H地区骑自行车者伤害的动态研究

[目的 ]分析H地区自行车伤害的发生率和死亡率及其动态变化 ,为开展伤害预防提供依据。 [方法 ]采用1994年到 1998年公安部交通管理局及部分H地区公安局的道路交通事故统计数据 ,及H地区人口统计资料进行分析。[结果 ]自行车伤害在不同交通方式伤害中居首位 ,其伤害的死亡率最高值为 2 5 82 /10万 ,是美国的 8倍多。其中至少有 61 5 %的死亡者为头部损伤 ,其中大部分 (74 6% )由头部与水泥或柏油路面碰撞引起。所有的病人无一在受伤时佩带头盔 ,而且在所有骑自行车的人群中都没有使用头盔。 [结论 ]在H地区同自行车相关的头部损伤是一个严重的公共卫生问题 ,应尽快建立自行车事故伤的监测系统 ,通过采取立法手段在公众中强制推行佩带头盔同时进行自行车安全教育干预 ,改善道路环境等措施控制自行车事故伤害     

A decrease in both mild and severe bicycle-related head injuries in helmet wearing ages--trend analyses in Sweden

Several international studies point at the efficacy of bicycle helmets in reducing head injuries. In Sweden, observational studies show that from 1988 to 1996 helmet use increased in all categories of cyclists. The objectives of this study were to analyse the trends of bicycle-related head injuries based on their main diagnosis and external cause of injury by different age groups. Our study area was the whole population of Sweden from 1987 to 1996. Outcome evaluation was based on data from the Swedish National Hospital Discharge Register concerning all bicycle-related injuries from 1987 to 1996, which presented 49 758 reported in-patient care. The trends in incidence rates (IRs) were studied with regression analyses. The results show that children under 15 years had the highest IRs. For these children, the IR decreased by 46%. The head injuries in children decreased both in collisions with motor vehicles and in other accidents. Similarly, the IR of concussion and skull fracture decreased. For non-head injuries, there were no significant changes for children. On the other hand, the incidence of both head and other injuries for adults aged 16-50 years increased. Ages above that showed no significant changes. Our conclusions are that the decrease in IR for bicycle-related head injuries refers to children in ages for whom bicycle helmet use during the period increased. This could not be explained by any general decrease in bicycle-related accidents or by any changes in the distribution of injuries after collision with motor vehicles. The increasing helmet use among younger schoolchildren probably contributed to the decrease in head injuries.     

Nonfatal occupational injuries and illnesses among workers treated in hospital emergency departments--United States, 2003

CDC's National Institute for Occupational Safety and Health (NIOSH) collects data on nonfatal occupational injuries and illnesses through the National Electronic Injury Surveillance System (NEISS), an emergency department (ED)-based surveillance system. This report summarizes data for 2003. The overall number and rate of occupational injuries and illnesses did not change substantially during the 5-year period since data were last reported in 1998. In 2003, age-, sex-, and diagnosis-related patterns of injury and illness among workers treated in EDs (ED-treated injuries/illnesses) were similar to those reported in 1998. To achieve substantial decreases in these injuries and illnesses, prevention efforts must focus on effective, targeted workplace-safety interventions for diverse occupations.     

