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Policy

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.

Guest Blog: ‘Breaking Down Walls – Taking Translation and Dissemination to the Next Level’

26 Sep, 16 | by Angy El-Khatib

 

Often, when people think of translational research, it is through the lens of Grand Rounds, seminars, and conference presentations. It is usually clinical in nature and comes directly from the researcher. There is another type of translational research – NIH calls it Type 2 translation.

I am part of a Type 2 translational research team at a child injury research center. Our team of five has a mission to educate and empower the vast audience of people who care about kids and keeping them safe. We do this by sharing information on child injury in a format that is accessible by meeting health literacy guidelines and providing opportunities for prevention through realistic, actionable safety steps.

That’s a pretty lofty goal but we are very good at what we do. When researchers from our center publish papers, it is not unusual for their work to be picked up by media around the world. In the last six months, we’ve had two papers that had over one billion impressions (estimates of potential audience size), and two others that have had around one million impressions. It helps that our product is related to kids – it makes people care. But there is more to it than that.

In working with media, we strive to understand their needs and how to create value for them to cover our work. This is not as simple as it sounds. We spend several days working on a press release. Our hospital sees the value in the work we do and often contributes resources for us to create supporting videos, including sound bites, demonstrations, and B-roll.

We pay attention to the ever-changing way the masses consume information, staying up to date on the pulse of the public to meet them where they are. Gone are the early days of technology where you could create a website, direct people there, and then forget about it. Now, a website must stay fresh, providing new content frequently. It must also stay current in the way it looks. If its appearance is outdated, no one will look at your information because there will be the assumption (correct or not) that what is on the site is also likely outdated. People may believe you and/or your organization are outdated, or worse yet, irrelevant. We constantly assess social media platforms, analyze how we can best use them for maximum effect, and then develop our marketing plans.

We talk to doctors, administrators, researchers, and other public health professionals about the findings of our research. We also train them to effectively communicate with those who trust them and look to them for guidance. After that, we can’t sit back and rest on our laurels – we have to do it all over again, and then again. By doing all of this, we increase the likelihood of and the speed with which our research can lead to changes in policy, regulation, and behavior.

In the realm of translational research, teams like ours are not the norm and our team didn’t become this successful overnight. When our manager began her quest to have a team devoted to translational research, translation and dissemination were barely on the radar. Beyond journal publication, dissemination typically just meant printing  copies of a paper and having it available upon request or presenting it at conferences. Our manager had a vision of something bigger and better. She specializes in health communication and has the passion and drive to push for what she believes in. Her director supported her vision and was willing to take a chance on, and fund, something that really hadn’t been done.

Slowly, she grew her team. What makes us effective and successful is that although we each have our own projects to manage, we bring our complementary sets of skills and experiences to the table, both literally and figuratively, collaborating on all of our products. These products include press releases, multi-media releases, media interviews, blog articlescynthia-anderson-profile-picture, website development and management, social media outreach, toolkits, photo shoots, conference planning, and network building. We hone our work through brainstorming sessions, writes, edits, and re-writes. Our work is always better after it has been through the rounds of the team.

Our manager began winning over colleagues one researcher at a time, as they saw the reach and the impact of their work grow. It took 10 years for her to get her team to where we are now – having a big impact and doing innovative work that can help keep kids safer.

Written by:
Cynthia Anderson, MPH, CHES.
She is a Program Coordinator at The Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. She can be contacted at cynthia.anderson@nationwidechildrens.org.

 

 

Censoring research

23 Jun, 16 | by Barry Pless

I am posting this for all Injury Prevention blog readers who are researchers or interested in research. I do so in part because John Langley is one of the pioneers in our field and was one of the Senior members of our editorial board from IP’s earliest days. But I also do so because the issue that prompted him to write this op-ed for his local Otago paper is by no means restricted to New Zealand. It is a widespread and important issue that has the potential to corrupt research in all manner of ways. IBP 

Read it and think carefully about the implications for your own work. Thanks to John for sharing it and for ODT for permission to reproduce it. Thankfully Injury Prevention, to the best of my knowledge, has never had to deal with this issue.

