Unintentional home-related injuries in the Islamic Republic of Iran: findings from the first year of a national programme

BACKGROUND: As elsewhere, unintentional injuries are a leading cause of death in Iran, but non-fatal injuries occurring in the home environment have not been analysed. OBJECTIVES: The primary purposes of this study were to describe the pattern of home-related injuries and to obtain incidence rates for their determinants in order to monitor intervention programmes for preventive purposes. METHODS: A surveillance system for home-related injuries in selected rural and urban areas was established for the systematic collection of data. The information obtained covers emergency department visits and health services provided between March 1998 and March 1999. RESULTS: In total, 79,723 unintentional home-related injuries were reported, primarily burns (49%, incidence of 19/10,000 rural and 13/10,000 urban inhabitants) and lacerations/cuts caused by contact with sharp instruments (30%, incidence of 8.4/10,000 rural and 11/10,000 urban inhabitants). Injury rates were highest among children aged 0--4 years and lowest among the elderly (60 years or over). Rates varied between the sexes; among children under 15 years of age, most patients were male, but the opposite applied to all groups >15 years of age. Leading causes of death were burns, falls and poisoning among 628 people who died because of home-related injuries. CONCLUSIONS: The injury pattern found in this study is generally similar to that of many other countries, with the striking exception of burns. Other reports focus on the same problem, particularly with regard to Iran. The prevention of burns should be an important feature of any national injury prevention programme. Due to the varied causes of home-related injuries in Iran, interventions should be targeted at people at the greatest risk, namely children. Home visitation as a tool for face-to-face training with a sharper focus on burns, falls and poisoning prevention can be recommended as a part of primary health care policy. Greater investment in surveillance also provides a way of reducing the threat of injury in the community.     

Home Unintentional Non-fatal Injury Among Children Under 5 Years of Age in a Rural Area, El Minia Governorate, Egypt

Injury is the leading cause of morbidity and mortality in children aged 1–14 years, with home injuries a particular problem in the preschool-age group. The focus of this study was to determine the frequency, and the outcome of unintentional non-fatal injuries among children under 5 years of age in the household, and to describe the related risk factors through a community-based survey. A cross-sectional community based study was conducted on a random sample of 1,255 rural Egyptian children under 5 years of age. Data were collected by a questionnaire which included; socio-demographic data, history, type, and the outcome of unintentional home injuries in the previous year. Of 1,255 children, 55.9 % were males and 44.1 % were females, and their mean age was 28.6 ± 11.8 months. The frequency of unintentional non-fatal home-related injuries was 20.6 %. Injury rates were the highest among children during the third year of life, those of less educated parents, those whom mothers are of young age, and those with low household socioeconomic standard. Homes of injured children were not significantly different from the homes of non-injured children. Burns were the most common injuries among all the study groups (38 %) followed by falls (35.3 %). ‘Handicaps’ were more strongly associated with falls and burns (6.6 and 4.1 % respectively). Unintentional injuries are common among children under 5 years of age in rural Egypt. Therefore, measures should be taken to prevent children from the most frequently recorded home injuries such as burns and falls.     

Investigating the longer-term health consequences of work-related injuries among youth

PURPOSE: To investigate the longer-term health consequences of work injuries among youth aged 15-24 years using a population-based, longitudinal study (1991-2001) of merged health care and workers' compensation records. METHODS: A group-based modeling approach was used (1) to identify unique trajectories of health care use defined by general practitioner visits among the study sample stratified by gender, and (2) to determine the injury factors that predict a youth's membership in a trajectory, adjusted for sociodemographic factors. RESULTS: Four long-term trajectories of health care use were identified among young injured workers, for both males and females. Similar trajectories were observed among a comparison, noninjured sample but the magnitude of health care use was consistently higher among the injured worker cohort, especially for females (attributable to general practitioner [GP] visits for symptoms, signs and ill-defined diagnoses), and a notable "spike" in health care use occurred in the year immediately after a work injury for both males and females that was not observed in the comparison population during the matched year (attributable to GP visits for musculoskeletal and injury diagnoses). For males, the type of work injury mattered with an increased odds of belonging to the higher health care trajectories associated with a musculoskeletal injury (odds ratio [OR] = 1.57, 95% CI = .76, 3.23; and OR = 1.61, 95% CI 1.08, 2.41 for the postinjury trajectories), adjusted for age, occupation, socioeconomic status, and geographic location. CONCLUSION: Persistent use of health care services may represent a cumulative burden of morbidity over the life course as a result of a work-related injury in general among young women and as a result of musculoskeletal injuries in particular among males.     

Residential injuries in U.S. children and adolescents

OBJECTIVES: Injuries are the leading cause of death and disability for U.S. children, but little research exists on injury in the home environment. The purpose of this study was to estimate the rate and severity of and trends in unintentional residential injury for U.S. children <20 years for 1993-1999. METHODS: Data on emergency department (ED) visits were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Rates and 95% confidence intervals (CIs) were calculated using SUDAAN. Chi-square analysis was used to test for differences among proportions. Time trends were analyzed using linear regression. RESULTS: Residential injuries accounted for an average of 4.01 million (95% CI 3.50 million, 4.56 million) ED visits each year for U.S. children, representing 39% of unintentional injury ED visits. There were an average of 531,000 (95% CI 456,000, 606,000) visits with moderate-to-severe injuries, resulting in 73,680 (95% CI 59,715, 87,645) hospital admissions annually. The rate of residential injury visits (excluding unknown locations) was 5.6 per 100 (95% CI 4.9 per 100, 6.4 per 100). The visit rates for children <5 years of age were higher than those for children >9 years (p<0.0001). Males had a higher rate of visits than females (p=0.01). Falls were the leading mechanisms, resulting in 1.5 million ED visits per year (95% CI 1.3 million, 1.8 million). Residential injury rates decreased by 28% over time (p<0.02), from 6.3 per 100 (95% CI 3.4, 9.2) in 1993 to 4.5 per 100 (95% CI 2.3, 6.7) in 1999. CONCLUSIONS: The predominant location of injury for U.S. children is the home, accounting for 4.01 million ED visits and more than 70,000 hospitalizations each year. Efforts targeted to the home environment are needed to reduce morbidity and mortality from unintentional injury in U.S. children.     

