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From evidence to policy and practice

13 May, 14 | by Bridie Scott-Parker

Regular readers of the Injury Prevention blog will be quite familiar with my obsession for getting our rigorous research translated into policy and practice. I regularly hear from individuals in industry and government, not to mention the general community, that researchers are great at communicating with other researchers, and not so great at communicating with ‘normal people’. Upon hearing this I have decided to create one-page summaries of my journal articles and conference papers, in plain English, summarising for the ‘normal person’ what I did, what I found, and what it means for them.

So you can understand my delight at reading an article published in a recent edition of Social Science & Medicine (see http://www.ncbi.nlm.nih.gov/pubmed/24632115). Zardo, Collie and Livingstone decided to wrangle with the twofold problem of getting research translated into policy and practice: “identify external factors that affect policy and program decision-making, and use this evidence to inform targeting of interventions aimed at increasing research use (in the context of injury prevention and rehabilitation compensation in Victoria, Australia)”.

Interestingly the interviews with employees from two state government agencies revealed that the following stakeholders were most influential, suggesting that researchers need to target these stakeholders if they are to be influential in  government policy and practice.

* the Minister and the government,

* lawyers, and

* agency stakeholders, including health providers, trade unions, and employer groups.

I love the idea of working smarter, not harder!

Motorcycle crashes decline: thank the weather

7 May, 14 | by Barry Pless

This is verbatim from FairWarning, increasingly one of my favourite and most respected go-to sites:

Preliminary figures show U.S. motorcycle fatalities falling 7 percent in 2013 as bad weather kept riders off the road. A report by the Governors Highway Safety Association projects that the number of motorcyclists killed last year will total 4,610, down from 4,957 in 2012 and nearly identical to the 2011 figure of 4,612. It is only the second time in the last 15 years that such fatalities have declined. Still, the association’s figures show that people in passenger vehicles are about twice as safe as they were in 1997, while there has been no improvement since then for motorcyclists, largely due to declining use of helmets. As FairWarning has reported, biker groups have pushed lawmakers and regulators to back away from promoting or enforcing requirements for safe helmets, the best way known to save bikers’ lives. The Washington Post, Forbes – See more at: http://bit.ly/1mHIQ8r

Editors note: This is another good reminder of how essential it is to pay close attention to changes in exposure whenever injury rates change, in either direction.

Wealth begets longevity (more so for some than others!)

29 Apr, 14 | by Barry Pless

An article in the Wall Street Journal, featured recently in Mother Jones, reminds us that the richer you are, the longer you’ll live. And that the gap is widening, particularly among women. The article notes that a man born in 1940 would be mid-career in 1980 and if his income was in the top 10% for his age group and he lived to age 55 he can expect to live an additional 34.9 years. This is six years longer than a man whose career followed the same arc, but who was born in 1920. (I squeezed in between those dates so I will split the difference). The important message is that for women ‘at every income level, for both those born in 1920 and 1940, women live longer than men. But for women, the longevity and income trends are even more striking. While the wealthiest women from the 1940s are living longer, the poorest 40% are seeing life expectancy decline from the previous generation.’ In other words, “At the bottom of the distribution, life is not improving rapidly for women anymore.” Part of the explanation may be differences in smoking rates but somewhat disappointing (but not surprising) is the failure to examine the well-known differences by income and by sex for fatal injuries. A mid-career paper that I co-authored addressed part of this topic for motor vehicle injuries and deaths in children. (Social class and the occurrence of traffic injuries and deaths in urban children. G Dougherty, IB Pless, R Wilkins – Canadian Journal of Public Health. 1989).   I have been interested in this topic ever since and still am uncertain whether the difference is driven (no pun intended) by environmental features associated with low income, worse driving, poorer enforcement, all of the above, or many other factors. I wonder what readers of this blog think.

