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Planning the implementation of an injury prevention programme

22 Feb, 16 | by Sheree Bekker

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(Photo: Steve CC BY-NC-ND 2.0)

I have invited Dr Alex Donaldson (follow him on Twitter @AlexDonaldson13), of the Australian Centre for Research into Injury in Sport and its Prevention, to share a little more about their new paper published open access in Injury Prevention: “We have the programme, what next? Planning the implementation of an injury prevention programme“.

The Translating Research into Injury Prevention Practice (TRIPP) framework, developed by Caroline Finch a decade ago, built on van Mechelen and colleagues’ ‘sequence of prevention’ for sports injuries. TRIPP highlighted the fact that only research that can, and will, be adopted by sports participants, their coaches and sporting bodies will prevent sports injuries. Stage 5 of TRIPP (‘Describe intervention context to inform implementation strategies) introduced the (then) novel idea of focusing research attention on understanding how the outcomes of efficacy research (TRIPP Stage 4) could be translated into interventions (policies, programmes, environmental or technical modifications) that could be actually implemented in the real-world context. This included developing an understanding of the best way to target and market evidence-based interventions to sport bodies and their participants.

However, implementing injury prevention programmes in the real-world is challenging and there is precious little information available in the scientific literature about how to transition from having an evidence-based intervention to getting that intervention widely, properly and sustainably implemented. As a consequence, most research remains in the early stages of these models/frameworks (i.e. describing the extent of the problem and identify causes or mechanisms of injury) which limits the potential for injuries to be prevented.

In a soon to be completed study investigating the factors that influence the translation of evidence-based injury prevention interventions into practice in community sport, I (as the project manager) found myself in the situation where my colleagues and I had:

What we then needed was an implementation plan for FootyFirst. The burning question was how can we ensure that the programme we had developed will be used and maintained for as long as it is needed by community-level Australian Football coaches and players?

Luckily for me, I had recently attended a short training course facilitated by Guy Parcel (then Dean Emeritus of the University Texas School of Public Health (Austin) on Intervention Mapping (IM). IM is a framework for health promotion intervention development underpinned by the notion that the impact of a health promotion (or injury prevention) programme is a function of the programme (its efficacy) and its implementation (whether people actually use it properly for sustained periods of time). IM is a six-step tool for planning and developing health promotion programmes. Like other programme planning frameworks, it starts with needs assessment and ends in evaluation. However, unlike other frameworks, it includes a step (Step 5) specifically focused on planning programme adoption, implementation and sustainability. IM Step 5 comprises seven tasks that are operationalised through six core processes (see Figure 1) and can be used independent of the other IM steps.

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The thing I found particularly useful about IM Step 5 was that it helped me to focus my attention on answering some key questions during the FootyFirst implementation planning process including:

  1. Who will decide to use FootyFirst and who will deliver it to the players?
  2. How can we involve the delivers (coaches) and participants (players) in developing the implementation plan for FootyFirst?
  3. What do community-AF coaches actually need to do to adopt and implement FootyFirst?
  4. What is likely to influence whether coaches adopt and implement FootyFirst?
  5. What needs to change for coaches to adopt and implement FootyFirst?
  6. What strategies could be used to help, support or encourage coaches to achieve the identified changes?
  7. Why do we think a particular implementation strategy is likely to work – what is the evidence or theoretical underpinnings for the selected strategy?

Programme effects have been shown to be up to three times higher when programmes are well implemented. If your target audience doesn’t know about your programme, use it properly and use it for a sustained period of time, it is unlikely your injury prevention programme will achieve the holy grail of ‘making a difference in the real-world’. For me, using IM Step 5 helped to ensure that our programme implementation planning process was:

  • based on a partnership between health promotion, implementation science, and injury prevention researchers, and community sports administrators and coaches;
  • informed by behaviour change theory, implementation science frameworks and published evidence about effective implementation strategies for safety programmes in community sport; and
  • supplemented with in-depth knowledge of the implementation context and input from the programme end-users.

