of Action for Road Safety, and in the case of Australia, our road toll returned to an upward trajectory in 2016 after many years of a downward trajectory, such innovative thinking is critical.

Fourthly, the researchers noted that the templates used by police to record crash-pertinent information did not provide adequate details regarding the crash circumstances. Unfortunately this is not an uncommon problem, and again one that I have come across in my own research endeavours. If we are to effectively prevent injury, we need as much contextual and other information regarding the incident contributing to the injury.

Fifthly, while the peanutabout appears to be an ideal solution to the critical issues identified for the area noted, I am mindful that drivers do not always ‘cope well’ with complex infrastructure such as roundabouts. As a researcher within the realm of young driver road safety, and the mother of teen with the learner licence which requires full supervision whenever she is behind the wheel, Learner drivers often tell me that they ‘freak out’ when they come to a roundabout, and it is not actually round! According to Learners, roundabouts must be round, while oval roundabouts and others shaped as a parallelogram should be called something different. Hmmmm, on reflection, maybe Learners will be okay with a ‘peanutabout’…..

Finally, I paused to reflect on the safety implications for motorcyclists – another vulnerable road user group. While traversing a roundabout on his Harley Davidson last year, a colleague was driven over by a driver behind the wheel of 4WD, texting, who reported that she had checked the roundabout for vehicles before entering, and that she did not see – or hear – my colleague already on the roundabout (and thus he had right of way) until her front right tyre was on top of his leg and his motorbike. Thankfully he has managed to retain his leg, however he has had multiple operations, requires additional surgery, and will be scarred for life and never walk without support again. My colleague is the first to acknowledge that motorcyclists sometimes deliberately place themselves in danger through their riding behaviours – himself included – however we both eagerly await any intervention that will increase motorcycle safety when traversing complex infrastructure such as roundabouts.

Life post-injury, aka preventing further injury

20 Sep, 16 | by Bridie Scott-Parker

While we as injury-prevention professionals, practitioners and policy-makers work tirelessly to prevent injury, the reality is – never more evident than at the Safety 2016 conference underway as I type in Tampere, Finland – that

“Beyond deaths tens of millions of people suffer injuries that lead to hospitalization, emergency department visits, and treatment by general practitioners. Many are left with temporary or permanent disabilities….”  Etienne Krug, MD, MPH, Director, Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization.

Moreover, diseases such as diabetes, heart disease, cancer, mental illness, and respiratory conditions to name a few, arguably lead to injury and disability, therefore we must continue in our efforts to reduce the incidence of disease wherever possible.

Now, to the other side of the coin…..

If you are one of the many lucky people out there who has never had to live with an injury (whether it was temporary or permanent) or a disease (particularly one that you have incurred through no fault of your own), try being the one living with that injury or that disease. Try then to prevent incurring further injury. As a person who has tango-ed for many years with the she-beast Multiple Sclerosis (MS), I can tell you it is pretty darn hard. Having recently visited our developed-nation’s capital, Canberra, for a conference, I was dismayed to encounter  injury-prevention issues every day. Two examples:

Example 1. I can no longer traverse stairs without a great deal of difficulty (and hilarity as my Students and/or Research Assistants are required to act as my ‘squishies’ by forming a human beanbag around me in case I fall during the journey up or down), and while there was an elevator that was available to use in an adjoining building (a casino), despite being advised by building b (my hotel) that I could use this elevator during casino hours, casino security advised me I was unable to use it as I was not a casino-patron. Despite all of my conference colleagues traversing the steps within 30 feet of the elevator, I had to leave the building to repeat my early morning trek of a (now uphill) ramp, road, broken paving (again uphill), footpath, and construction zone, using my walking stick and my wheelie bag to keep me upright, with an overall distance that was at least 3 times that of my able-bodied colleagues. I fall quite regularly and I am always very careful in how I land as if I lose the use of one or more arms through an injury my capacity to care for myself, let alone work, be a mother etc, will be greatly impacted upon. Managing fatigue is very important for staying upright, and having a finite pool of energy which is impacted upon by MS, this is not the way to prevent further physical injury. How about offering assistance or solutions that are not only realistic but also allow me some independence? I am not my disease or my disability.