Age gradient in the cost-effectiveness of bicycle helmets

OBJECTIVES: This study analyzed the reduction in risk of head injuries associated with use of bicycle helmets among persons ages 3 to 70 and the cost-effectiveness of helmet use based on this estimated risk reduction. METHODS: To derive our cost-effectiveness estimates, we combined injury incidence data gathered through a detailed and comprehensive injury registration system in Norway, acute medical treatment cost information for the Norwegian health service, and information reported in the scientific literature regarding the health protective effects of helmet use. The analysis included all cases of head injuries reported through the registration system from 1990 through 1996. We performed an age-stratified analysis to determine the incidence of bicycle-related head injuries, the 5-year reduction in absolute risk of injury, the number needed to treat, and the cost-effectiveness of helmet use. To test the robustness of the findings to parameter assumptions, we performed sensitivity analysis. RESULTS: The risk of head injury was highest among children aged 5 to 16. The greatest reduction in absolute risk of head injury, 1.0 to 1.4% over 5 years estimated helmet lifetime, occurred among children who started using a helmet between the ages of 3 and 13. Estimates indicate that it would cost approximately U.S. $2,200 in bicycle helmet expenses to prevent any one upper head injury in children ages 3-13. In contrast, it would cost U.S. $10,000-25,000 to avoid a single injury among adults. CONCLUSIONS: Bicycle safety helmets appear to be several times more cost-effective for children than adults, primarily because of the higher risk of head injury among children. Programs aiming to increase helmet use should consider the differences in injury risk and cost-effectiveness among different age groups and target their efforts accordingly.     

Workers' health in Israel.

BACKGROUND: Occupational hazards are important causes of morbidity, mortality, and disability in the community. This article presents a review of workers' health in Israel. METHODS: Data were collated from the Occupational Health Institute of the University of Tel Aviv, the National Insurance Institute, the Occupational Health Departments of the General Sick Fund, and the Institute of Safety and Hygiene of the Ministry of Labor and Welfare. International comparisons are based on data derived from the WHO Health for All database for the European region. RESULTS: Levels of most biological and chemical exposures in 1996 were found to be in accordance with the standards, except for dust, gases, pesticides, and noise exposure. In 1996, 4.3% of the working population received injury compensation from the National Insurance Institute. 78% of workers' claims approved in 1992-1994 were for injuries to the back and spine. 93% of new cases of occupational diseases and injuries reported in 1996 by the occupational health service of the largest Health Fund were due to noise-induced hearing impairments. In 1996, there were 87 reported deaths following work accidents; about 50% of them were falls that occurred in the construction industry, and 26% of fatalities were among foreign workers. Rates of work accidents, average days of incapacity per accident, and fatalities have been increasing since 1991. Rates of occupational accidents and of occupational fatalities are higher than the European Community average. CONCLUSIONS: Rates of occupational diseases and of injury compensation among workers are increasing, despite the efforts and resources invested in the prevention of work accidents and the promotion of workers' health. These findings indicate the necessity for further research and efforts toward the prevention of injuries and the promotion of occupational health in Israel.     

Summary of "Proposed national strategies for the prevention of leading work-related diseases and injuries, Part 1"

Strategies for the prevention of leading occupational health problems have been proposed by the National Institute for Occupational Safety and Health (NIOSH). NIOSH prepared these strategies following publication in 1983 of its suggested list of ten leading work-related diseases and injuries. At a national symposium in 1985, occupational health experts from academia, organized labor, management, professional associations, and voluntary organizations conducted an in-depth evaluation of the prevention strategies for the first five conditions on the list: occupational lung diseases, musculoskeletal injuries, occupational cancers, severe occupational traumatic injuries, and occupational cardiovascular diseases. The strategies were then revised to incorporate improvements suggested at the symposium and were published in booklet form. A summary of the revised strategies is provided.     

Prevention of eating disorders: challenges and opportunities

OBJECTIVE AND METHODS: On April 25, 2000, the National Institute of Mental Health (NIMH) convened a Roundtable on the Prevention of Eating Disorders to review the state of prevention science in eating disorders and formulate recommendations regarding future steps to be taken in this area of research. RESULTS AND DISCUSSION: This report summarizes the roundtable discussion. The discussion focused on four major areas: the state of the art of risk factors research, translational research, prevention research in related fields, and cutting-edge efforts in eating disorder prevention. CONCLUSIONS: The report concludes with specific recommendations.     