Although the WSJ article raised questions about the implications of these findings for Social Security equity in the U.S., for me they served as a reminder that we still do not have good explanations for the large and persistent sex and social class differences in injury mortality.

http://blogs.wsj.com/economics/2014/04/18/the-richer-you-are-the-older-youll-get/

Poorly-fitted child seats an injury waiting to happen

24 Apr, 14 | by Bridie Scott-Parker

Thinking about the recalls yesterday, particularly those related to child seats, reminded me of a recent story I read recently. A 2013 survey of over 10,000 child seats in England, Wales and Scotland revealed that 60% of the child seats were poorly-fitted (see http://www.express.co.uk/news/uk/470156/Millions-of-infants-at-risk-60-per-cent-of-all-child-seats-not-fitted-safely). One poorly-fitted child seat is a problem, let alone 6,000 in a sample of 10,000. This statistic is alarming.

Why is this an issue? According to Kevin Clinton, head of Road Safety at the Royal Society for Prevention of Accidents in the United Kingdom,

“The importance of properly fitting a child seat cannot be overstated. Make sure it is compatible with the car and remember to seek expert help on fitting. We encourage parents to check that the seat is fitted correctly before every journey, esp­ecially if they are regularly taking it in and out of the car.”

He urged the public to “avoid purchasing second-hand car seats as they might not comply with the latest standards, the fitting instructions may be missing and you cannot be sure of their history, such as whether they have been in an accident.”

So why isn’t the message getting through to parents? As a parent myself, I cannot imagine another parent willingly installing a child seat in an unsafe manner, deliberately putting their child in harm’s way. How do stakeholders important in injury prevention get the message across?

Timely action is particularly important when we consider that our most vulnerable could be travelling at 110km/hr, with parents mistakenly believing that their child is as safe as possible. Timely action is also especially important when we realise that this has been an issue for some time (eg., a 2011 story reporting similar statistics: http://www.theguardian.com/money/2011/sep/17/child-car-seats-motoring).

It will continue to be an issue unless more is done, and sooner rather than later.

 

Recalls on the radar

23 Apr, 14 | by Bridie Scott-Parker

Over the past few months I have noticed an abundance of recalls for various products, including mass recalls after ignition switch defects in General Motors cars. As noted on their website (http://www.gmignitionupdate.com/faq.html),

“There is a risk, under certain conditions, that your ignition switch may move out of the “run” position, resulting in a partial loss of electrical power and turning off the engine. This risk increases if your key ring is carrying added weight (such as more keys or the key fob) or your vehicle experiences rough road conditions or other jarring or impact related events. If the ignition switch is not in the run position, the air bags may not deploy if the vehicle is involved in a crash, increasing the risk of injury or fatality.

Additionally, some of these vehicles have a condition in which the ignition key may be removed when the vehicle gear is not in the “Off” position. If the ignition key is removed when the ignition is not in the “Off” position, unintended vehicle motion may occur: (a) for an automatic transmission, if the transmission is not in “Park”; or (b) for a manual transmission, if the parking brake is not engaged and the transmission is not in reverse gear. This could result in a vehicle crash and occupant or pedestrian injuries.”

Alarmingly many of these recent recalls are products intended to protect our youngest and most vulnerable, for example child seats (eg., faulty harness buckles, http://www.usatoday.com/story/money/business/2014/03/13/graco-adds-more-child-seats-to-recall/6365789/), and cots (eg., possible entrapment of infant limbs,  http://www.recalls.gov.au/content/index.phtml/itemId/1054130).

Some food-related recalls are of particular concern, given the potentially-life threatening nature of many nut allergies (eg., cereal, http://www.recalls.gov.au/content/index.phtml/itemId/1057890; Easter eggs, http://www.recalls.gov.au/content/index.phtml/itemId/1057600).

Whilst I have heard about these recalls through different means (such as newspapers, online forums, and active research for this blog), I wonder how many of the products’ consumers actually know about these recalls? We received a letter earlier this year advising that our model of Sonata required a minor tweak to circumvent potential brake-related issues (ironically enough this ‘minor tweak’ radically affected the vehicle’s braking, as the replacement part itself was faulty). What if the consumer has moved address (which is entirely possible given we purchased the vehicle 5 years ago), does not have internet access, and does not subscribe to or read a newspaper? Should there be greater onus on producers to not only ensure that they have as safe a product as possible in the marketplace, but that they also make every effort (and not a ‘token’ effort) to ensure that they minimise any potential harm that could be caused by their faulty product by ensuring they recall, then repair/replace these products, in a timely manner for the consumer?