 

Broken paving which strikes fear in the heart of anyone who is a falls' risk

Broken paving which strikes fear in the heart of anyone who is a falls’ risk

 

Example 2. There was a delay with our return flight home, as there often is as we leave our nation’s capital, and as I have mobility issues I need assistance to board the plane. My friend and colleague was kind enough to assist me through this process, and we were ‘bumped’ to the head of the queue so that we could get seated with as little difficulty as possible. Unfortunately as we traveled down the ramp to the plane a fellow traveler yelled out ‘So what did you do to yourself?’, to which I stopped, steadied myself with the handrail and turned around before replying ‘I didn’t do anything to myself, I have multiple sclerosis’. Understandably the gentleman was very apologetic, however it can be very confronting to have complete strangers ask you why you walk the way you do, or you use a stick, or you are in a wheelchair. Some days it just rolls right off me, but other days when your reserves might be low, you might already have had a dozen people ask you, and you have managed to get through airport security with a walking stick (no easy feat itself!), you just feel like saying ‘Give me a break, did I ask if you have hemorrhoids?’ I am pretty resilient – indeed I could be the poster child for resilience and tenacity, despite my husband saying it is just plain pigheadedness and stubbornness – but even I reach my limits. We are already coping with a pretty full load, 24 hours a day, 7 days a week, with no break EVER. Someone stronger may not be able to cope with the constant questioning. This is not the way to prevent further mental injury. Again, how about offering assistance or solutions that are not only realistic but also allow me some independence? I am not my disease or my disability.

Here in Queensland last week was Disability Action Week, with the aim of empowering people with disability, raising awareness of disability issues, and improving access and inclusion throughout the wider community. This year has been pretty tricky. Unfortunately I had a pretty horrid weekend before the DAW, and the doctors at our local hospital were just wonderful despite struggling with my collapsing veins.

You can see the result of two collapsed veins during failed IV insertion, 10 days later (you can’t see the bruise from the one that succeeded, on the back of my hand)

The result of two collapsed veins during IV insertion, 10 days later

 

I had intended to blog last week about the exciting Rio 2016 Paralympic Games and what a great chance for people to see disability and disease through a different lens. Instead I spent much of last week struggling to manage new medication, work, being a mum/wife/daughter/friend, and independence as friends and family acted as chauffeurs and gophers, nurses and hug-machines.

Anyone who knows me knows that I am a do-er. Get in there and get it done! As the saying goes, if you want something done, ask a busy person 🙂 I don’t usually share about how tricky it can be living with MS ALL DAY EVERY DAY, but this seemed the ideal time to give some tiny insight into what it is like to further prevent injury when you already have an injury, which is what we also need to be about if we are to make injury prevention progress.

How to cut violence painlessly: Increase alcohol taxes

1 Sep, 16 | by Sheree Bekker

photo-1455641064490-74f5f8dbf598

[SB] This post is by Nicholas Page and Jonathan Shepherd.

Nicholas Page is a Senior Research Assistant at the Wales Institute of Social and Economic Research, Data and Methods (WISERD) and former Research Associate at Cardiff University’s Violence Research Group. Follow Nick on Twitter @Nick_Alan_Page

Jonathan Shepherd is a Professor of Oral and Maxillofacial Surgery and Director of the award winning Violence Research Group based at Cardiff University. Follow the Violence Society RG on Twitter @ViolenceSociety

[NP & JS] Alcohol abuse is a major risk factor for violence. For this reason, interventions seeking to reduce alcohol consumption often form a central part of violence prevention strategies, both globally and domestically. Increasing the price of alcohol, for instance, has been linked to significant reductions in many alcohol-related disease and injury conditions, including violent injury. A study in England and Wales, for example, found a negative relationship between violent injury and the price of beer, after accounting for other potentially influential factors. The logic here is that higher prices mean we buy and drink less alcohol – an assumption that is well supported by numerous peer-reviewed studies. From this, we understand the relationship between alcohol price and violence as a two-stage process; first, from alcohol price to alcohol consumption and second, from alcohol consumption to acts of violence.

But, in this previous study, violence was measured using rates of emergency department (ED) attendance between 1995 and 2000, and the price of beer was based on the average value of a single pub-bought (tavern-bought) pint over the same period. Acknowledging that purchasing trends and licensing laws have changed over the last two decades, we at Cardiff University’s Violence Research Group – the authors of the original study – repeated the study using the same ED violence measure but substantially extended the scope of the research beyond the price just of beer and on-license prices.

This latest study – recently published online in Injury Prevention – compares violence-related attendances from 100 EDs across England and Wales between 2005 and 2012, with alcohol prices (including beers, wines, spirits, and ‘alcopops’ – flavoured alcoholic beverages) from both on-trade (e.g. pubs and clubs) and off-trade (e.g. supermarkets and off-licenses) alcohol outlets. In support of our previous finding, the risk of violent injury was once more strongly negatively related to the price of alcohol in both outlet types; again, taking into account the influence of other potential confounding factors.

