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Offbeat

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.

 

 

 

 

 

 

Response to John Langley from the Patron of Paper Cuts

3 Nov, 14 | by Barry Pless

For some while Langley and I have been debating whether injury prevention workers  should try to prevent all injuries because (as I reason) we simply cannot predict which will be severe, or, as he argues, we need only prevent those that will be serious. After some  back and forth, in a recent issue of Injury Prevention Langley wrote a long letter that ended by attempting to ridicule my position. It concluded, “Accordingly, I intend to nominate him as a Patron of the about to be formed International Society for the Prevention of Paper Cuts.” Because we are such good friends, I wrote the following by way of rebuttal. Wisely, however, our editor decided ‘enough is enough’,  declined to publish my response but agreed I could post it here. Enjoy!!

(PS – If you are not familiar with the poetry of Edward Lear (1812-88), especially his limericks and nonsense poems, you are missing a huge chunk of  enjoyment. Make haste to your local library and read on!!!)

Response to Langley’s letter “Severity of injury can be assessed on a number of dimensions” (Injury Prevention, Inj Prev 2014;20:218)

 How pleasant to know Prof Langley

Who has written such volumes of stuff.

Some think him ill-tempered and dangly

But I find him pleasant enough.

 

His mind is concrete and fastidious,

His nose is remarkably big;

His visage is not at all hideous,

His beard (when he has one) is a twig.

 

He sits in a beautiful parlour (that’s queer),

With hundreds of books on the wall,

He drinks a great deal of marsala (read ‘beer’),

But hardly gets tipsy at all.

 

He has many friends, lay and statistical,

Old Jack is the name of his dog;

His body is far from spherical,

And his hat resembles a log

 

My problem is simply stated:

I beg he explain how to tell

(Without being singularly ‘creative’)

When a fall will break, bruise, or be well!

 

POIS studies are flawed we are told

Because subjects are not hospitalized

This contradiction leaves me cold:

As many are long disabled or immobilized!

 

Langley would have us believe mostly

We need only prevent injuries severe or costly

He assures he can tell, which will be which

POIS recruitment shenanigans just a glitch

 

When he writes in scholarly journals,

His old editor chides him so!

Calling “He’s gone out in his nightgown,

That crazy old Kiwi, oh!”

 

He should weep by the side of the ocean,

He should weep on the top of the hill;

He thinks he can foresee the future,

But contradicts himself yet and still

 

Yet I am not swayed, ‘Patron of Paper Cut Prevention’ is fine

Over them I happily reign (pronounced ‘rine’),

But if the paper cuts an artery first grade

Would John remain quite so sanguine? (pronounced sang wine)

 

He reads, does not use logic, or speak Spanish,

Does not abide ginger beer, or reason till dawn;

As the days of his pilgrimage vanish,

How tough to debate Langley John!

 

(with apologies to Edward Lear)

Work-related traumatic brain injury

29 Oct, 14 | by Bridie Scott-Parker

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

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

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

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

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

 

Non-suicidal self-injury: Another effective avenue of intervention?

15 Oct, 14 | by Bridie Scott-Parker

The 10th of October is World Mental Health Day, and here in Australia a variety of activities helped ensure that mental health was openly discussed during Mental Health Week (5-12 October). As a researcher who works with adolescents, I am interested in their mental health, particularly as it can have pervasive implications for their injury prevention. I thought I would share an interesting article regarding non-suicidal self-injury (NSSI), an intentional injury which unfortunately has been found to be associated with a breadth of other injuries including suicide.

As part of a larger study exploring how adolescents cope with emotional problems, Voon, Hasking, and Martin (2014) explored the role of a number of variables in NSSI amongst a sample of 41 Australian high schools (Time 1 n = 2637 students; Time 2: 12 months post-baseline, n = 2328; Time 3: 24 months post-baseline n = 1984). Lifetime prevalence of NSSI increased over time (8.1% – 10.1%), with adolescents engaging in NSSI typically starting the behaviour aged 12-14 years. Experiencing more adverse life events and high psychological distress increased the risk of the first episode of NSSI, consistent with other research findings that adolescents respond to acute life stress and emotional distress through NSSI. This suggests that adolescents in these tumultuous states could benefit from NSSI-targeted interventions which could prevent NSSI include cognitive reappraisal in particular.