American trauma surgeons on gun control

22 Apr, 14 | by Barry Pless

I think going to this site is well worth the visit. It presents the position of American trauma surgeons with respect to gun control issues. It is a healthy antidote to the bizarre arguments that also appear on the Medscape site suggesting that doctors should NOT provide advice about gun control in part because they lack the expertise and in part because they have more important things to do. I invite readers to describe what expertise is needed to convince us that bullets in a child’s body are not a good idea and whether they truly believe that treating otitis media is more important than a gunshot wound. The website in question is:

http://tinyurl.com/kqc96g9

Talking about Suicides

15 Apr, 14 | by gtung

The Board of the American Association of Suicidology recently voted to create a new division to represent and recognize individuals who have attempted suicide and survived.  This move seems to be representative of the beginning of a shift in how those involved in suicide prevention view openly talking about and learning from those who have made suicide attempts and survived.  A trend summarized nicely in this NY Times article:

http://www.nytimes.com/2014/04/14/us/suicide-prevention-sheds-a-longstanding-taboo-talking-about-attempts.html?src=xps

Those involved in suicide prevention have taken a cautious approach toward openly talking about or publicizing individual stories about completed suicides and attempts.  The issue of copycat suicides and suicide clusters gives justifiable concern toward publicizing completed suicides but what will be the effect of increased discussion around suicide attempts?

There is optimism around what can be learned from suicide attempt survivors and how those experiences can be used to prevent future suicides.  The website LiveThroughThis.org provides a collection of portraits and survivor stories in an attempt in part to build greater awareness and humanize survivors.

It will be interesting to see how this trend progresses, what is learned, and what impact, if any, it ultimately has on the very real need to develop effective interventions to prevent suicides.

The most popular suicide location in the world

8 Apr, 14 | by gtung

San Francisco’s Golden Gate Bridge looks poised to get a safety net to prevent suicides, something that various people and organizations have been requesting for over 60 years.  Since the Bridge was first opened in 1937 approximately 1,600 people have committed suicide by jumping off the bridge, more than any other location in the world.  In 2013, 46 people committed suicide from the bridge (that authorities know about) and another 118 were talked down or otherwise stopped from jumping by bridge workers.

In May of this year authorities will vote on the installation of a safety net that will be 20 feet below the walkway and is estimated to cost $66 million US dollars.  The proposal seems likely to pass.

http://www.nytimes.com/2014/03/27/us/suicides-mounting-golden-gate-looks-to-add-a-safety-net.html?src=xps

Arguments against installing some type of guard railing or safety net have included concerns about negatively impacting the bridge’s appearance and assertions that suicidal individuals will simply find some other way of committing suicide and therefore a safety net would not actually save lives.  Scientific studies examining means restrictions on suicides clearly indicate that lives will be saved if safety measures are put in place on the Golden Gate Bridge.  In addition, work done by Richard Seiden at UC Berkeley looking at individuals that have been stopped from jumping and those that have survived the jump has revealed that the vast majority (over 90%) do not go on to commit suicide by other means.  All of this research has been summarized nicely by the Bridge Rail Foundation, an organization devoted to installing a safety net and preventing suicides from the Golden Gate Bridge.

http://www.bridgerail.org/lives-can-be-saved/what-science-tells-us

Why has it taken so long when there has clearly been a need for a safety net?  The policy process is complex and it is difficult to say for certain but the media is referencing the recent increase in the number of suicides as motivation.  It can’t hurt that in 2012 the federal government passed legislation making federal funding available for the construction of safety barriers on bridges.  This is an interesting example of the complex interplay of science, misinformation, advocacy, and incentives in policy outcomes of public health consequence.  Too bad it took 60 years.