 Restrictive publication clauses in health research contracts

I was both pleased and disappointed to read the two ODT articles (20 February, 5 March) on this subject. Public airing of this important issue is long overdue. I was disappointed as I gained the impression that despite several scientists publicly expressing their concerns, the University of Otago Deputy Vice-Chancellor for Research appeared to have none. The Deputy Vice-Chancellor’s apparent lack of concern, however, is consistent with my experiences of research administration at the University.

For 20 years I was the Director of the University of Otago’s Injury Prevention Research Unit. This Unit was entirely dependent on funds from government agencies. Contrary to my expectations, the University of Otago did not pro-actively seek to protect me, or the public, from clauses in draft contracts that placed restrictions on publishing research findings. Protecting researchers increases the chances that they can serve the public interest, and meet the University’s legislated role of being the critic and conscience of society.

I spent a significant amount of time challenging clauses that would allow a government agency to censor a finding they disagreed with, or deny the right to publish work at all. On a couple of occasions during contract negotiations I was reminded by government agencies that they could purchase the outputs they wanted from other Universities or private organisations who would accept the restrictive clauses.

Why would Universities be accepting these clauses? I believe a key factor is the importance of, and competition associated with, generating research income. Collectively, NZ’s eight publicly funded universities derive approximately 15% of their income from research contracts. The success a University has, relative to others, in obtaining external research funds also has a significant role in determining the funding it receives from government through the Performance Based Research Funding scheme. Research income is critical to ensuring high quality research, thereby maintaining and enhancing a university’s reputation and thus attracting students, staff, and further funding. The purchasers of research can use the competition between universities, and researchers, to their advantage in getting restrictive publication clauses accepted.

Private research suppliers can accept restrictive publication clauses as they are typically uninterested in publishing in peer-reviewed journals and have no statutory or moral obligation to serve the public interest. While they would produce a research report for the purchaser, these reports are not frequently published, easy to access, or subject to rigorous quality control, e.g., independent peer review.

It was also my experience that many senior researchers did not care about the restrictive clauses. Why would this be so? Success in attracting research funding is, for most researchers, critical to pursuing their research, producing publications, and to promotion and public recognition.

This behaviour contrasts with Royal Society of New Zealand’s (RSNZ) Code of Professional Standards and Ethics in Science, Technology, and the Humanities. Section 8.1 of that code states that members of the Society must: “oppose any manipulation of results to meet the perceived needs or requirements of employers, funding agencies, the media or other clients and interested parties whether this be attempted before or after the relevant data have been obtained;”

I accept the right of a purchaser of research to see an advance copy of any paper for publication and to make any comments on it. But requiring modification beyond correcting factual errors is unacceptable. Even purchasers suggesting toning down a phrase here and there and putting in some qualifiers is problematic from a purchaser who is concerned to minimize bad publicity that might arise from the paper. It also places the researchers in a bind. Should they comply? If they don’t comply are they putting at risk future research funding from the purchaser? I suggest they might be. Why deal again with a ‘difficult’ group of researchers when you can purchase the work elsewhere?

The best approach to this issue is transparency. Make the deliberations between researchers and purchaser accessible to all as in the open review practiced by some scientific journals so readers can trace the discussion. This approach would not deal with contracts that explicitly prohibit the researchers publishing at all.

The Health Promotion Agency (HPA), a crown entity, charged with promoting healthy lifestyles recently put out a request for proposals (RFP) to assess whether the reduction in trading hours in Wellington has any impact on alcohol-related harm. The ‘indicative’ contract for this RFP stated: The Supplier will not publish the results of the Services undertaken pursuant to this Contract”. Only when challenged did HPA advise that it was a negotiable clause. Potential University researchers interested in bidding for such research should be able to take the ‘indicative’ contract as a reflection of the intent of the purchaser. Irrespective of this, preparing a high quality research proposal involves significant resources and many researchers would consider it was not worth the effort given the uncertainty of their right to publish.

In effect, some government purchasers are getting to decide what findings, if any, the public gets to see from research the public has paid for, either by pressuring some universities to accept restrictive clauses or by buying what they want from private suppliers.

Universities of New Zealand, the representative body of New Zealand’s eight universities, and the RSNZ need to enter in discussions with Government with a view to ensuring government research RFPs do not impose these restrictions. Interference with researchers ability to bid for, execute, and publish research compromises the role universities have as critics and conscience of society.