EFFECTS OF BICYCLE HELMET LAWS ON CHILDREN'S INJURIES

In recent years, many states and localities in the USA have enacted bicycle helmet laws. We estimate the effects of these laws on injuries requiring emergency department treatment. Using hospital‐level panel data and triple difference models, we find helmet laws are associated with reductions in bicycle‐related head injuries among children. However, laws also are associated with decreases in non‐head cycling injuries, as well as increases in head injuries from other wheeled sports. Thus, the observed reduction in bicycle‐related head injuries may be due to reductions in bicycle riding induced by the laws. Copyright © 2013 John Wiley & Sons, Ltd.     

Human exposure assessment and the National Toxicology Program.

The National Institute of Environmental Health Sciences/National Toxicology Program (NIEHS/NTP) is developing a new interagency initiative in exposure assessment. This initiative involves the NIEHS, the Centers for Disease Control and Prevention through its National Center for Environmental Health, the National Institute for Occupational Safety and Health, the EPA, and other participating institutes and agencies of the NTP. This initiative will benefit public health and priority setting in a number of ways. First, as discussed above, it will strengthen the scientific foundation for risk assessments by the development of more credible exposure/response relationships in people by improving cross-species extrapolation, the development of biologically based dose-response models, and the identification of sensitive subpopulations and for "margin of exposure" based estimates of risk. Second, it will provide the kind of information necessary for deciding which chemicals should be studied with the limited resources available for toxicological testing. For example, there are 85,000 chemicals in commerce today, and the NTP can only provide toxicological evaluations on 10-20 per year. Third, we would use the information obtained from the exposure initiative to focus our research on mixtures that are actually present in people's bodies. Fourth, we would obtain information on the kinds and amount of chemicals in children and other potentially sensitive subpopulations. Determinations of whether additional safety factors need to be applied to children must rest, in part, upon comparative exposure analyses between children and adults. Fifth, this initiative, taken together with the environmental genome initiative, will provide the science base essential for meaningful studies on gene/environment interactions, particularly for strengthening the evaluation of epidemiology studies. Sixth, efficacy of public health policies aimed at reducing human exposure to chemical agents could be evaluated in a more meaningful way if body burden data were available over time, including remediation around Superfund sites and efforts to achieve environmental justice. The exposure assessment initiative is needed to address public health needs. It is feasible because of recent advances in analytical technology and molecular biology, and it is an example of how different agencies can work together to better fulfill their respective missions.     

Risky business

Unintentional injury is one of the leading causes of morbidity and mortality in children aged one to 14 and puts more children in hospital than any other cause. The Department of Health (DH) asked the National Institute for Health and Clinical Excellence (NICE) to produce public health guidance on the prevention of unintentional injuries among children and young people aged under 15. This paper, by a member of the NICE programme development group, aims to provide an overview of the recently published guidance. The guidance focuses on strategies, regulation, enforcement, surveillance and workforce development in relation to preventing unintentional injuries in the home, on the road and during outdoor play and leisure. A summary of the main recommendations will be given and those recommendations or considerations directly applicable to community practitioners will be outlined.     

Head injury resulting from scooter accidents in Rome: differences before and after implementing a universal helmet law

OBJECTIVES: To estimate the incidence rates and related determinants of head injuries before and after the implementation of a new universal helmet law in Italy. METHODS: The investigation took place in the Emergency Room of the Accident and Emergency Department, Teaching Hospital 'Umberto I', Rome, in 1999 (before the new law), and 2000 (two periods after the new law). Personal data, injury circumstances, helmet use, others involved in injury and health data, were collected. Incidence rates by time period were calculated and differences between groups were analysed. Logistic regression models were conducted to assess the association between head trauma and potential determinants. RESULTS: The incidence rate of all injury among scooter riders rose from 64.36/10,000 person-years before the new law (1999) to 98.05/10,000 person years afterwards. The incidence rate of head trauma among scooter riders showed an opposite trend, i.e. a decrease from 26.65/10,000 person-years (1999) to 8.88/10,000 person-years in the second post-legislation period. Helmet use among injured scooter riders rose from 5% before the new law to 90% afterwards. Helmet use is a protective factor for being a patient with head trauma, in all the periods considered (OR 0.24-0.44). After implementation of the new law, age (18+) showed a protective effect as well (OR 0.42-0.44). CONCLUSION: Helmet use has a protective effect on head trauma among scooter riders. One year after implementing a universal law, helmet use has increased substantially and a sharp reduction in head trauma among persons older than 18 years could be observed.     

