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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.


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!

Children in virtual traffic testing situations – can we approximate real traffic situations?

20 Aug, 15 | by Klara Johansson

Young children are developmentally very bad at traffic safety. This was early demonstrated by Swedish researcher Stina Sandels in the 1960’s. In her groundbreaking studies where she studied children’s behaviour in traffic situations, she came to the conclusion that children under the age of 12 are developmentally unable to handle traffic in a safe way. She stated that ‘even the best road safety education cannot adapt a child to modern traffic, so that traffic has got to be adapted to the child.’

Since then, research has repeatedly shown this to be true. For instance, children before the age of eleven are usually not able to think from another perspective, and thus often fail to understand that a curve, hill or parked car may obstruct their view.

But in order to adapt traffic to children, we still need to study the choices children make in various traffic situations. And nowadays, when we’re aware of the high injury risk, we need to do such studies “in vitro”, in perfectly safe conditions.

How can we do that?

Well, nowadays there are technical options never before seen. An article in our current issue of Injury Prevention is using and further developing virtual reality to study if children crossing a street adjust their walking speed to avoid oncoming traffic. The technology is obviously still at an early stage, but Morrongiello, Corbett, Milanovic, Pyne & Vierich is building on previous research but with the improvement that they use a system that allows children to physically walk across a street in a virtual environment (while actually walking in an empty room, supervised by researchers).

The virtual environment used in the study (picture courtesy of Barbara A Morrongiello)

The virtual environment used in the study (picture courtesy of Barbara A Morrongiello)

The study shows that children’s average walking speed is a bad proxy for how fast they walk under the threat of oncoming traffic. This finding emphasizes the importance of using a VR testing environment where children can actually move around themselves instead of controlling an avatar that corresponds to their average normal walking speed, which has been used in previous studies.

Incidentally, I just read a long feature in Time about how far virtual reality has developed. The full article is unfortunately only available to subscribers, but there is a brief version here. To give a very short summary: virtual reality tec has come further than we think, but many headsets and graphics on the market are still fairly clunky (but new tec is set to reach the market within 18 months). The article also points out that VR can be useful for a wide range of purposes, including conference meetings, treatment of phobias, empathy training, and research. They don’t mention traffic safety research, but that just goes to show that each of us nerds in the world have our own specific interest to bring to the table.

One major differentiating feature of VR systems seems to be whether one would explore the virtual worlds by walking around or sitting on the couch. Well, for traffic safety research, the article by Morrongiello et al shows the value of one that lets the subject walk around.

Or cycle around – that seems easier to accomplish, using a training bike that responds to the virtual environment. For adults, studies using car driving simulators has been available for more than 20 years, but of course, that doesn’t require a VR headset.

The next technological step that VR geeks dream of is apparently “enhanced reality” – a headset that superimposes virtual holograms onto your real field of vision. From what I understand, this is more difficult technologically, but if accomplished, I imagine it could be a gold mine for safety research and training.


Home safety and the prevention of falls

17 Aug, 15 | by Bridie Scott-Parker

The Royal Children’s Hospital (RCH) Safety Centre has created a new online resource to tackle the number one cause of injury to children in Victoria, Australia – falls.

Targeting parents of children aged from birth to 14 years old, the site details simple steps parents and caregivers can take to prevent common injuries by age group, such as

* changing a baby’s nappy on the floor rather than on an elevated change table, and

* wearing protective gear, including mouth guards, when playing contact sports.

RCH Trauma Service Manager Helen Jowett says the frequency of under 14-year-olds requiring a hospital admission following a fall has increased by 29 per cent since 1998, at an annual cost of $18.6 million.

Most of those injuries occur in the home and behind those statistics are children like Ella, who had a tough lesson in gravity when she fell from a tree she was climbing in her back garden. The eight-year-old, from country Victoria, landed head-first when she fell, and was rushed to her local hospital where she was assessed as having a significant head injury.

Ella was promptly sent to The Royal Children’s Hospital by air ambulance for emergency surgery. After discharge, she spent several weeks resting and was unable to play contact sport for three months.

The new website shows that, unlike Ella’s hospital stay, safety around the home doesn’t need to be expensive, emotionally draining, complicated, or time-consuming.

Importantly for injury prevention around the world, the website is an easy-to-access repository for information regarding, and links to, useful tips and advice that can be applied in any home anywhere, anytime. For example, falls-prevention safety pertaining to furniture, and to bunk beds specifically, may have helped prevent my nephew from breaking his arm as a young boy.

Step 1 of improving bicycle safety: gather data better!

14 Aug, 15 | by Angy El-Khatib

The month of August is the unofficial, “Blog about Road/Bicycle/Pedestrian Safety!” month here at IP BMJ Blog. Part of that is due to the August 2015 issue of Injury Prevention, which features several publications regarding the aforementioned topics.