We need an independent audit of government research contracting to determine to what degree restrictive publication practices and the use of private suppliers is undermining the public’s right to be fully informed of the findings of research they have paid for.

Emeritus Prof John Langley

Concussion in sport: Changing the “Culture”

8 Jun, 16 | by Sheree Bekker

 

photo by Scott Beale / Laughing Squid This photo is licensed under a Creative Commons license. If you use this photo within the terms of the license or make special arrangements to use the photo, please list the photo credit as "Scott Beale / Laughing Squid" and link the credit to http://laughingsquid.com.

Photo by Scott Beale / Laughing Squid CC BY-NC-ND 2.0

[SB] Concussion remains the current hot topic in sports injury prevention. Injury Prevention has published many an article on the topic, including the recent An examination of concussion education programmes: a scoping review methodology. I have blogged about this here too.

I have invited Dr Johna Register-Mihalik (follow her on Twitter @johnamihalik), an assistant professor in the Department of Exercise and Sport Science at The University of North Carolina at Chapel Hill, to share her thoughts on concussion prevention with us. Dr Register-Mihalik serves as a research scientist at the Injury Prevention Research Centre at UNC-CH. She is on the Brain Injury Association of North Carolina Board and USA Baseball’s Medical and Safety Advisory Committee, and is also an active member of the National Athletic Trainers’ Association (NATA) and the American College of Sports Medicine (ACSM), amongst others.

[JRM] Few injuries receive the attention and the discussion that concussion does, especially those occurring in sports such as football, in both the mainstream and medical communities. Concussion is a complex injury that is the result of forces transmitted through the brain, resulting in a complex neurometabolic cascade leading to a wide array of signs and symptoms. The more we learn about concussion, as well as exposure to head impacts, the more we realize that we don’t know. It is an injury, that – perhaps because it is the brain that is affected – most in the sporting community are hyper aware of, regardless of level of participation.

However, due to this increasing attention and focus, one of the most common discussions and recommendations is to change the “culture” to improve safety concerning concussion and head trauma. However, when we say “change the culture”, what are we actually trying to change? Certainly, we can think of key things we want to see changed universally, such as: recognizing as many injuries as possible, student-athletes disclosing these injuries if they haven’t been identified (when possible), individuals and organizations consistently adhering to  no same day return to play, no student-athlete returning to play without clearance from a medical professional with the training to make the decision, and perhaps more general, a sporting environment that encourages safe practices, not playing through injury, and creates a positive environment for players, coaches, fans, and families alike. I am sure we could continue to add to this list of things we want to change or see as a consistent part of sport. However, most factors or behaviors around the culture of sport are complex and multifaceted.

For one, many aspects of the culture of sport that are at their core good, may progress to risky decisions down the road. Let’s take the concept of persistence and not quitting. While at the core those are good things, these may be the constructs that then drive playing through injuries, especially those like concussions that we cannot always see.  While no studies have directly addressed these relationships, data does highlight not wanting to let teammates or coaches down and not wanting to be pulled from play as primary reasons for not disclosing a concussion (McCrea, 2004, Register-Mihalik, 2013; Kerr, 2016). In addition, there is data to show that even some of the efforts that we direct to improve the culture, may have a negative effect (Kroshus et al, 2015) . This body of work highlights the importance of careful thoughtful messaging and imagery giving in our educational sessions, videos, and programs.

The type of change we talk about around concussion and head trauma is multifaceted. As such, the work to truly improve outcomes, improve behaviors, and create a “safe” environment (both social and physical) must also be multifaceted and affect multiple levels of the socio-ecological framework. It is also work that should be thoughtful, not sensationalized, and rooted in evidence – which can all be difficult things in the face of such heightened attention around a topic, where many have opinions. The work to truly insightful change will continue to require an interdiscplinary and community-based approach to not only develop the interventions and tools for change, but to see them be both successfully implemented and sustainable. I for one am excited about this work ahead and look forward to working with others to continue to see change happen for the better.