Balcony collapse – a potential (unseen?) threat to users of all ages

7 Apr, 14 | by Bridie Scott-Parker

Unfortunately here in Australia we have had a number of collapses of the family home balcony, and last month the casualty was a 3 month old baby boy who had been cradled in his mother’s arms moments before the fateful fall (http://www.dailytelegraph.com.au/newslocal/central-coast/death-of-baby-in-niagara-park-balcony-collapse-prompts-building-safety-warning/story-fngr8h0p-1226857651952). Such balcony collapses are by no means unique events here in Australia (e.g., http://www.theaustralian.com.au/news/nation/balcony-collapse-injures-five-people-at-nowra-in-nsw/story-e6frg6nf-1226743237328;  http://www.abc.net.au/news/2013-02-28/seven-injured-in-sydney-balcony-collapse/4544180). I know that in my own experience here in Australia, where the summer can be long, hot and humid, and autumn and spring can mean balmy days continue, the balcony is the perfect place to gather family and friends together.

Overloading of balconies, poor maintenance and shoddy workmanship at the time of construction has been suggested as contributing to their collapse, however I would suggest that much of the threat is indeed unseen by the user. I have never inspected a balcony or deck prior to standing on it, and I would not know what I should be looking for if I did try to inspect it. There are numerous tips for home-owners with decks and balconies which have the potential to cause injury if they collapse (e.g., see http://www.archicentre.com.au/publications/archicentre-blog/629-check-the-deck), however as a visitor, I am unlikely to know if the home-owner is aware of these tips, let alone if they have acted upon them.

Recent collapses have sparked a call for tighter rules by the Australian Institute of Architects (http://www.abc.net.au/news/2014-04-01/architects-say-up-to-12000-decks-at-risk-of-collapse/5359072). “Up to 12,000 balconies and decks across Australia could be at risk of potentially deadly collapse”.

Gino Andrieri, of Maurice Blackburn Lawyers representing the Diefenbach family (their baby girl died in 2010 after her father’s foot fell through a rotted floorboard in the rented home’s deck), stated “It’s a hidden trap because from the outside there are no significant visual indicators of the danger.” The Queensland coronial recommendations include:

  • Mandatory decks, verandas and balconies inspections;
  • Wood rot and termite activity be considered an emergency repair;
  • Real estate agents must record and act on tenants’ complaints.

In addition, Professor Roy Kimble (Royal Children’s Hospital, Brisbane), recommends decks and balconies be given a maximum load rating.

 

Low speed vehicle run-over incidents remain in the spotlight

31 Mar, 14 | by Bridie Scott-Parker

PubMed abounds with articles exploring the epidemiology of low speed vehicle run-overs (e.g., doi: 10.1136/ip.2010.030304; 10.1111/jpc.12188; 10.1111/wvn.12014; 10.1136/injuryprev-2013-040932; 10.1186/1471-2458-14-245; 10.1186/1471-2458-14-245). The devastating consequences of low speed vehicle run-over incidents has led to a plethora of suggested intervention and ‘tips’ for parents and others interested in child and infant injury prevention (for example, http://www.kidsafewa.com.au/drivewaysafety.html; http://www.safekids.org.nz/index.php/page/driveway-run-over-kit-locations; http://www.keepyourchildsafe.org/child-safety-book/child-driveway-accidents.html). In addition, after-market reversing cameras are available for purchase, and many new cars now come with this option as a standard feature.

Despite these resources, low speed vehicle run-overs continue to occur and they are not an isolated phenomenon unfortunately. Examples are commonly found in the news media (e.g., in Australia earlier this month: http://www.theherald.com.au/story/2153058/baby-hospitalised-after-being-run-over-in-driveway-by-4wd/). In New Zealand, a news report summarising a recent tragedy finished with a summary of 7 other driveway deaths (see http://www.stuff.co.nz/national/9879675/Child-run-over-in-driveway-dies). Similar events are also summarised in an article reporting a 2013 tragedy in Texas (see http://www.theeagle.com/news/local/article_55db2af5-f68b-5344-9e00-60c79f109c6a.html).

So how do we progress in preventing injury to our most vulnerable? Are parents and other caregivers unaware of the potentially-devastating injuries that can be sustained in the family driveway, thus suggesting that education is the key? Or is engineering, in the form of barriers and mandatory cameras, the solution? I would argue that a multilevel approach is needed, and is needed urgently. I welcome your ideas!

 

 

 

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