Prevention of bicycle-related head injuries

Each year in the United States, bicycling accidents cause approximately 1,300 deaths and 60,000 injuries. The death and injury rates are particularly high among children. The death rate from bicycle injuries in children exceeds the death rate from accidental poisonings, falls, firearm injuries, and many major illnesses. Head trauma is the most frequent cause of death and serious injury among bicyclists. Bicycle helmets have the potential to decrease the frequency and severity of bicycle-related head injury. Unfortunately, however, most bicyclists do not use a helmet. The helmet-use rate is extremely low among children. The failure of bicyclists, particularly children, to use bicycle helmets presents an opportunity for prevention of thousands of the traumatic head injuries that occur annually in the United States. Helmet use could be encouraged by schools, community safety programs, and office-based education by physicians.     

Long-Term Effects of Education and Legislation Enforcement on All-Age Bicycle Helmet Use: A Longitudinal Study

Bicycle-related injuries are a leading cause of child and youth hospitalizations in Canada. The use of helmets while bicycling reduces the risk of brain injuries. This study investigated the long-term effect of legislation coupled with enforcement to improve helmet use rates. We conducted a longitudinal observational study of helmet use at 9, 11, and 14 years after bicycle helmet legislation was enacted. Data were compared to baseline observations collected after legislation was passed in 1997. A comprehensive enforcement and educational diversion program, Operation Headway–Noggin Knowledge (OP–NK), was developed and implemented in partnership with regional police during the study period. Helmet use was sustained throughout the post-legislation period, from 75.3 % in the year legislation was enacted to 94.2 % 14 years post-legislation. The increase in helmet use was seen among all age groups and genders. Helmet legislation was not associated with changes in bicycle ridership over the study years. OP–NK was associated with improved enforcement efforts as evidenced by the number of tickets issued to noncompliant bicycle riders. This observational study spans a 16-year study period extending from pre-legislation to 14 years post all-age bicycle helmet legislation. Our study results demonstrate that a comprehensive approach that couples education and awareness with ongoing enforcement of helmet legislation is associated with long-term sustained helmet use rates. The diversion program described herein is listed among best practices by the Public Health Agency of Canada.     

A cost-benefit analysis of the community-based injury prevention programme in Motala, Sweden--a WHO Safe Community

The objective in this study was to calculate costs and benefits caused by a safe community injury prevention programme in Motala, Sweden. The study design was a quasi-experimental evaluation involving an intervention population and a non-random control population. All injuries were recorded before and after an intervention programme. The presented calculations show that costs of injuries in a societal perspective decreased from 116 million Swedish Crowns (SEK) to 96 million SEK, while the cost for the intervention was estimated at approximately 10 million SEK. Thus, the safe community injury prevention programme in Motala should be judged as cost-effective.     