“The Beautiful Game”… minus headers?: Discussing USSF’s recent announcement to limit headers in youth soccer leagues

23 Nov, 15 | by Angy El-Khatib

In the United States, sports-related traumatic brain injuries (concussions and otherwise) have been a HOT topic. In 2013, approximately 4,500 former NFL players sued the league, claiming that the NFL failed to educate, manage, and protect its players from head injuries. Judges approved a settlement of $765 million that would fund concussion-related compensation, including medical exams and research for ex-players. This past year, Chris Borland, a 24 year-old, highly revered linebacker, decided to retire after playing only one year of professional football. His reasoning was that football was “not worth the risk” to his health.

The NFL is not the only sporting organization looking at concussions among its players; other organizations include the National Hockey League (NHL) and the National Collegiate Athletic Association (NCAA). Most recently, the U.S. Soccer Federation (USSF) announced that it has developed a set of guidelines for its youth leagues in which it recommends a ban on headers for players ages 10 and under and a limit on headers for players between 11 and 13 years of age. The USSF also developed a standard protocol in which medical professionals, as opposed to coaches or referees, make decisions about return-to-play for players who are suspected of sustaining a concussion.

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The USSF developed these guidelines in response to a class-action lawsuit which targeted six of the largest youth soccer groups, including FIFA, U.S. Youth Soccer, and the American Youth Soccer Organization. The lawsuit claims that these organizations have “failed to adopt effective policies to evaluate and manage concussions.”

But will policy changes – “banning headers” – solve the concussion problem among youth soccer players?

Unlikely.

A September 2015 study in JAMA by Comstock, et al. evaluated trends in soccer concussions among youth players. The study found that the most common concussion mechanism was contact with another player (player-player), not a ball – this is consistent with other literature.

The most common mechanism for all concussions was contact with another player, accounting for 68.8% of all concussions among boys and 51.3% among girls. The most common mechanism among heading-related concussions was also contact with another player, accounting for 78.1% of heading-related concussions among boys and 61.9% among girls.

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Among soccer-specific activities, heading was responsible for 30.6% of concussions among boys and 25.3% of concussions among girls.

The study concludes that reducing athlete-athlete contact across all phases of play – not just headers – would be more likely to prevent concussions. It also mentions that, culturally, banning headers may not be a feasible prevention effort. After all, an integral part of the Beautiful Game is headers (Robin Van Persie during the 2014 FIFA World Cup, anyone?). The soccer community, anecdotally, seems exceptionally resistant to the prospect of banning headers. As injury researchers, we know that one of the most important aspects of a successful and effective public health intervention is cultural feasibility.

With this in mind, I don’t think it is likely the USSF’s announcement about banning or limiting headers will significantly affect the epidemiology of concussions in youth soccer.  At most, this sends a strong message to coaches and brings safety management to the forefront. (The new rule which requires a Health Care Professional, [shoutout to Athletic Trainers!] to be present to make decisions regarding concussions instead of coaches or referees could be positive, though!)

Either way, one has to commend USSF’s attempt at targeted prevention efforts to bring soccer to its high and honorable state:

 

Joga Bonito!

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P.S. – you’re not allowed to make fun of me for calling it “soccer” instead of “football”! 🙂

Dissemination and implementation of best practice in falls prevention across Europe

28 Aug, 15 | by Bridie Scott-Parker

As injury prevention researchers, practitioners, and policy-makers, we are all aware that falls are an important public health issue. Today I wanted to profile a novel approach to preventing falls. Dr Helen Hawley-Hague of the University of Manchester is the Scientific Coordinator of ProFouND, the Prevention of Falls Network for Dissemination, and she has shared with me some information regarding this innovative injury prevention approach.

ProFouND is a European Commission-funded initiative dedicated to bring about the dissemination and implementation of best practice in falls prevention across Europe. ProFouND comprises 21 partners from 12 countries, with a further 10 associate members. ProFouND aims to

  • influence policy to increase awareness of falls and innovative prevention programmes among health and social care authorities, the commercial sector, NGOs and the general public,
  • ultimately increasing the delivery of evidence-based practice in falls prevention and
  • therefore reducing the numbers of falls and injurious falls experienced by older adults across Europe.