One of them being this paper by Lusk, Asgarazdeh, and Farvid, looking at how bicycle-crash-scene data is being reported and how to improve our databases for the greater purpose of improving the safety of roadways and vehicles.

Lusk, Asgarazdeh, and Farvid report that, although police in the United States have been reporting bicycle crashes since bicycle use became popular in the 1890s, the reporting templates and coding practices have room for improvement. For example, the current police templates only have diagrams of two cars – no bikes. Lusk and her colleagues want police reporting mechanisms to include pictures of a bike. Another example, there are only two ways to code a bicycle crash – (1) “pedal cyclist” vs. motor cyclist and (2) whether the cyclist was wearing a helmet or not. Lusk and her colleagues purport that a template and reporting mechanism which includes the side of the bicycle that was impacted, whether the crash was caused by an open car door, or whether a cyclist was riding in the bike lane could help to improve future plans for the built environment (i.e., less parallel parked cards) and car designs (i.e., sliding car doors) will have a profound effect on how we view future bicycle/road safety endeavors.

Who would’ve ever thought that improving the way we report bicycle crashes could potentially help make bicycling safer and more prevalent?(Shhh… that’s a rhetorical question.)

Snow safety in Australia: Perceptions from a well-travelled snow sport injury researcher

12 Aug, 15 | by Sheree Bekker

tailgrab whistler

This week I have the pleasure of sharing the views of one of my colleagues here at the Australian Centre for Research into Injury in Sport and its Prevention (follow us on Twitter @ACRISPFedUni). Matthew Shumack (follow him on Twitter @snowboardPhD) is researching snow sports injury prevention (cue: research envy).

A cursory keyword search in Injury Prevention shows that snow sports injury prevention research in this journal is largely focused on head injuries and attitudes towards helmet use. Matt paints a picture below of a different, yet common-sense and just as important, consideration for snow sports safety.

I (MS) have spent the majority of my adult life chasing winter, the search for fresh snow and deep pow will continue. I am not the only one that chases the snow, Dickson even conducted a study to find out how many Australians travel for skiing and snowboarding. However, when you arrive in places like the U.S.A, Canada, or Japan the question is always asked…

“You get snow in Australia?”

Well we do, we get a lot of it. This year alone we have seen multiple evacuations from different places in Tasmania of people being snowed in. Snowboarders trapped in their car, and even a group of 10 people who needed to be airlifted out of a national park. Considering that winter is nowhere near over, awareness of the possibility of injury and even death needs to be articulated, not only our community, but to the international community as well. Last year (2014) we saw some tragic events occur over our winter, whether it was avalanche deaths, or injury and death occurring in organised ski areas.

These are not the first, and will not be the last, but the numbers may be limited with better injury prevention awareness campaigns. There is never going to be a seatbelt for skiing and snowboarding, but ensuring adequate health promotion of the risks of injury and death are needed on a wider scale.

As an interesting parallel to this, I (SB), have some Canadian friends living here in Australia (shout out to Wagga Wagga) who have told me that they never felt the cold as much in Canada as they do here. In fact, they would agree that Australian houses are just glorified tents in winter (read the interesting research linked in the article which shows that the poor quality of housing is behind many preventable deaths from exposure to cold in Australia). 


Treating firearm violence like a contagious disease

12 Aug, 15 | by jsantaella


Following up on a previous post by aelkhatib.

When I first heard about the 1996 amendment prohibiting the Center for Disease Control and Prevention from conducting research on firearm violence prevention I was very surprised. I could not believe that there was a legal mechanism that would prevent researchers from studying the causes of something impacting so heavily the health of populations. The amendment, authored by former U.S. House Representative Jay Dickey, stated “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control”; the language did not explicitly ban research on gun violence, but along with the cuts to CDC’s budget, there was a clear message against researchers trying to study this topic. Later, in the next decades, funding for firearm injury prevention dropped by 96%, while the annual rate of 10 firearm related deaths per 100,000, was relatively immutable.

Amazingly, even after the occurrence of recent absurd events in which citizens have lost their lives at the hands of armed individuals, the US House of Representatives Appropriations Committee rejected an amendment that would have allowed the CDC to conduct research on the causes of firearm violence. The message: CDC should not be studying this topic! As put by one House Speaker “I’m sorry, but a gun is not a disease. Guns don’t kill people – people do.”

