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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

Controversial ad during US Super Bowl broadcast

4 Feb, 15 | by Brian Johnston

American football’s championship game, the Super Bowl, was played last Sunday (those of us based in Seattle would rather not dwell on the result).

The game was the most watched telecast in U.S. history, with an estimated 114.4 million viewers. Not surprisingly, this huge audience is an advertising jackpot – the revenue from this year’s game exceeded 330 million U.S. dollars. An average 30-second ad during the broadcast cost 4.5 million U.S. dollars. Companies spending that much money aim to make their ads memorable; some people watch the telecast as much for the ads as for the game. Most ads are humorous or inspirational.

This year Nationwide insurance company aired a decidedly less upbeat commercial about the toll of unintentional injury in childhood. You can see the ad here.

This ad has generated a surprising amount of reaction and discussion online, in social media and in traditional media outlets, not all of it positive. To be fair, it wasn’t the only ‘sobering ‘ ad of the day – there was also a domestic violence awareness ad, but this may have been forgiven as US football has had a number of high profile scandals involving interpersonal violence this year.

Many viewers objected to the topic of child death; others worry about the impact of the spot on parents who’ve lost children; and a few question the motives of the company (was the ad positioned to suggest that “there are things out there more dangerous to children than playing football?”) .

Purely from an editor’s perspective, I want to ask: do ‘awareness campaigns’ result in behavior change or reductions in injury outcome? How can we measure or study the impact of a campaign like this?

 

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 safety hysteric speaks again

15 Jan, 15 | by Barry Pless

In some circles I am regarded as an injury prevention fascist, safety hysteric, protect the children fanatic, a wuss, or worse. This has come about because I consistently push for more prevention and less risk taking. I am not at all convinced that risk-taking is good for child development, as some would have us believe. Nor am I convinced that having a serious injury with possible life-long (if not life-threatening) consequences builds character, or whatever. But I was not the least bit surprised when I recently came across two newspaper accounts one of which challenged these views. I responded to it but not yet to the other.

 

The first was in Canada’s National Post (NP). It was written by its editorial board who were prompted by a municipality’s ban on tobogganing on certain hills. That action was based in part on the work of Dr. Charles Tator, a renown pediatric neurosurgeon and founder of ThinkFirst Canada. Tator’s study revealed huge risks of a ‘catastrophic injury’ from tobogganing. (http://www.tandfonline.com/doi/abs/10.1080/17430437.2011.614787?journalCode=fcss20#.VLapHsZpwyE) To be specific, his research found that over 4 years tobogganing had the fourth highest chance of grave risk, exceeded only by diving, snowmobiling, and parachuting. In that time frame about half of the serious injuries involved the head and one quarter the spine. This placed tobogganing among the most dangerous of all recreational activities. Tator made it clear that he was not suggesting that tobogganing be banned or regulated, but he did urge greater caution.But the lawyers for the municipality fearful of liability suits had other ideas.

 

In contrast to the ill-informed NP editorial board, a wiser and more responsible health reporter, Andre Picard, argued that tobogganers should not have to “pay for ‘liability chill.” He acknowledged that tobogganing is a “high-risk” activity but that the risks can easily be reduced. He added, “What is more difficult to contain is the voracious appetite of personal injury lawyers and the financial fearfulness of cash-strapped municipalities.” He went on to write, “In fact, while helicopter parents and overly cautious public health officials often get blamed when ridiculous bans on tobogganing, road hockey, skateboarding and the like are instituted, the real culprit is a torts system that has lost touch with reality.” As Picard summarized, “risks can be reduced by improving control and better head protection”. Importantly, he also quoted Drs. Tator and Francescutti (former Canadian Medical Association president) who asserted that “municipalities should provide information on how to ride safely rather than block off popular hills”.

 

In contrast, in its infinite wisdom, the National Post editorial that bordered on ridiculing Tator and which encouraged many commentators to contribute their mostly foolish and irresponsible views. (The link to the editorial is http://news.nationalpost.com/2015/01/05/national-post-editorial-board-the-freedom-to-toboggan/) Only a few commentators, (including, ironically, the editors themselves), acknowledged that the community had an obligation to remove dangerous obstacles, etc. I was disgusted with the tone and content of the piece and posted this comment. Undoubtedly, as is true for most letters I write to editors, it will do little except make me feel a bit better.