The ripple effect of such support for adolescents in particular could indeed offer another effective avenue of intervention for a breadth of injuries during the developmental period of adolescence and young adulthood.

Pedestrian safety video worth watching

6 Oct, 14 | by Barry Pless

Ted Miller, editorial board member and famed for much else, kindly sent a link to an excellent youtube video that I urge you to watch. I do so because I have long cautioned that pedestrian signals can be dangerous if you assume that cars will always respect them. I plead with my friends, family, and former patients (I am now retired) to always establish eye contact with drivers before assuming that a green light means it is safe for you to cross. This is especially true for elderly folk like me. But it seems youth in particular are often impatient at crossing lights and this video presents one way to keep them from jumping the light. It is very clever and I hope the strategy will be widely adopted. Even then, however, I still recommend eye contact with the nearest driver before stepping onto the road. The video is here: https://www.youtube.com/watch?v=SB_0vRnkeOk&feature=share

Let me know what you think. Just copy and paste the link into your browser. Thanks Ted.

Different questions for more answers?

19 Sep, 14 | by Bridie Scott-Parker

This week I have been pondering the larger issue. You may wonder what brought this on?

I live in Queensland, the Australian state with the dubious title of ‘skin cancer capital of the world’. I was a child of the 70’s. We spent hours in the sun covered in all sorts of oil that smelled great (coconut especially) to see who could get the darkest tan in the shortest time possible. Sleepovers often involved mutual peeling of large segments of skin, which ended up being some sort of weird Silence-of-the-Lambs-esque trophy. Slip, slop, slap was new, and for the social misfits only.

Needless to say in an era of increased awareness of the considerable skin cancer risks of too much sun exposure, I am very proud of the fact that my children have never been sunburnt. Well, I can no longer say this.

One day this week my 14 year-old son returned from a school field trip redder than a tomato, despite his protestations that yes indeed he did wear his hat (it kept blowing off in the wind at the beach, according to his urgent explanation to his very cross mother) and yes indeed he did wear sunscreen (apparently of SPF1 as he was red red red!). As a child who wears glasses, I was particularly concerned about a long day in which the sun’s UV rays were concentrated into his eyeballs. He (unconvincingly) claimed that he wore his sunglasses all day. Even worse – his maternal grandmother had a particularly nasty and aggressive skin cancer cut from her face just one week earlier, so sun protection is very high on our family’s radar at the moment!

After a lengthy – and at times loud – discussion about the need to look after his skin particularly in our climate, and that now he is growing up he needs to start taking care of his own health (yes, he did agree that having Mum attend the field trips with him would be embarrassing, and yes, it would definitely harm his reputation with the opposite sex), I started to think about injury prevention more generally.

Initially I had tried to identify the predictors of risk as a way to intervene: what about this field trip contributed to him being sunburnt? Like most injury prevention researchers, we want to know what contributes so we can ameliorate or eliminate it altogether. According to him, hat, check; sunscreen, check; sunglasses, check. Then I started to think about it a different way. What about this field trip helped him be less-sunburnt? What protected his classmates from sunburn (if indeed, as I hope, some managed to avoid the sun’s wrath)?

Maybe as injury prevention researchers we should be spending more time considering what helps to minimise risk, not only what increases risk. I think these ‘different questions’ will lead to more answers in the long term. Think big picture!

Engagement appears the key

25 Aug, 14 | by Bridie Scott-Parker

Regular readers of the Injury Prevention blog will be well aware with my obsession with engagement. Traditionally, injury prevention – such as in road safety – focuses on the “Three E’s” of Engineering, Enforcement, and Education. I think that Engagement is the fourth, often-forgotten, essential “E”, albeit it can be very tricky to actually manage, and manage effectively.