This in turn enabled us to develop an implementation plan specifically designed to bridge the gap between research (top-down) and community (bottom-up) driven programme implementation processes.

Our experience demonstrates the critical importance of researchers, practitioners and community end-users collaborating early in the implementation planning process underpinned by a mutual respect for the knowledge, skills and experience that these different groups bring to the implementation planning process.

 

 

Focusing on the ‘why’ and the ‘how’

20 Jan, 16 | by Sheree Bekker

 

 

I draw attention to a recent post  from The BMJ blog – Chris Baker: Child obesity in India? Tell me something I don’t know! as it struck me as relevant to the field of injury prevention. 

The BMJ blog post centres around the fact that only two qualitative studies have been published in the past 15 years on the issue of child obesity in India, with the majority of research being prevalence studies – and concludes:

…let us divert resources away from the “what” and “who” of child obesity towards the “why” and “how.” These questions require the application of qualitative research methods with families and health professionals to explore the lived experience of being overweight or obese, and the broader social and cultural beliefs related to this growing burden.

As we know, and as a quick search for qualitative studies in Injury Prevention shows, our field does indeed recognise the importance of qualitative work, with skilled researchers using qualitative methods to answer the types of ‘why’ and ‘how’ questions that we encounter with regards to our injury prevention interventions.

Over and beyond the qualitative/quantitative debate however, this blog post struck me as pertinent to readers of Injury Prevention as it raises the important point of relevancy. Relevancy of methods to the research question, and relevancy of research questions to the population.

Relevancy matters.

Do make sure to read the post for thought-provoking points that are raised as to the types of questions we should be asking, and thus the deeper issues that we can seek to uncover and address through our intervention research.

On career building: networking and mentoring

7 Dec, 15 | by Sheree Bekker

 

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(SB) Recently, Bridie Scott-Parker and I attended the 12th Australasian Injury Prevention and Safety Promotion Conference in Sydney Australia. We had never met before, yet Bridie and I have been working together both on the executive board of the Australian Injury Prevention Network (which hosted the conference along with The George Institute for Global Health), as well as here on the social media editorial team for Injury Prevention. I was, therefore, delighted to meet Bridie in person. It seems this has been a pattern in my own networking recently: online before in person, as I reflected here on cementing online networks and collaborations. Those of you who read this blog, and have perhaps followed my musings on other platforms, will know that I often wax lyrical about the power of social media for this purpose – particularly for postgraduates.

At the conference, as the student representative of the AIPN, I coordinated a discussion panel for student delegates. The panellists brought diverse points of view: full professors, early career researchers, practitioners, and PhD students (and not a manel in sight). This session was designed to be organic in nature, and evolved into a discussion largely around career paths, networking, mentoring, and also the ‘mess’ (or ‘dirt’ – inside joke for those that were there) of work-life balance.

It is often assumed that formal mentoring and networking are the cornerstones of career development advice for postgraduate students. Yes, these are important and should be formalised, especially for women. However, well-meaning advice often translates into flawed advice that negates the lived experiences of students themselves (particularly when those include experiences of structural inequality). Indeed, when I was planning the student panel session, and after talking to some fellow students, it became clear that generic mentoring and networking advice was not what students want to hear.

From my point of view, as a current PhD scholar, it was fascinating to see how willing more established researchers are to opening up and having honest conversations about the very same struggles and failures that we have – if they are only asked about them. Impostor syndrome, introversion, emotional work…holding space for vulnerable conversations about these topics made more of a difference for many of us than formal career advice ever will. It is so easy to forget that academics are humans too, and it is this personal side that students like me find encouraging to hear about.

In talking career pathways, it was encouraging to hear from panellists that a career is not a linear pathway. So often the stories we hear are of successful people who were ‘in the right place at the right time’, or ‘lucky’ that their careers evolved as they did. But in reality there were, in fact, clear and often difficult choices that panellists had made over the course of their careers. The importance of personal boundaries set in place from which career risks can then be taken, or moves that can then be professionally and/or personally made were mentioned by all panellists. We each have a guiding instinct as to where we want to go – trust it. Career paths are sideways and forwards and backwards and upwards and onwards  – and that is okay.