However, even if a gun is not a disease, can’t the firearm violence problem be tackled using an evidence-based approach? This strategy has been used in the past to confront non-infectious problems such as the incidence of fatal motor-vehicle crashes or the harms associated with second hand smoking. What if we could treat, not guns, but firearm violence like a contagious disease? This angle, endorsed by many, and clearly presented by physician Gary Slutkin in his TED talk, has lead to important reductions in firearm homicides in many neighborhoods across the US, as he describes. Interestingly, the call for more research on this topic has also been adopted by former representative Jay Dickey as shown in a 2012 co-authored Washington Post op-ed with Mark Rosenberg: “…we are in strong agreement now that scientific research should be conducted into preventing firearm injuries and that ways to prevent firearm deaths can be found without encroaching on the rights of legitimate gun owners.”

Yes, more research is needed! Time and resources must be used to rigorously study the causes of firearm violence in order to come with appropriate solutions; otherwise, answers to confront this problem might just serve as innocuous palliatives.




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?


Injury prevention: the new performance enhancing?

9 Aug, 15 | by dbui


Many people think of injury prevention as a purely medical endeavor: a method for keeping patients, athletes and teams healthy.

And whilst this is certainly part of it, there are many other important aspects to consider! For example, if a medical team can keep your athletes on the field, injury-free, that gives you a huge performance advantage. In English Professional Football, the average (SD) number of days absent for each injury was 24.2 (40.2), with 78% of the injuries leading to a minimum of one competitive match being missed. From a financial standpoint – it makes a lot of sense as well – with reports that injuries cost the game at least 40 million pounds per year!

There are many ways injury prevention can be achieved. At its most basic, good strength and fitness holds many in good stead. However, there are sports-specific interventions that have been validated to prevent injury, for example the Nordic Hamstring exercise program. Introduced in 2001, it has been shown to decrease the risk of Hamstring injury by 50% in football.

Unfortunately, uptake of this relatively simple program has been poor: of 50 professional football teams surveyed (32 from the UEFA Champions League, 19 from Tippeligaen), only 16 (10.7%) completed the programme in full (Bahr, Thor and Ekstrand, 2015). This is surprising given the potential upsides, to the clubs, their players and of course their paying fans.

These benefits can be applied on an individual level as well. Earlier this year I was lucky enough to visit the Micheli Center for Sports Injury Prevention, affiliated with Boston Children’s Hospital and the Harvard group, which not only conducts cutting-edge research and educates health professionals in this sphere, but also provides individualised injury prevention services.

For example,  3D kinematic analysis is offered for golfers and pitchers to identify suboptimal biomechanics. Poor biomechanics not only contributes to injuries, but also to technique! Combined with a  comprehensive musculoskeletal screen, the clinicians and researchers here aim to not only keep people in the game, but also take it to the next level. Patients leave with preventative strengthening exercises as well as a detailed report for their coach. Other services include prevention of Concussion, ACL tears and Running injuries. What I found inspiring was that these services weren’t just in the research sphere, they were out in public – treating everyone from professional athletes to weekend warriors and their kids!

Hopefully I’ve convinced you that injury prevention isn’t just about safety, that it isn’t just for pro athletes – and maybe, it might be for you!

Would love to hear your thoughts – let me know below or on Twitter at @BMJ_Injury

David Bui

Safety in numbers or safety to get the numbers up?

7 Aug, 15 | by Klara Johansson


The August issue of Injury Prevention is online! And it has already led to media coverage. Cycling weekly has a nice news story based on the article by Christie & Pike.



The big question is: are cyclists safer when there’s more of us? as was posited in the classic paper by Jacobsen, reprinted in this issue.

We hope to discuss this question more in depth in this blog during August! But for the moment, the take-home message seems to be that we still don’t know whether there is truly safety in numbers, but we do know that system-wide traffic safety measures do increase safety. Cycling weekly also points out that when there are more cyclists, traffic planners and politicians are pressured to invest in cycling safety.


The author of this blog post is a keen bicyclist, even on days when the numbers of cyclists are very low…

There are many reasons to wish for more people to take the bicycle! More physical activity for the people = better health. Fewer cars = more space for people, and less car exhausts – which benefits health as well as local and global environment. But in order to facilitate more bicycling, there is a strong need to construct traffic systems that are safe for both cyclists, pedestrians and vehicles. There are many facets of this: to a high extent the physical properties of roads and paths, but also the behaviour of cyclists and drivers (and the social norms and systems which drive this behaviour!), the willingness to embrace safety measures like helmets, and the new innovations for safe technology in vehicles and on roads.

Among the draft global Sustainable Development Goals, expected to be passed by the UN in September, goal number 9 calls for countries to “build resilient infrastructure” and also to “foster innovation”. It seems to me that an indispensable part of this would be safe and practical cycling infrastructure, using new innovations.

During August, this blog will have a special focus on bicycle safety, traffic safety overall, and the question on whether there is “safety in numbers” or not. Stay tuned! And keep the discussion alive, in the comments below, on Twitter, or on Facebook.

Now, have a nice weekend – and when you’re not out cycling, there’s tons of interesting reading in the new issue of Injury Prevention!

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