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Offbeat

The Mysterious Green Hand

24 Feb, 15 | by Barry Pless

FullSizeRenderI voted for the design of the Journal’s new cover even though I was not sure why I liked it better than the alternatives. I’m pleased that whatever attracted me to it pleased others as well. But, from the start, the small green hand has puzzled me. It seemed a bit mysterious and not just because it cleverly merged into the background. I’m still not sure what it is intended to represent. The red is obvious: it is what most injury prevention messages say, “Stop; don’t go here.” Or, “Don’t do this; it’s dangerous and could cause a serious injury.” So, the red hand is no mystery. But the green hand is another matter. It could mean many things.

 One thing I hope it is not intended to convey is that the Journal encourages risk-taking. I know some regard my opposition to this as foolish, but even if I’m wrong, at least I’m consistent because I’ve held this view for many years. Recently, however, some distinguished colleagues insisted that I was wrong because they were convinced risk-taking is essential for healthy child development. They even argued that risk avoidance was itself ‘harmful’. When I asked for evidence in support of these assertions they insisted that not all evidence needs to be ‘scientific’.

 Respectfully, I disagree. I am not an evidence-based evangelist but I do believe that there is a clear hierarchy in the many paths to knowledge. Most scientists agree that clinical wisdom, years of experience, or the convergence of opinions from diverse disciplines is not equivalent to what we learn from disciplined, well-designed research. They (and I) believe the best evidence comes from true experiments but we accept that these are often impossible in a field such as ours. So we often resort to quasi-experimental designs. But I hope there are not many among us who would accept that ‘proof’ of a position can comfortably rest only on anecdotal accounts or personal experience.

 Back to the green hand: I repeat that I trust it is not intended as a symbolic nod to those who are convinced that risk taking is essential to healthy development or even a good way to prevent injuries. Instead, I hope it is intended to say something like, ‘Follow me along this path. Evidence suggests it may be risky but it is safer than the alternatives.’ In other words, the green hand is intended to remind us that there is a middle ground. For example, some communities in the US and Canada have recently banned tobogganing on hills that were found to be extremely dangerous. I think this makes good sense. However, many of these and other communities pointed users to hills that are far less dangerous because icy patches and obstacles have been removed. 

I hope the green hand is there to wave us towards safer alternatives but NOT to urge abandoning reasonable caution.

 PS. I urge, beg, implore all who disagree to submit comments to this blog. Let’s liven things up and debate our views vigorously.

Cyclones down under

23 Feb, 15 | by Bridie Scott-Parker

Summer and cyclones – they seem to go together down under. Here in Queensland, we copped another battering over the last couple of days courtesy of category 5 Cyclone Marcia.

Each cyclone has the capacity to reawaken slumbering memories of other cyclones. For many Queenslanders, 2011 Cyclone Yasi is still very fresh in our memories. In the aftermath of the storm which was more than 600 kilometres wide, a record 99% of our state was declared flooded. Our children watched inside for close lightning strikes as my husband and I filled sandbags. Helicopters flew over our house with sirens alerting us to evacuate. How? To where? Our road was under fast-flowing water, and even if we could get through, all roads leaving our region to the north, the south, and the west (the ocean is to the east) were underwater. We had a plan, though – we were going to throw everyone in our neighbour’s boat, and tie my mother in her wheelchair to some inflatables and sail out if it came to that! Panicked hilarity, but it kept us sane when we had no land phone lines, no mobile communication options, and no way of knowing if any of our family members were washed away, for days.

Post-cyclone, I understand the focus on communicable diseases – the ensuing water creates the perfect home for creatures like mosquitoes which transmit some pretty nasty diseases. However, this morning I was pleased to see a paper by Ryan, Franklin, Burkle, Watt, Aitken, Smith and Leggat: Analyzing the impact of severe tropical cyclone yasi on public health infrastructure and the management of noncommunicable diseases. Having seen first hand the damage of Yasi, and knowing well the pervasive impact of noncommunicable diseases, this research tackles an issue relevant for all jurisdictions in our (at-times) temperamental home.

We continue our post-Marcia clean-up, but the latest sandbags are staying in close reach!

 

 

 

 

 

Crotchety post?

9 Feb, 15 | by Barry Pless

I recently came across a posting on some website or other about a ‘new study’ that discovered that poverty is linked to children’s injuries!! Am I alone is wishing that editors would resist publishing studies that simply repeat what is already well known? When a Journal asks authors to state “what this study adds” or something along those lines, I think reviewers need to look carefully at what is written and decide if the paper in their hands is not simply a ‘me too’.  And, please don’t say that some repetition is justified because it has never been shown to be true for Little Forks, Stateville, Timbucktoo before!

Or am I simply being too crotchety on this cold, miserable Monday in Montreal? And, yes, before I am leapt upon too vigorously, I do agree that most new findings require replication. But come on…. there must be a limit to how often a well documented finding can be reported!

Mentor VIP

9 Feb, 15 | by Barry Pless

I received this email from David Meddings. This excellent program seeks volunteers. Do consider doing so.

Dear MENTOR-VIP participants (past and present),

Applications for the ninth cycle of MENTOR-VIP are now open. This means individuals wishing to apply to be mentored during 2015-2016 may make their applications via our website (link given below) between now and May 8.

As you know, MENTOR-VIP is designed to assist junior injury practitioners develop specific skills through structured collaboration with a more experienced person who has volunteered to act as a mentor. The programme provides a mechanism to match demand for technical guidance from some people with offers received from others to provide technical support.

Mentoring arrangements may take place in whatever language or languages the mentor and mentee are comfortable to communicate in. The majority of interaction between mentor and mentee takes place through low cost electronic communication such as email, internet-based telephony, or telephonic exchange.

I would appreciate if all of you could take steps within your own communications to make people aware that the programme is now accepting applications. The main message for potential candidates is that applicants who wish to apply for one of the available positions must do so by the application deadline of May 8 through the capacity building section of WHO Headquarter’s website for injury and violence prevention.

All applications to the programme are made online and more detailed information is available at http://www.who.int/violence_injury_prevention/capacitybuilding/mentor_vip/.

Please feel free to forward this email within your networks and do let me know if you have any questions.

Best wishes,

David Meddings

Applications for MENTOR-VIP are now open
Do you work in the injury and violence field and want to improve your skills?
MENTOR-VIP is a global mentoring programme for injury and violence prevention developed by WHO and a global network of experts. Applications for mentees to be mentored during the 2015-2016 period are now open through May 8, 2015.
To find out more, or to submit your application to be mentored please go to:

http://www.who.int/violence_injury_prevention/capacitybuilding/mentor_vip/Mento

Workshop blog correction

2 Feb, 15 | by Bridie Scott-Parker

My apologies, it seems I need tuition in proof-reading! I mistakenly omitted Dr Ted Miller, Injury Prevention, as one of the Editors who will be leading the discussion at this great workshop.

SAVIR 2015 Workshop

1 Feb, 15 | by Bridie Scott-Parker

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

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

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

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

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

 

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

23 Jan, 15 | by Bridie Scott-Parker

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

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

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

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

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

 

The Missing Link

13 Jan, 15 | by Barry Pless

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

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.

 

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