On the dreaded “networking!”: building a network is more about quality of connection than quantity. One new strong connection is better than a fistful of business cards. Yes, flattery will open up a conversation (top tip: don’t know how to initiate a conversation with an academic? Comment on their work! Even better if it is a favourable comment), however genuine conversation, and giving something back to others will sustain it. More often than not, people want to help other people – and are happy to do so. This may not need to be in the form of a formal mentor or networking connection – often one quick coffee together can be enough to impart valuable tacit knowledge.

As a personal note to other postgraduate students, it is well worth the effort to get involved in an executive board of an organisation, or a conference organising committee. The true value in any career building/mentoring/networking opportunity lies in adding value yourself. It has taken me a long time to figure this out. In my opinion, you will get more out of being useful and getting involved, than you ever will out of being given passive advice by others. How can you be useful? This does not need to be a grand gesture or even include a highly specialised skill – in my case, offering to do social media has been my easiest path to making myself useful. Prove yourself competent at something, no matter how small, and people will take notice.

The best mentoring/networking relationships lie not in a one-way give-and-take, but rather are two-way streets. The very best mentors and colleagues learn as much from students, as students learn from them. That is your gauge as to whether a professional relationship is worth the effort. I often think that emerging researchers can, and should, be more discerning as to who they choose to learn from. Also remember that it is good to have more than one mentor – people have skills in different areas, and not everyone can be everything to everyone. In our wide-eyed idealism we are often a little too keen to make every connection that we can into everything we can.

In this spirit of great connections, I have asked my ten-minute one-off networking-mentor Bridie Scott-Parker (I saw her great networking skills in action during a valuable ten-minute conversation at the conference) to add her perspective here as a panellist at the session.

(BSP) I have blogged previously on the importance of attending conferences, with one of the most beneficial aspects being the opportunity to network with others in the field. After chatting with Sheree – in person after many email and telephone conversations – I realised that the value in networking really lies in both parties having the chance to learn as they share different perspectives. In this respect no matter at what stage you are currently at in your injury prevention career someone can learn from you and you can learn from others. Network away!

For me, the conference panel was an opportunity to show students that life as an injury prevention researcher is not a bed of roses upon which you frolic with unicorns, rather that there is no one path that everyone will follow and that is okay. For me personally, the panel was also an opportunity for me to be kinder to myself, as you will be hard pressed to find a greater critic of me than myself. I became very ill during one of my undergraduate degrees, and I thought I would only ever be the ‘token disabled person’ in my classes and in any employment I ever achieved, if I could achieve any employment. I also had the double-whammy of juggling two small children – another great source of anxiety, as what the heck am I doing studying and trying to work, while juggling fun things like medication trials, when I should be focused on being Mum?

I think sharing a snapshot of some of the self-doubt I have felt, the relentless voice that tells me I am the equal opportunity person when I am not, and how I ended up in injury prevention after a long and winding road, and not just how I managed to succeed academically and in the increasingly-competitive domain of research, resonated with some of the students who may themselves be struggling with self-doubt, feeling like a failure as a Mum who cannot get any semblance of a work-life balance, and who cannot see any clear trajectory from where they have come from to where they aspire to be in the future. In many ways, that is the magic of life, but that phrase would have been cold-comfort to me as a stressed student! And that is okay.

(SB) Yes! I will repeat: academics are humans too.

 

More on writing

5 Dec, 15 | by Barry Pless

I am not a fan of Elsevier and thus ambivalent about posting this. But, on balance, it may help some novice authors and perhaps some more experienced ones as well. Check out this link to the Elsevier Publishing Campus… many pdfs available to download on various aspects of writing and publishing. Hope it works.

https://www.publishingcampus.elsevier.com/pages/154/Colleges/College-of-Skills-Training/Resources-for-Skills-Training/Quick-Guides-and-Downloads.html

“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”! 🙂

Undergraduate research experience

9 Nov, 15 | by Bridie Scott-Parker

I read an interesting blog last week in which two undergraduate students shared their perspectives after completing a research placement, and it prompted me to reflect upon my own research training, and how much of what we researchers – while it sometimes feels as if it is innate – is actually learned skills and abilities (oft by trial and error) that need to be shared with our up-and-coming researchers. Today I want to share a recent experience with an undergraduate student from another Queensland university.

