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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.

Hope for future gun control

28 Dec, 14 | by Barry Pless

Last week was the anniversary of the horrific Newtown shootings. That was when I saw an item on Mother Jones that prompted this posting. That item described the work of Moms Demand Action for Gun Sense in America (MDA). This group was founded after the Newtown massacre and it has had several important victories, largely by following the example of Mothers Against Drunk Driving (MADD). It aims to change the gun culture in America, just as MADD did in the 1980s when driving while intoxicated was still taken for granted. Thirty years ago most Americans saw drunk-driving deaths as “a problem you had to live with.” MADD helped to redefine them as crimes. It put pressure not on political leaders and on the liquor industry by “turning a spotlight on kids who had been killed.”

 

Some years ago I served on the National Board of MADD Canada. Today I am convinced that the strategies MADD used are equally well suited for MDA’s vital mission to bring to bring some sanity to the gun scene in the US. Largely, those strategies focus heavily on the wise use of the media, and nowadays, the web, combining human interest stories with solid statistics. In each case the major focus is politicians and all successes are brought to the attention of the media. MDA now has over 200,00o members, a sizeable war chest, and has joined forces with other influential groups such as Bloomberg’s ‘Mayors Against Illegal Guns.’

 

 So far MDA has persuaded some restaurant chains, internet companies, and retailers to oppose lax gun laws. They must be on the right track because they have elicited strong responses from many gun rights activists. MDA members and leaders have been called “Bloomberg’s whores,” “thugs with jugs,” and far worse. They get menacing phone calls and see violent images posted online.

 

 When Sandy Hook failed to bring about substantial changes in gun laws MDA focused on corporations like Starbucks where guns were being ‘openly carried’. Moms response was to urge members to “#SkipStarbucks” and post pictures of themselves having coffee elsewhere. Starbucks changed its policy after Facebook posts resulted in a petition with over 40,000 signatures. Other similar successes offer hope that large-scale changes in attitude will come before the next massacre.

 

 One experienced Washington lobbyist stated, “Changes to the culture are more important than legal changes in some ways. This sends a message that having guns everywhere makes people uncomfortable, which goes directly against the gun lobby’s agenda—to normalize having them everywhere.”

 

 

 

 

Preventing clothing-related burns in children

16 Dec, 14 | by Bridie Scott-Parker

Burn injuries are dreadful for any person of any age, but arguably they are most horrific for our most vulnerable: children. In Australia as in many other countries, we have mandatory standards which regulate the design and labelling of children’s nightwear. Having grown up in a rural area where we heated our house (our melted marshmallows and burnt our toast) via an open fireplace, I am well aware how quickly clothing can catch fire. Therefore preventing these injuries is of vital importance. To prevent, we must understand, therefore I was pleased to see an interesting article by Harvey, Connolley and Harvey (see http://www.ncbi.nlm.nih.gov/pubmed/25435488).

The authors examined the clothing-burn-related hospitalisation data for the entire state of New South Wales from 1998-2013 inclusively, and report the following clothing-related burn statistics:

* 18% of burns were nightwear-related (despite our mandatory legislation)

* exposure to open flame the most common mechanism (open fire, cooking)

* 25% of clothing-related burn hospitalisations occurred amongst children aged 5-14 years

* nightwear-related burns decreased by approximately 7% per year, compared to other clothing (reduction of approximately 2% per year)

* accelerant use was reported in 27% of cases

Whilst difficulties with coding data in official records were identified, which leads to underestimation of the clothing-related burns burden for all persons, including children, the authors note the reduction in burns as a result of the mandatory legislation introduced in 1987. Further legislative efforts targeting all clothing, and education of parents and extended family members regarding clothing-related burns risk for children is also recommended, and these findings can help us all in our injury prevention efforts as we keep safe over the festive season.

Engagement: The fourth ‘E’ in injury prevention

4 Dec, 14 | by Bridie Scott-Parker

Regular readers of the Injury Prevention blog will know what a keen advocate I am for the fourth ‘E’ in injury prevention: Engagement. I firmly believe that engagement is vital to transforming and translating education, engineering and enforcement efforts into real world advances in injury prevention. I know that in the domain of my own research and injury prevention efforts – young driver road safety – that young drivers want to be engaged with, and talked with, not TALKED AT and TOLD WHAT TO DO. Think about yourself as a teen – did that work with you? Providing such agency is the first sure step in making inroads in their safety, increasing their ownership and investment in injury prevention efforts and outcomes.