 

“It is hard to imagine why a supposedly responsible editorial board of a respected paper should ridicule the important message Dr. Tator issued. For the editors to make the comparison with car crashes is entirely inappropriate and ironic because I assume they have no problem with laws that regulate how cars are used! Similarly the comparison with personal responsibility with feeding grizzlies is simply embarrassing. Surely even Post editors would agree that at the very least the community shares the responsibility to prevent injuries of all kinds; that it is not simply up to the individual. That is why grizzlies don’t wander freely and communities notify snowmobilers that lakes are half frozen. This is a disgusting editorial that comes close to ridiculing one of Canada’s leading neurosurgeons and one of the few who makes a huge effort to keep people out of his operating room. Praise, not mockery, is the morally correct response and the editors owe Dr. Tator and their readers a huge apology.”

 

To which “John Smith” (??) wrote: “@barrypless – your angst is what is ridiculous. Are you Dr. Tator’s houseboy? Be thankful for writers and editors that don’t kneel down and kiss the ring of someone with a bit of fame and are willing to question their statements. And yes, it is up to the individual. Grow something in that mansack.”

 

Then, just as I was getting ready to post this blog, I came across a report from the Irish Times based on an editorial in the BMJ that criticized rugby’s “tribal, gladiatorial culture”. (Note: European rugby is not the same as American football). The editorial describes the rugby culture as one that “sees parents, coaches and schools encouraging excessive aggression and playing on when injured.” As the author, a paediatric neurosurgeon, Michael Carter wrote, “Anyone who has spent an hour picking skull fragments out of the contused frontal lobes of a teenage rugby player is entitled to an opinion on the safety of youth rugby.”

 

One possible solution offered by Carter is that the age of contact rugby be increased to 12 years. He noted, however, that a 14-year-old sustained three head injuries in one game and speculated that the increased interest in rugby is related to it becoming a professional sport. That has lead to a preference for hulk-like players. These problems seem similar to those now experienced by the National Football League in the US. Carter called attention to New Zealand’s approach to the issue which entails “teaching people how to play the game safely and correctly. “

 

The BMJ editor, Fiona Godlee, added: “Let’s call the current state of monitoring and prevention of rugby injury in schools what it is: a scandal. It needs urgent remedy before more children and their families suffer the consequences of collective neglect.”

 

My reaction is, “Right on, Fiona!” (although I doubt if more monitoring will help much). To my surprise and pleasure, so far most of the Responses in the BMJ have been supportive and constructive. Eventually, however, I expect we will hear some vociferous ‘risk-is-good’ voices but somehow I doubt that their owners would accept a spinal cord injury if risk-taking continues to be encouraged.

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.

Surfing and injury prevention

8 Jan, 15 | by Bridie Scott-Parker

As a Queensland-er, I must confess that I feel a little remiss as I cannot surf. In fact, I am pretty sure I would fall off a surfboard on the sand, let alone try and stand on a surfboard in an ever-moving ocean! I appreciate and admire the skills required, however, to not only stand up, but to actually stand up for any period of time. As an injury prevention researcher during the peak of our summer season and annual holidays, I was interested to see a recent publication exploring the nature and magnitude of injuries sustained during surfing. Woodacre, Waydia and Wienand-Barnett summarised the self-reported injuries sustained during 2012 for 130 surfers from the UK. Having seen surfers and surfing incidents first-hand, I was unsurprised to see that head injuries featured most commonly, cuts and lacerations were the most common injury type, and that surfers reported most often colliding with their own boards. My interest was peaked!

A quick Google Scholar search, and I came across a number of other interesting surfing-injury papers that you may also care to read. Nathanson, Haynes and Galanis examined the self-reported injuries sustained by 1348 surfers, again finding that cuts and lacerations were the most common injury type, and that most injuries emerged from collisions with the surfer’s own board. Taylor, Bennett, Carter, Garewal and Finch examined injuries sustained by Victorian surfers, similarly finding that cuts and lacerations were the most common injury type, and collisions with surfboards and other surfers were the main injury mechanism. Taking a different approach, Nathanson, Bird, Dao and Tam-Sing examined the medically-treated injuries sustained during competitive surfing, reporting a 2.4 times greater risk of injury when surfing larger waves and 2.6 times greater risk of injury when surfing over hard surfaces such as rocks and reefs.

So what does this mean for injury prevention? In my case, it means that I won’t be taking up surfing! For those who do surf, however, how can the research findings help keep them safe? Sunshine has suggested a number of treatment options and harm minimisation strategies, such as rubber surfboard nose covers. Woodacre and others acknowledge that helmets – which can prevent serious head injuries – are unlikely to be used by surfers as head injuries are a relatively uncommon occurrence. I am interested to hear other’s experiences, and tips for injury prevention.

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