ProFouND contributes to the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), with the ultimate objective of adding an average of two active healthy life years to the lives of European citizens by 2020. ProFouND’s objective is to embed evidence-based fall prevention programmes for elderly people at risk of falls using novel ICT solutions in at least 10 countries/15 EU regions by the end of 2015, thus to reduce falls incidence in those regions by 2020. The following resources are available to support falls injury prevention:

  1. ProFouND Falls Prevention App (PFNApp), accessible for registered health care practitioners and available in multiple languages;
  2. Cascade training using face-to-face and e-learning approaches and available in multiple languages; and
  3. A free resources library, in addition to information regarding upcoming conferences, and other recent research.

Having seen the ramifications of falls in my own family, with my elderly grandmother fracturing both her pelvis and vertebrae in one fall, this program definitely seems like a step in the right direction!

 

 

“Drive Your Bike, Don’t Just Ride It”

21 Aug, 15 | by Angy El-Khatib

Last week, I wrote a short blog highlighting a publication in this month’s issue of Injury Prevention which stressed the need to gather “better” data as a step towards improving future bicycle safety endeavors.

This week, I am absolutely delighted to introduce a guest blog by someone who is equally passionate and enthusiastic about data as he is about bicycle safety – my mentor and inspiration, Dr. Christiaan Abildso (follow him on Twitter at @walkbikemgw)! He is an assistant professor in the Department of Social and Behavioral Sciences at WVU School of Public Health. His main areas of research include health promotion program evaluation and the social ecological determinants of physical activity, including policy and the built environment. Recently, he presented “The Burden of Pedestrian- and Cyclist-Motor Vehicle Crashes (PCMCVs) and Costs in West Virginia: 2000-06” as a part of the 2014 WVU Injury Control Research Center’s webinar series (you can watch it here).

Christiaan rode his bike to the 2015 MPH and PhD graduation ceremony while wearing his academic dress.

Christiaan rode his bike to the 2015 WVU MPH and PhD graduation ceremony while wearing his academic garb.

Christiaan has two very notorious and very utlized catchphrases; the first is “I love data!” and the second is “Change the world!” which he very well does by engaging in the community. He served as the Chairperson for the Morgantown Pedestrian Safety Board from 2008 to 2014, has been an Ex-officio Member of the Morgantown Municipal Bicycle Board since 2012, and is a current member of both the West Virginia Connecting Communities and the Morgantown Traffic Commission.

Since this month’s blogging topic was to be focused on bike safety, I asked Christiaan to write a guest blog about his own experience as he transitioned from a novice cyclist to a trained traffic rider.


 

“Drive Your Bike, Don’t Just Ride It”
By guest blogger: Christiaan Abildso

My first taste of freedom was experienced on a teal-green Peugeot in the mid-1980s in suburban Washington DC. With each passing summer and my super cool 5-speed, I was given more and more leeway by my parents to “ride to John’s house,” then to Tom’s house, then to the community pool and parks. As a young lad in pre-helmet days I had a great time riding on and off sidewalks, and on wide streets mostly of 25 mph speed limit. It was suburban America in a Levitt town in the summer. I was safe.

As I grew up I rode less or not at all until I got back into bicycle commuting about 6 years ago when I became a father, gas prices were high, and I didn’t have time to go to a gym. I began to experience that freedom yet again. However, I was now riding in a more urban environment with more traffic, narrower lanes, no bike lanes or separate infrastructure, and less kindness toward me as a cyclist – let’s face it, kids on bikes get more leeway to mess up than mid-thirties cyclists! One day, I moved from the end of 5 cars at a red light in the left lane in a three lane, one-way downtown road to the middle lane to be at the front of the traffic. I did this to jump the traffic and move back over in front of the left lane traffic to make a turn. As I jumped back to the left lane, a kind gentleman driving by leaned his Livestrong band covered left wrist and wagged a finger at me, saying “you should know better. You’re gonna get killed.”

This statement made me think, what did I do wrong? That moment began my evolution from thinking like a “bike rider” to thinking like a “bike driver.” I began seeking the opinion of Frank Gmeindl – a League of American Bicyclists certified League Cycling Instructor (LCI) in Morgantown, WV, and uber-experienced rider with tens of thousands of miles of experience. He offered to ride behind me one day giving only these instructions (as I recall them): 1) ride like a vehicle, 2) be predictable, 3) be seen, and 4) take the lane. Following the ride – during which, in retrospect, I did a bunch of things that put me in harm’s way (like riding as far to the edge of the road as possible) – Frank patiently offered these same four suggestions, then took the lead. His few suggestions have, without a doubt, saved my life.