So you can understand how pleased I was when I saw a recent Scandinavian Journal of Caring Sciences article by Latimer, Chaboyer, and &Gillespie in which hospital patient perceptions regarding prevention and treatment of pressure injuries were explored. I particularly liked their closing comment that “If patient participation as a pressure injury prevention strategy is to be considered, nurses and organisations need to view patients as partners.”. I would argue that this should be extended to all injury prevention strategies, and that patient/target participation should not only be considered, it should be an essential component.

 

High school start and finish times

26 Nov, 14 | by Bridie Scott-Parker

High school start and finish times can be a controversial topic! A quick search of school start and finish times in Queensland, Australia, my home ground, sees a range of start times generally between 8.20-9.00am, and a range of finish times generally between 2.30-3.30pm.

High school start and finish times can be controversial indeed if you have more than one child in more than one school. I know that as a parent that I spent a number of years juggling kids and different start and finish times, and when schools suggest changing these times a media furore can erupt. Such was the case when, for various reasons, my son’s high school moved the finishing time from 3.00pm to 2.30pm (thus the start time moved also), resulting in the adjoining primary school moving their students’ finishing time from 3.00pm to 2.40pm.

So, if you are not a parent juggling kids with different school start and finish times, why are school start and finish times so interesting? Because there appears to be a mounting body of evidence that these times have considerable implications for injury prevention.

The November edition of the Journal of Clinical Sleep Medicine contains an article by Vorona, Szklo-Coxe, Lamichhane, Ware, McNallen, and Leszczyszyn in which the road crash rates for teens attending early-start schools were compared to teens attending later-start schools in Virginia, US. Teens in early-start counties had a significantly higher crash rate, with crash peaks coinciding as expected with the earlier times that students commute to and from school. It is noteworthy that adult crash rates and traffic congestion did not differ between the counties with an early start and the counties with the late start, further validating the importance of the research findings.

I also came across a webpage for a “non-profit organization dedicated to healthy, safe, equitable school hours“, which summarises the experiences of 43 US states that have moved their start times from early starts (e.g., 7.30am) to later starts (e.g., 8.30am), including the impact upon their students. I must say that as a parent of teens, who often feels like she needs to get a hose to spray water on them so that they actually drag themselves out of bed in the morning, I found such early start times shocking.

We know adolescents experience different sleep needs than children and adults, and that sleep deficits can have a pervasive impact psychologically, physiologically, and – I would argue – socially. The dialogue regarding sleep times needs to consider this pervasive impact if we are to protect some of our most vulnerable community members.

 

 

 

 

 

 

Ending men’s violence against women

24 Nov, 14 | by Bridie Scott-Parker

Tuesday 25 November is White Ribbon Day in more than 60 countries around the world. Visit the Australian online resource to find out more about this inspiring campaign which is a male led Campaign to end men’s violence against women. The mission of the campaign is to make women’s safety a man’s issue too. The campaign works through primary prevention initiatives involving awareness raising and education, and programs with youth, schools, workplaces and across the broader community. A great systemic approach!

 

 

House fires

24 Nov, 14 | by Bridie Scott-Parker

Australia was rocked by the deaths of 11 people from 2 families who perished in 1 house fire in a Brisbane suburb in August 2011. Just months after the three-year anniversary, the Coroner currently has the tasks of

(1) The findings required by s.45(2) of the Coroners Act 2003; namely the identity of the deceased persons, when, where and how they died and what caused their deaths.

(2) The circumstances surrounding the deaths, particularly the cause of the fire and any factors that may have prevented the deceased persons from escaping the fire or otherwise contributed to their deaths.

(3) Whether any accommodation issues contributed to the circumstances in which the deaths occurred.

(4) Any actions that may be taken to help prevent deaths in similar circumstances happening in the future.

I and many others look forward to hearing the final determination, particularly regarding point 4 which can help us in our injury prevention efforts.