I was approached by Sehana last month regarding the potential to gain some experience in research during her summer semester studies. I invited her to accompany myself and my University of the Sunshine Coast (USC) Research Assistant Ms Jamie Caldwell as we collected data during week four of the the first wave of an 18-month longitudinal study. Today Sehana shares her story:

When speaking to the placement officer at USC regarding a work experience in research, Bridie Scott-Parker was the first name she mentioned.  She thought the placement would be perfect for me especially because of Bridie’s extensive knowledge in research and having recently being awarded the Tall Poppy Science award for her research contributions. 
 
From reading about her extensive research online, reading a couple of her published papers, and speaking to her about her work, I am now a full convert to “the dark side of research” – as she calls it.
 
Throughout my degree I have done numerous research assignments, doing certain sections of a report for various courses.  You are always given data, or parts of the report are completed for you and you do the rest.  I have never been involved in any research related activities out in the real world. 
 
We visited a school, collecting and distributing surveys and sleep diaries to adolescent school children.  From the beginning there were issues that as a novice researcher caught me off guard.  The students came in drips and drabs, many did not have their sleep diaries, others had multiple from previous weeks, some students did not attend at all. 
 
I stood there the entire time panicking with “missing data” running through my head, while Bridie and Jamie casually took it all in their stride.  It wasn’t until I reflected on it at the end that my theoretical learning and practical experience actually fit together.  And it was exactly that – experience – which they had and I didn’t that made the difference. 
 
I could see that Bridie and Jamie both had enough experience to know the little things such as bringing spare pens and surveys.  It was when I heard them speaking about participant codes for the research that I realised my degree may have taught me how to do ANOVAs and correlations, but experience like this, out in the real world, surrounded by real participants (and real missing data) is invaluable. 
 
The first day of any job is nerve wrecking, but I feel this experience has taken away much of the anxiety associated with being a graduate fresh in the research field.  I would highly recommend to anyone who is leaning towards a research career to spend time with real researchers, speak to them, help collect data and just see how it all works in the real world. 

Ms Sehana Naz

Howzat?! An Injury Prevention and Prediction App for Cricket?

8 Nov, 15 | by dbui

As the 1st test is underway between Australia and New Zealand at the Gabba, British Medical Journal Injury Prevention brings you an interview with Dr Naj Soomro, a physician with a passion for Technology and Sports Medicine in Cricket. I met Dr Soomro at the National Conference of Sports Medicine Australia last month where I was representing the University of New South Wales Sports Medicine Society, and his presentation was one of my personal highlights of the conference! He presented on a novel Injury Surveillance, Prevention and Prediction App, “Cricket Predict”.

Dr Soomro kindly agreed to answer a few questions for the blog!

Q1. Tell us about Cricket Predict; what is it and how did you come up with the concept?

I’ve been interested in prediction for a long time now. Today, we use technology and science to predict everything from the weather to cardiovascular risk. This carries into Sport as well: If you have a look at NFL, previous injury is used extensively in determining injury risk; Rugby players are similarly triaged using GPS data and the number of tackles per game. My aim was to develop a similar system for Cricket.

Cricket predict is a mobile app that harnesses technology in the surveillance of injuries, measures risk factors for injury and ultimately, aims to predict (and prevent!) injury. By tracking risk factors for injury in real-time, medical and coaching staff can receive alerts when an individual player’s risk profile is high – and interventions can be implemented. Further, whenever a player is injured, there is an electronic injury form which can be filled out through the app that goes onto a central online database, helping with identification of injuries.