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Christiaan playing the “hipster” and picking up his Community Supported Agriculture (CSAs) on his bike.

I continued to seek out information, eventually taking the Safer City Cycling class offered by Frank and another local LCI. I have ridden thousands of miles over the past few years with the advice of Frank and others in my head. I now am confident enough in my abilities to ride in almost any condition on nearly any road without fear. Over the years I have evolved to be very calm in traffic and now help others when I see them riding in a way that puts them (or me as “one of those pesky bikers”) at risk of injury. I honed in on one statement I heard or read a few years back that summarizes how to operate a bicycle: “Drive your bike, don’t just ride it.” That neatly summarizes Frank’s four key lessons, and I often use that with others when they say I’m crazy for riding all the time and on almost any road. I also make an offer to them, as Frank did, to go for a ride to help.

To my fellow cyclists, when in traffic. Remember, we are traffic. We are adults. Vehicle drivers don’t want to hit us.

My advice when in traffic: Be seen. Be predictable. Take the lane. Drive your bike like you would a car…and, give a hand of thanks when a vehicle driver treats you well. It will make driving a bike safer for all of us.

 

 

Follow Dr. Christiaan Abildso at @walkbikemgw!

Concern for prehospital care/ambulance services

10 Aug, 15 | by jmagoola

I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.

In this scenario, all the ambulance is manned by only a driver (no paramedic, no nurse) whose role is to pick you up and drop you at the nearest health facility. One of 2 ambulanes currently used by the district to transport patients during emergencies.No triage, no first aid, no prehospital care until arrival. This could contribute to the trauma mortality rates, which are already higher in rural areas before victims reach the hospital. It is known that travel time is a predictor of the outcome of an injury and as such many fatal injuries or their severity may be reduced by adequate prehospital trauma care. A previous study in Uganda found that fewer than 5% of injured patients are transported by ambulance to hospital  most of which ambulances are privately run and expensive. In neighboring Tanzania, a study evaluating access to prehospital care found there was no prehospital care in the region.

The interior of the ambulance, lacking paramedic supplies for first aid.

The interior of the ambulance, lacking paramedic supplies for first aid.

This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?

 

BokSmart: 5 questions with Dr James Brown

15 Jul, 15 | by Sheree Bekker

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A study in the June 2015, Volume 21, Issue 3 of Injury Prevention, The BokSmart intervention programme is associated with improvements in injury prevention behaviours of rugby union players: an ecological cross-sectional study comes to us from researchers based in South Africa. This research assessed whether player behaviour improved since the launch of the BokSmart nationwide injury prevention programme for rugby union.

One of the authors on this paper, Dr James Brown, kindly agreed to answer a few questions on this work for this blog post. James is a Post-Doctoral Fellow for BokSmart and the Chris Burger Petro Jackson Players’ Fund at the Division of Exercise Science and Sports Medicine, University of Cape Town.

1) Tell us about BokSmart. What is it and why is it important?

BokSmart is a nationwide injury prevention program for rugby in South Africa. It is based on the successful New Zealand program, RugbySmart, and is a joint initiative of the national rugby federation of South Africa – the South African Rugby Union (SARU) – and the Chris Burger Petro Jackson Players’ Fund. Mainly through extensive coach and referee education, the program attempts to reduce all injuries, but specifically catastrophic (permanently disabling) injuries in players. Preventing injuries is particularly important in rugby as it is a collision sport with a higher risk of injury than most other sports and because it is particularly popular in South Africa with an estimated 400-500,000 players.

2) I know that you are active on Twitter (follow James @jamesbrown06), so what is the main message of this research in 140 characters or less?

Injury-preventing behaviours of rugby players have improved since the launch of the @BokSmart nationwide injury prevention program in South Africa in 2008

3) What are the implications of the findings of this study for readers of Injury Prevention?