Smoke alarms are fundamental for occupant protection – depending on the alarm type, they alert occupant(s) to the presence of smoke and/or flame, allowing occupant(s) time to exit the premises safely. This is premised on smoke alarms being in good, reliable, working order, and our family recently upgraded a number of detectors throughout our home which we were concerned had reached their use-by-date. A recent Journal of Epidemiology and Community Health article summarises the findings efficacy of a theory-based health education intervention which aimed to improve the rates of functioning smoke alarms in homes, with intervention homes containing more working smoke alarms.

I was interested to note in the recent news media article, however, that it was suggested that rather than exiting safely and in a timely fashion, occupant(s) may have spent time trying to extinguish the flames, thus preventing the safe and timely exit of all occupants. I had not previously considered that this behaviour may be an added ‘house fire risk’. Given his recent – albeit limited – workplace fire warden training, my husband has waxed lyrical regarding how confident he is that he would be able to extinguish any house fire using our extinguishers and (for cooking-related fires) a fire blanket. I think we shall be reconsidering this plan!

Response to John Langley from the Patron of Paper Cuts

3 Nov, 14 | by Barry Pless

For some while Langley and I have been debating whether injury prevention workers  should try to prevent all injuries because (as I reason) we simply cannot predict which will be severe, or, as he argues, we need only prevent those that will be serious. After some  back and forth, in a recent issue of Injury Prevention Langley wrote a long letter that ended by attempting to ridicule my position. It concluded, “Accordingly, I intend to nominate him as a Patron of the about to be formed International Society for the Prevention of Paper Cuts.” Because we are such good friends, I wrote the following by way of rebuttal. Wisely, however, our editor decided ‘enough is enough’,  declined to publish my response but agreed I could post it here. Enjoy!!

(PS – If you are not familiar with the poetry of Edward Lear (1812-88), especially his limericks and nonsense poems, you are missing a huge chunk of  enjoyment. Make haste to your local library and read on!!!)

Response to Langley’s letter “Severity of injury can be assessed on a number of dimensions” (Injury Prevention, Inj Prev 2014;20:218)

 How pleasant to know Prof Langley

Who has written such volumes of stuff.

Some think him ill-tempered and dangly

But I find him pleasant enough.

 

His mind is concrete and fastidious,

His nose is remarkably big;

His visage is not at all hideous,

His beard (when he has one) is a twig.

 

He sits in a beautiful parlour (that’s queer),

With hundreds of books on the wall,

He drinks a great deal of marsala (read ‘beer’),

But hardly gets tipsy at all.

 

He has many friends, lay and statistical,

Old Jack is the name of his dog;

His body is far from spherical,

And his hat resembles a log

 

My problem is simply stated:

I beg he explain how to tell

(Without being singularly ‘creative’)

When a fall will break, bruise, or be well!

 

POIS studies are flawed we are told

Because subjects are not hospitalized

This contradiction leaves me cold:

As many are long disabled or immobilized!

 

Langley would have us believe mostly

We need only prevent injuries severe or costly

He assures he can tell, which will be which

POIS recruitment shenanigans just a glitch

 

When he writes in scholarly journals,

His old editor chides him so!

Calling “He’s gone out in his nightgown,

That crazy old Kiwi, oh!”

 

He should weep by the side of the ocean,

He should weep on the top of the hill;

He thinks he can foresee the future,

But contradicts himself yet and still

 

Yet I am not swayed, ‘Patron of Paper Cut Prevention’ is fine

Over them I happily reign (pronounced ‘rine’),

But if the paper cuts an artery first grade

Would John remain quite so sanguine? (pronounced sang wine)

 

He reads, does not use logic, or speak Spanish,

Does not abide ginger beer, or reason till dawn;

As the days of his pilgrimage vanish,

How tough to debate Langley John!

 

(with apologies to Edward Lear)

Work-related traumatic brain injury

29 Oct, 14 | by Bridie Scott-Parker

Traumatic brain injury (TBI) can occur through various mechanisms, including violence and car crashes, but the mechanism of TBI I am focusing upon today is through a work-related injury. As a wife and mother, I know that I want my husband to return from work at the end of each shift in relatively the same condition as when he left for his shift, albeit a little more grubby! You can understand my alarm, then, as I read an article by Chang, Ruseckaite, Collie and Colantonio which explores the epidemiology of 4186 husbands, wives, mothers, fathers, sisters, brothers, sons, daughters, aunts, uncles, grandparents and grandchildren who did not come home from work in the same state as they went to work.