Q2. Cricket predict utilises a number of different risk factors to help predict injury, what is the evidence for using these risk factors specifically?
The risk factors that are used in Cricket Predict are all validated in the literature. They include:
I. Cricket workload, such as number of balls bowled
II. Non-cricket workload e.g. Strength and conditioning sessions, cross-training
III. Psychological status – measured by a modified Profile of Mood States (POMS) questionnaire, usually 76 items but modified to 10 items to be cricket-specific and “player-friendly”.
IV. Sleep, a measure of fatigue and documented risk factor for injury, measured by an accelerometer and analysed by Activ Graph.
V. Previous injury profile
VI. Pre-season strength parameters, including Internal Rotation to External Rotation ratio (predicts injury in Throwing Athletes), Hamstring to Quadriceps ratio (predicts hamstring injury)

Cricket Predict’s algorithm incorporates all of these risk factors and displays to the user a graphical representation of the player’s injury risk. However, exactly how predictive these risk factors are in cricket players is yet to be studied and my research group is running a prospective validation study to do just that.
Q3. What are the implications of the findings of this study for readers?
There are 2 main implications of this research:

One of the biggest implications of my research is the integration of technology into Sports Medicine, which I see as the way forward. Its one of the reasons I developed this mobile app. Developing an electronic injury surveillance system makes data collection very easy, and numerous studies have demonstrated that electronic injury surveillance systems are superior to paper-based systems. Additionally, with the advent of wearable technology, large amounts of quantitative data can be incorporated.

Secondly, if the algorithm in Cricket Predict is validated, this research will revolutionise the way that Sportspeople play the game. Based on what we prove and validate, the coaches are going to change their coaching techniques, they will be able to select the best players for their teams, and develop policies for junior players as well.

Q4. Has this type of research been undertaken in other sports?
There is a recent article by Tim Gabbett which studied an injury prediction model in Australian Rugby League in which he was able to predict approximately 50-80% of soft-tissue non contact injuries over the course of 2 seasons. In the course of a tournament, an injury to a key player can change the balance of a team. Even if an algorithm can predict 10-20% of injuries, for an elite team that is very significant.

Q5. This research is heavily reliant on Technology, where do you see Technology and Medicine, or Technology and Injury Prevention going forward?
A lot of data that we get these days is subjective data from players, and I think the best way to quantify data and validate data is to get data electronically from the use of sensors. Sensor-based technology and imaging technology is going to go very far in terms of performance analysis and the usage of physical characteristics of players. I see the usage of wearable technology being really big in sports. What I mean by this is the use of accelerometers or gyroscopes to look at movement patterns, similar sensors to look at medical data such as the amount of perspiration, and the amount of stress hormones such as Cortisol that can be measured in saliva and also in sweat. We can also look at blood sugar levels, heart rate, oxygen saturations – all of these things can be measured using wearable technology which can send wireless information to the medical and coaching staff. One of the most important things coaches can get out of this is the amount of fatigue of their players. If we can use technology to quantify this fatigue, that is going to revolutionise sport.

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If you’d like to keep this conversation going, or be involved with Cricket Predict in the future, please get in touch with Dr Najeeb Soomro via email cricdoctor@gmail.com or Twitter @CricDoctor. Specifically, if you are a cricket club, sports scientist or health professional interested in doing injury surveillance or helping to validate the app, Dr Soomro is happy to share the app with you! 
Let us know what you think @BMJ_IP too!

David Bui is a final year medical student at the University of New South Wales and outgoing President of the University of New South Wales Sports Medicine Society. He has an interest in Orthopaedics, Sports Medicine and Injury – in all forms! @David_Bui_

Water safety in Australia: The Royal Life Saving National Drowning Report 2015

6 Nov, 15 | by Sheree Bekker

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Kudos to Royal Life Saving for releasing both an infographic and video along with their National Drowning Report 2015, making the content more accessible and easier to share. The video – linking data, story, and prevention measures – is an excellent example of a clear, simple way of disseminating research findings.

This important information, in these formats, speaks for itself – and in lieu of an in-depth post.