The success of any intervention is reliant, in part, on the intervention’s ability to influence the behaviour of the intervention target. Thus, it was important to the BokSmart implementers to assess if there was a change in player injury-preventing behaviour. While we could not exclude other potential influences on these players’ behaviour in this ecological study, it is a positive sign that most of the behaviours improved in this five year period, particularly the behaviours that were targeted by the intervention’s implementers.

4) This research focuses on player behaviour, why is this an important component of an injury prevention programme?

Besides what is mentioned above, this study was also an important comparison to New Zealand’s evaluation of RugbySmart, as BokSmart used a very similar questionnaire to assess their players’ behaviours.

5) Tell us more about Rugby Science 

Starting the RugbyScientists.com website was an attempt to deliver some of the plethora of useful, practical scientific research that exists in rugby to the end-user. A colleague, Dr Sharief Hendricks, and I were involved in rugby at both a research and practical level as coaches/players a couple of years ago. We both had experiences a number of coaches, parents and players who asked us questions that had already been answered in the form of scientific publications. From research that Dr Hendricks had conducted, it was obvious that it would be unlikely that coaches would read any scientific publication, so we hoped this might bridge that gap.

James and I would be happy to keep this conversation going either on the comments of this blog, or over on Twitter. Feel free to contact him directly via these Rugby Science contact details.

Thank you for your insight James!

Management of sports-related concussion: is research making a difference yet?

8 Jul, 15 | by Sheree Bekker

Presentation1

Sports-related concussion is currently, arguably, the most heated topic in sports injury prevention. Sensationalist media headlines and stories about the toll of concussive hits, particularly in contact sports, are all-too-common. Recently, during the FIFA Women’s World Cup, we saw this head-knock between Alexandra Popp and Morgan Brian, which once again called into question protocols around the handling of suspected concussion in sports settings.

Concussion is known to be an important issue, and its prevention is of utmost importance for the health and safety of all those who play sport. A recent study monitored the number of people treated in hospital for sport-related concussion over a period of nine years in Victoria, Australia. It showed that more people are being hospitalised for sports-related concussion than in the past, but we don’t know why. We think that better healthcare, more people knowing about concussion and the importance of being monitored for symptoms, as well as changes in the way that sport is played could all have contributed to the increase.

Concussion recognition tools and management guidelines are available freely online: the Sideline Concussion Assessment Tool (SCAT3) and the Child SCAT3  are based on this International Conference on Concussion in Sport consensus statement.

The SCAT3 clearly states:

Any athlete with a suspected concussion should be removed from play, medically assessed, monitored for deterioration (i.e., should not be left alone) and should not drive a motor vehicle until cleared to do so by a medical professional. No athlete diagnosed with concussion should be returned to sports participation on the day of injury.

Yet, as is shown in the media and on our sports fields, more often than not this advice is not followed. It is true that general knowledge about concussion symptoms is good (and most people now understand that you do not need to be knocked ‘out cold’ to experience concussion), but knowledge about concussion management in sport settings is lagging.

A recent article published in Injury Prevention, An examination of concussion education programmes: a scoping review methodology showed that concussion guidelines effected:

short-term improvements in knowledge, attitudes and behaviours; however, the long-term benefits of concussion education programmes were less clear

It has been found that coaches and sports trainers tasked with concussion management do not yet know how to fully use concussion guidelines, even if they are aware of them being available. They need more education and hands-on practical experience. Asking a player if they want to play on after a head-knock is about as useful as a chocolate teapot. Whilst it may appear a common sense question at first, we just do not know enough about how potentially concussive head-knocks affect individuals, and as such cannot rely on the athlete with potential concussion to make such a call. It is vitally important that concussion management is addressed by sports governing bodies, put into operation by clubs, and handled correctly and ethically by team doctors, coaches, and sports trainers  – for the ultimate welfare of athletes.

Research into the management of sports-related concussion can, and should, do more to effect change. Guidelines are necessary but insufficient. Conceiving injury prevention interventions differently by recognising the unique and nuanced challenges of sports culture – such as the win-at-all-costs attitude, and the celebration of hero-athletes returning to play – within complex sports settings is vital.

*Thanks Reidar Lystad for suggesting the chocolate teapot metaphor on twitter last night.

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