I was interested to read the engagement experiences of a team of Australian colleagues who trialled an online injury surveillance program in 78 community sports clubs in five football leagues (see http://www.injepijournal.com/content/1/1/19). I have previously blogged regarding injuries in sports such as football, and in particular related to concussion, and this and similar contact sports continue to be of interest to injury prevention researchers, practitioners, and policy-makers. As such, community-based injury surveillance can help everyone from persons in injury prevention to those actually on the sports field. While Ekegren et al note that 44% of the 78 clubs targeted for the intervention actually adopted the program, overall only 23% of the clubs implemented the program by recording injuries in the online program in 2012, and 9% maintained the program by recording injuries in 2013.

Barriers included personal factors like a lack of importance being placed on injury surveillance; socio-contextual factors such as staff shortages/changes, injury underreporting, lack of leadership/support for reporting injuries; and system factors included technical issues, data requirements, time to input data, and adjusting to a new online reporting system. Notwithstanding these barriers, facilitators include recognition that injury surveillance is important and is part of the trainer’s role (personal factors); association with a simultaneous injury prevention program (socio-contextual factors); and ease of use (system factors).

Engagement to reduce barriers and maximise benefits appears essential, and expertise and guidance in engagement appears to be a definite need in the realm of injury prevention across all domains of injury. In my own area of young driver road safety, I and others struggle to engage one key partner: parents. Perhaps learnings from one domain can help other domains, and information sharing is vital.

Domestic violence

4 Aug, 14 | by Bridie Scott-Parker

Blog readers are well aware of my passion for conferences – the immeasurable benefits that can arise from presenting, networking, developing and maintaining collaborations, and sparking ideas, just to name a few. So today I won’t talk at length about the wonderful experiences I had last month as I spoke at a conference in Paris, then at another conference in Krakow. I will talk, however, about domestic violence.

Whilst in Europe, I had no idea that a verdict had been handed down in a local murder trial which has grabbed our attention since the victim’s disappearance more than two years ago (see http://www.brisbanetimes.com.au/queensland/gerard-badenclay-found-guilty-of-murdering-wife-allison-badenclay-20140715-ztdon.html). I also had no idea of the insidious nature of the domestic violence, inflicted upon the victim, which emerged during the trial and has insipired a variety of responses including efforts to start a dialogue around the unacceptability of domestic violence  (eg., see http://www.couriermail.com.au/news/queensland/tragedy-of-allison-badenclay-inspires-cousin-to-set-up-online-antidomestic-violence-site/story-fnihsrf2-1227006310512?nk=e46ae81c51bf6c72de6319e37bb46706).

It is easy to lay blame and cast judgement in such circumstances. Some will lay blame at the perpetrator’s feet. Others will lay blame at the victim’s feet. Hindsight is frequently 20/20, and laying blame may not help those in a similar situation. Rather, is there a way we can break the victim/perpetrator dynamic by understanding the victim’s perspective, with the ultimate goal of supporting the victim to extricate themselves from this situation?

A recent article by Taket, O’Doherty, Valpied, and Hegarty (see http://www.ncbi.nlm.nih.gov/pubmed/24925714) summarised the interview responses of 254 women who had experienced intimate partner violence. Interestingly, as noted by the authors, “The sample of women was extremely diverse in terms of their experience of abuse, including those still actively working to improve the relationship; those who were staying in the relationship and could not see how it could change; those working to stay safe in the relationship while they worked out how to leave; those in the process of ending the relationship and sorting out finances, housing, and custody of children (if applicable); and those who had ended the relationship but were still experiencing abuse and/or were dealing with the physical or psychological effects of abuse.” Participants shared a range of experiences and advice relating to what they value – and do not value – from their family and friends, including instrumental, informational, emotional and companionship support.

I was particularly touched by their concluding statement: “Notably, women value both support that is directly related to abuse and support related to other areas of life.” How can I help?

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