The implications of these findings are both theoretical and practical. First, because alcohol prices are not affected by rates of violence, the argument that links between violence and alcohol simply reflect the propensity of violent people to drink more alcohol than people who are nonviolent can be dismissed in this instance. Second, and most importantly, our findings showed that as little as a 1% increase in alcohol prices could reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales by around 6,000 patients per year. Crucially, to achieve such a substantial reduction, the price of alcohol must be raised in both on-trade and off-trade outlets. This would mean, since on-trade prices were found to be more influential in driving violence and that alcohol prices in this trade are already far in excess of the proposed minimum unit price (MUP) range of around 45-50 pence in the UK, that alcohol pricing policies which focus on tax increases are likely to have a greater influence on violent injury than MUP.

Together with similar findings from the USA, this research provides compelling evidence that making alcohol more expensive would reduce violence. Increasing the price of alcohol through tax increases is a national intervention which would be relatively straightforward to implement. The evidence speak for itself: even small price increases could substantially reduce alcohol-related harms, lead to safer towns and cities, decrease costs to health and criminal justice services, and increase revenue for governments.

So what are policy makers waiting for?

 

Ohio – “the epicenter of the heroin epidemic”

1 Oct, 15 | by Angy El-Khatib

Unintentional drug overdose deaths have increased in the last decade in the United States. In the state of Ohio (which is where I now work as a researcher!), unintentional drug overdose is the leading cause of injury-related death (ODH, 2014).  Since 1999, more than 13,000 Ohio residents lost their lives to unintentional drug overdoses.  Based on 2014 preliminary data from death certificates, unintentional drug overdoses caused the deaths of 2,482 Ohio residents – a 17.6% increase compared to 2013.

Number of Deaths and Death Rate per 100,000 from Unintentional Drug Overdose by Year, Ohio Residents, 1999-2014

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Source: Ohio Department of Health, Office of Vital Statistics; Analysis Conducted by Injury Prevention Program

The rise in drug overdose deaths is thought to be attributed to the reemergence of an opioid called “fentanyl” – a synthetic opiate that is that is 30 to 50 times more potent than heroin; often times, fentanyl is mixed in with other commonly abused drugs, like heroin.

According to the National Forensic Laboratory Information Systems (NFLIS) – a U.S. Drug Enforcement Administration program that collects drug chemistry analysis results from cases analyzed by state, local, and federal laboratories – fentanyl drug seizures in the South, Northeast, and Midwest parts of the United States increased by 300% from the second half of 2013 to the first half of 2014.

Fentanyl-Related Drug Overdoses, Ohio, 2012-2014

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Source: Ohio Department of Health, Office of Vital Statistics; Analysis Conducted by Injury Prevention Program

Six days ago, the Washington Post released an article calling Dayton, Ohio “the epicenter of the heroin epidemic.” This is likely due to several different drug trafficking groups having easy access two major highways: (1) I-70 is used to move their product east to west to Indianapolis, Indiana and Columbus, Ohio; while (2) I-75 is used to move drugs north to south from Toledo, Cleveland, and Cincinnati in Ohio.

Intersection of Interstate-70 and Interstate-75 in Ohio

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With this in mind, and since 2011, the state of Ohio has been partnering and building on several initiatives to improve interdiction, raise awareness, reduce prescription abuse, and expand treatment options.

As a harm reduction strategy, Ohio Governor John Kasich signed HB 4  into law on July 16, 2015.  This allows pharmacists and pharmacy interns to dispense naloxone, an opiod overdose reversal medication, without a prescription but in accordance with a physician-approved protocol and while calling 911 for medical assistance. When administered through intramuscular injection, intranasal spray, or auto-injector, naloxone reverses the effects of an overdose by blocking receptors in the brain from the effects of opioids while restoring breathing.

Another harm reduction strategy used by opioid overdose prevention programs (OOPPs) are take-home naloxone kits. Recently published in the BMJ – Injury Prevention, researchers Kelly Gurka, Alexnadria Macmadu, and Herbert Linn, found that the acceptability and feasibility of a take-home naloxone program was high among participants.

Both harm reduction strategies empower drug users to protect themselves and others. Although objections exist over economic benefit and moral disarray, working on preventing overdose deaths rather than focusing exclusively on stopping opioid and opiate use may be more developmentally and culturally appropriate and may enable drug users to pursue effective treatment.

 

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