Two recent Injury Prevention articles on this topic for further reading:

Interventions associated with drowning prevention in children and adolescents: systematic literature review

Does teaching children to swim increase exposure to water or risk-taking when in the water? Emerging evidence from Bangladesh

On a cheeky note: unfortunately no infographics to summarise these – something I feel we as researchers/authors/bloggers should consider for key papers!

On a related note: Justin Scarr, the Chief Executive Officer, Royal Life Saving Society – Australia, and Convenor, Australian Water Safety Council will be a keynote speaker at the 12th Australasian Injury Prevention and Safety Promotion conference – hosted by the Australian Injury Prevention Network, and The George Institute for Global Health – in Sydney from 25-27 November 2015. There is still time to register today to hear him, or indeed for any of the other speakers on the program, present. More information here.

 

Botswana reflections: on learning the ABCs

15 Oct, 15 | by Sheree Bekker

I am currently in Botswana: a landlocked southern-African country of roughly two million people. I grew up here, and it is a place that I consider one of the most beautiful in the world (particularly the Okavango Delta – a bucket list destination for wildlife). The country and its people were beautifully portrayed in this music video from Nico and Vinz (take note Taylor Swift).

Although Botswana is amongst the most economically and politically stable countries in Africa, the need for public health improvements (as with other countries) remains a priority.

The top ten causes of death in Botswana, according to the Centers for Disease Control and Prevention (2010) are:

  1. HIV
  2. Cancer
  3. Stroke
  4. Tuberculosis
  5. Ischemic Heart Disease
  6. Diarrheal Disease
  7. Diabetes
  8. Road Injuries
  9. Lower Respiratory Infections
  10. Malaria

It is no surprise that HIV remains at number one on this list, in 2014 the prevalence of HIV in adults aged 15 to 49 was 25.2% – second in the world only to Swaziland.

The ubiquitous presence of the HIV epidemic can still be seen in the faded remains of the educational messaging that was painted on every available public wall in the 1990s and early 2000s.

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Indeed, I so clearly remember that we learned our ABCs at school in Botswana, the letters themselves certainly, but almost more importantly the potentially life-saving versions too: A) Abstain, B) Be wise, C) Condomise. To this day, condoms are widely and freely available (useful, except when the HIV awareness ribbons are stapled to – through – the condoms themselves).

Botswana has generated what is often referred to as a ‘stunning achievement‘ in its multi-faceted response to the HIV epidemic. This success means that the government can now allocate resources to start to address other public health concerns.

Number eight on the above list, road injuries, is now seeing an uptick in prevention initiatives. A 2012 abstract published in Injury PreventionCharacteristics of casualty crashes in the Republic of Botswana: identifying evidence-based prevention opportunities showed that:

Fatality rates increased by 383% (per 10 000 vehicles) from 1975–1998, with recent estimates indicating a 50% higher fatality rate per population than the global average.

The Global Burden of Disease 2010 Study showed that alcohol use was the leading risk factor for disease burden in Botswana. A 30% tax on alcohol (reduced from the initial plan for a 70% tax) was subsequently introduced. A second 2012 abstract in Injury PreventionComparing fatal alcohol-related road traffic crashes in Botswana pre- and post-passage of a national alcohol levy showed:

A large percentage of fatal alcohol-related crashes (FARCs) occurred on weekends (49%), among males (78%), and among 25–34 year-olds (35%).

Comparing changes pre- and post-levy, we found that there was a statistically significant change in FARCs per 10 000 registered vehicles (rate pre-levy=10.4; 95% CI 9.1 to 11.8 vs rate post-levy=8.3; 95% CI 7.3 to 9.3; p=0.01). However, rates per 100 000 population remained stable pre- and post-levy (rate pre-levy: 6.9; 95% CI 6.0 to 7.7 vs rate post-levy: 7.5; 95% CI 6.6 to 8.4; p=0.29).