The Authors examined the TBI workers’ compensation claims during the period 2004-2011 in the Australian state of Victoria, identifying clear gender differences in the experience of TBI. To illustrate, male employees were considerably more likely to sustain a TBI (nearly 64% of claims were male), which may reflect the difference in occupations apparent across the claims (males worked predominantly as tradesmen/technicians, machinery operators/drivers, and labourers; females as professionals/scientific/technical services and community/personal service workers).

TBIs were incurred most commonly by being struck by/against an object (53%), falls (24%), assaults/violence (13%) and car crash (7%), with struck by/against accounting for a greater proportion of female TBI, and assaults/violence and car crashes accounting for a greater proportion of male TBI. Interestingly, most falls for males were found to occur from a height, whilst females were more likely to fall from the same level. Notwithstanding this, the proportion of falls increased for both genders with increasing age. For TBI victims who claimed lost-work-time,  the TBI resulted in an average of 219 days of work disability, at a claim cost of $96,343 on average. Males were more likely to be hospitalised, and for longer, with commensurate greater TBR-associated costs.

What does this mean for intervention? While a gradual downward trend in TMR was observed throughout the measurement period, particularly for males, as a wife with a husband who operates a very large machine and is at risk of a TBI during every work shift, I want to be sure that everything is being done to keep him – and other workers – safe. This means safe policies and practices in government regulations, workplace conditions, company management, and by him and his offsiders. It means regular equipment maintenance, including equipment repair, and the provision of personal protective equipment in addition to fully-functioning guards on the machine and rails on the catwalk. It means reasonable work expectations and management of customer demands, particularly as his company operates 24-hours a day to meet the demands of a 24-hour society. It means support at work, including through risk management and rehabilitation in case of injury. It means responsibility for safety at all levels, from government, to managers, to those on the coalface. It means a culture of safety, not a culture of shifting the blame if something does go wrong and someone is injured. It means learning from the past -for the present and the future – including learning from epidemiological studies such as Chang et al.

Let’s keep our workers safe, and for reasons beyond the negative impact upon the employer’s hip pocket.

 

Taking the good with the bad: bike helmet website

22 Oct, 14 | by Barry Pless

I recently came across a website that managed to be both impressive and depressing. The link is http://www.cycle-helmets.com/index.html

I have no idea how old it is or even, precisely, who is responsible for it. What is impressive is that it includes a massive amount of data on bicycling, bike helmet use, and helmet legislation for several countries, but principally for Australia. Some of the data are presented as graphs and others in tables. The amount of work that must have gone into assembling all this is staggering. I somehow suspect it has not been updated recently but it is still worth a visit if you are looking for any statistics related to these topics.

So why did I find it depressing? Simply because the commentary and text make it clear that all this effort is intended to discredit and oppose helmet legislation. Clearly, nothing I read convinces me that the data well support their opposition but to be fair, this is a far site better than the usual diatribes unsupported by anything remotely ‘scientific’.

For the record, I am not convinced helmet legislation discourages cycling or even if it does, the effect is short-lived. More importantly, as I have argued elsewhere and repeatedly, I am also not convinced that casual cycling, by children or adults, can do much to enhance cardiac fitness or reduce obesity. By casual cycling I mean trips of a few kilometres, by children or adults, to and from school or work, at a pace much slower than racers or couriers. In other words, the kind of recreational bicycling that is typical or average.

But even though I remain unhappy about the goals of this website, I must admit it is well done and exhaustive. And, for the most part, it seems that the data are accurate, even if they are consistently misinterpreted.

PS – At the very end I found this note: 

This website is maintained by Chris Gillham, a print/radio journalist and web designer based in the West Australian capital of Perth.
The site has been on the internet since 2000 and the accuracy of its data has never been challenged by relevant authorities. All information on the site is sourced to academic and government reports.

 

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