湖北省伤害监测点60岁及以上老年人伤害情况分析

目的 了解湖北省伤害监测点老年人伤害流行状况,为制定伤害干预策略提供科学依据.方法 对天门市伤害监测哨点医院2014年首次因伤害就诊的60岁及以上老年人伤害病例进行分析.结果 共报告60岁及以上老年人伤害病例2 999例,其中男性1 577例.主要伤害原因为跌倒/坠落(1 422例,47.42%);其次是道路交通事故(1 046例,34.88%);伤害发生地点主要是家中(1 083例,36.11%);伤害发生时的主要活动是做家务(1 357例,45.25%)和休闲活动(965例,32.18%);伤害性质以挫伤/擦伤(1 164例,38.81%)为首位;伤害部位主要是头部(842例,28.08%).结论 跌倒/坠落是造成老年人伤害的主要原因,家中是伤害首要发生地点.建议应以家庭为重点,积极主动干预,采用必要的防止跌倒发生的设施,以减少老年伤害的发生.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.     

珠海市农村学龄前儿童伤害情况及其父母、教师相关知识调查

目的 了解珠海市农村学龄前儿童的伤害情况及其父母、教师的儿童伤害知识，为实施干预提供科学依据。方法 采取整群抽样的方法，对珠海市三灶镇在园儿童942个家庭的父母，45名任课教师进行儿童伤害情况及儿童伤害知识调查。结果 儿童伤害发生率为5．0％，伤害以意外跌落或坠落伤(61．4％)、烧烫伤(17．5％)为主，头部及四肢为主，分别为57．4％、37．0％。伤害的地点：幼儿园占14．0％，家庭占40．4％，幼儿园和家庭以外的其他场所为占45．6％。单次伤害的平均经济损失790．7元。父母的年龄越小和化水平越高，相关知识的正确回答率越高。母亲的知识一般高于父亲。国家工作人员的知识高于其他职业，农民最低。结论 农村学龄前儿童伤害较为严重，应该对儿童、家长及老师3类人群开展与儿童安全相关知识的健康教育，采用健康促进策略来预防与控制儿童伤害的发生。     

Incidence and costs of injuries in The Netherlands

BACKGROUND: Injuries are a major and persistent public health problem, but a comprehensive and detailed overview of the economic burden is missing. We therefore estimated the number of emergency department (ED) attendances and health care costs as a result of injury. METHODS: We estimated lifetime health care costs of injuries occurring in The Netherlands in the year 1999. Patient groups were defined that are homogeneous in terms of health service use. Health service use and costs per patient group was estimated with data from national databases and a prospective study among 5755 injury patients. RESULTS: Total health care costs due to injury in 1999 were euro 1.15 billion, or 3.7% of the total health care budget. Major cost peaks were observed among males between ages 15 and 44 due to a high incidence, and among females from age 65 onwards due to a high incidence and high costs per patient. For the age groups 0-14, 15-44, 45-64, and 65+ ED attendances per 1000 person years were 85, 85, 43, and 49, respectively, and costs per capita were euro 38, euro 59, euro 43, and euro 210, respectively. Costs per patient rise about linearly up to age 60 and about exponentially thereafter. From age 25 onwards, females have higher costs per patient than males. Hip fracture (20%), superficial injury (13%), open wounds (7%), and skull-brain injury (6%) had the highest total costs. Most costs were attributable to falls (44%) and traffic injuries (19%). CONCLUSION: Young adult males, elderly females, falls, hip fractures, and minor injuries without medical need for hospitalization account for a substantial share of health care costs.     

Epidemiological aspect of traumatic brain injury in Northeast Italy

Background: Traumatic brain injuries (TBIs) remain an important public health problem in developed countries. Hospital records were reviewed to ascertain the epidemiology of TBIs in Northeast Italy. Methods: The annual rates of TBI-associated hospitalisation were estimated by analysing data collected from hospital records from 1996 to 2000. TBIs were identified according to the Centers for Disease Control and Prevention definition and the ICDMAP-90 was used to assess their severity. Findings: 55,368 TBIs were collected between 1996 and 2000, with an overall 29.4% decline in the number of cases. As for severity, moderate TBIs dropped by 34.1%, whereas a less conspicuous decline was observed for mild injuries. Severe injuries remained stable between 1996 and 1999, but rose in 2000, when the unclassified injuries were better distributed. Concerning outcome, fatal TBIs dropped slightly, but only in 2000. Causes of TBI were recorded in 59.2% of cases: 48.5% were motor vehicle accidents, 8.8% occurred at work and 12.2% at home. There were more males than females in all age groups. The highest number of cases per 100,000 person of motor vehicle accidents was recorded among 16–25 year-old and 36.5% occurred at weekends. Domestic accidents showed two age peaks, in children and the elderly. Occupational accidents occurred at all working ages, tending to decline with older age. Interpretation: Better health care and educational campaigns may have contributed to the declining rate of TBI-associated hospitalisation. Special efforts should be made to further reduce the motor vehicle accidents involving young people and welfare programs are needed to limit the risk of falls and contain functional impairment in the elderly.