Alcohol is, obviously, only one element of the highly complex issue that is road safety in Botswana. Road safety issues that I notice here daily include: lack of seatbelt use, unrestrained children, unroadworthy vehicles, animals on roads, speeding, negligent driving, potholes, and overcrowded vehicles. It is encouraging to see work being done on the ground to improve safety (police spot licence checks for example), however it will take time and a multifaceted, focused, local strategy similar to that seen in the HIV response for any great strides to be made. Encouragingly, we know that research and policy have had positive impacts in similar countries around the world. Interestingly, Botswana’s current road safety initiatives do not seem to be as creative as the robots in the Democratic Republic of Congo.

Whilst there is much to achieve in Botswana on the issue of road safety, the success of the HIV campaign means that Botswana can be proud of its initiatives to prevent injury to and illness in its citizens and visitors alike.

 

*Please note that I am not a researcher in the area of HIV or road safety, and this blog is largely based on my personal observations and knowledge. I welcome comments and insights from people who are – either below, or on our Twitter or Facebook.

Ohio – “the epicenter of the heroin epidemic”

1 Oct, 15 | by Angy El-Khatib

Unintentional drug overdose deaths have increased in the last decade in the United States. In the state of Ohio (which is where I now work as a researcher!), unintentional drug overdose is the leading cause of injury-related death (ODH, 2014).  Since 1999, more than 13,000 Ohio residents lost their lives to unintentional drug overdoses.  Based on 2014 preliminary data from death certificates, unintentional drug overdoses caused the deaths of 2,482 Ohio residents – a 17.6% increase compared to 2013.

Number of Deaths and Death Rate per 100,000 from Unintentional Drug Overdose by Year, Ohio Residents, 1999-2014

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Source: Ohio Department of Health, Office of Vital Statistics; Analysis Conducted by Injury Prevention Program

The rise in drug overdose deaths is thought to be attributed to the reemergence of an opioid called “fentanyl” – a synthetic opiate that is that is 30 to 50 times more potent than heroin; often times, fentanyl is mixed in with other commonly abused drugs, like heroin.

According to the National Forensic Laboratory Information Systems (NFLIS) – a U.S. Drug Enforcement Administration program that collects drug chemistry analysis results from cases analyzed by state, local, and federal laboratories – fentanyl drug seizures in the South, Northeast, and Midwest parts of the United States increased by 300% from the second half of 2013 to the first half of 2014.

Fentanyl-Related Drug Overdoses, Ohio, 2012-2014

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Source: Ohio Department of Health, Office of Vital Statistics; Analysis Conducted by Injury Prevention Program

Six days ago, the Washington Post released an article calling Dayton, Ohio “the epicenter of the heroin epidemic.” This is likely due to several different drug trafficking groups having easy access two major highways: (1) I-70 is used to move their product east to west to Indianapolis, Indiana and Columbus, Ohio; while (2) I-75 is used to move drugs north to south from Toledo, Cleveland, and Cincinnati in Ohio.

Intersection of Interstate-70 and Interstate-75 in Ohio

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With this in mind, and since 2011, the state of Ohio has been partnering and building on several initiatives to improve interdiction, raise awareness, reduce prescription abuse, and expand treatment options.

As a harm reduction strategy, Ohio Governor John Kasich signed HB 4  into law on July 16, 2015.  This allows pharmacists and pharmacy interns to dispense naloxone, an opiod overdose reversal medication, without a prescription but in accordance with a physician-approved protocol and while calling 911 for medical assistance. When administered through intramuscular injection, intranasal spray, or auto-injector, naloxone reverses the effects of an overdose by blocking receptors in the brain from the effects of opioids while restoring breathing.

Another harm reduction strategy used by opioid overdose prevention programs (OOPPs) are take-home naloxone kits. Recently published in the BMJ – Injury Prevention, researchers Kelly Gurka, Alexnadria Macmadu, and Herbert Linn, found that the acceptability and feasibility of a take-home naloxone program was high among participants.

Both harm reduction strategies empower drug users to protect themselves and others. Although objections exist over economic benefit and moral disarray, working on preventing overdose deaths rather than focusing exclusively on stopping opioid and opiate use may be more developmentally and culturally appropriate and may enable drug users to pursue effective treatment.

 

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