News Reports and Their Role in Child Agricultural Injury Prevention

Objectives: The news media can be important sources of health information. News reports of child agricultural injuries were examined to assess what was reported and to evaluate potential implications for health communication and surveillance efforts. Methods: A content analysis was conducted of a convenience sample of 113 US news reports from 2012 to 2014 involving agricultural injuries to children less than 18 years of age. The data collection instrument included basic elements of injury surveillance, as well as variables related to injury causation and prevention. Results: Law enforcement personnel were the main source of information on the injury event (79%). Severity, age, sex, injury mechanism, and source were reported more than 90% of the time. However, few news reports mentioned use or lack of protective equipment (12%) or a prevention message (6%). Recommended prevention messages from the research team included keeping young children out of the farm worksite (38%) and following guidelines for age-appropriate work and recreational activities (31%). Conclusions: This study shows that news reports provide a valuable and relatively inexpensive addition to other childhood agricultural injury data sources. They highlight current serious events and have potential to be an effective communication tool with respect to education, prevention, and framing the public’s perception of injury risk. An important next step may be to partner with law enforcement to develop three to five prevention messages that can be shared with reporters to educate readers on risks and steps that can be taken to prevent similar injuries on farms and ranches.     

Injury status and perspectives on developing community safety promotion in China

The objective of this paper is to introduce the epidemiology of injuries in China, and then consider the development of safe communities in regard to injury prevention and safety promotion. The disease spectrum has changed in recent decades in the People's Republic of China. Both in cities and rural areas, injury has become the fifth leading cause of death. At least 800 000 people die from injury each year, and 50 million non-fatal injuries occur, of which 2.3 million lead to disability of varying degrees of severity. The average injury-related death rate in China from 1990 to 1997 was 66 per 100 000, which accounts for 11% of total deaths. The potential years of life lost (PYLL) of injury accounts for 24% of the total, and disability-adjusted life years (DALYs) account for 17%. Main injury causes of death, in descending order, are: suicide, traffic accident, drowning, falling, poisoning, homicide, burn and scald, and iatrogenic injury. Considering China's current injury status and its rapid societal change, injury prevention and safety promotion need to be strengthened further, and there is a special need for the development of Safe Communities programmes. The prevention of injuries through safety promotion has been increasingly focussed on over recent decades. The WHO Safe Community model is recognized as representing an effective and long-term approach to the prevention of injuries at a local level, and has been beneficially applied all over the world. A programme may cover several aspects of injury prevention and safety promotion simultaneously, or only include one or two aspects. In a Safe Community programme in China, children, the elderly, cyclists and their passengers, and farmers should be among the prioritized target populations. However, multi-focussed inter-sectoral programmes have been shown to have additional effects to distinct sectoral programmes.     

A labor perspective of workplace violence prevention. Identifying research needs

BACKGROUND: During the past decade, labor unions have contributed to efforts to increase awareness of the importance of workplace violence as an occupational hazard. Research by the National Institute for Occupational Safety and Health and the U.S. Department of Justice have bolstered these efforts. This research revealed that workplace violence is the second leading cause of traumatic-injury death on the job for men, the leading cause of traumatic-injury death on the job for women, and accounts for some 2 million nonfatal injuries each year in the United States. LABOR PERSPECTIVE: Ten years ago, the debate focused on whether workplace violence is an occupational hazard or strictly a police and criminal justice issue. Labor unions have joined with occupational safety and health professionals in recognizing that workplace violence is a serious occupational hazard that is often predictable and preventable. They have advocated that employers establish multidimensional violence-prevention programs. CONCLUSION: Although the nature of workplace violence varies from industry to industry, implementation of the federal Occupational Safety and Health Administration (OSHA) Violence Prevention Guidelines for Health Care and Social Service Workers and for Late-Night Retail Establishments is a high priority to unions in the affected industries. Labor wants employers to invest in protecting workers from violence through voluntary programs and state legislation, and it supports the promulgation of a mandatory federal OSHA standard. To that end, intervention research can play a key role in demonstrating effective, technically and economically feasible prevention strategies     

Increasing injuries as trampoline parks expand within Australia: a call for mandatory standards

Objective : To quantify an apparent increase in indoor trampoline park related injuries in children and young people across Australia, and to understand the implications for current regulatory standards. Methods : Retrospective analyses of three state‐based Injury Surveillance databases, identifying children and adolescents presenting to emergency departments between the years 2005 and 2017, who had sustained injuries during trampolining activity at an indoor trampoline park. Results : Across the three datasets, 487 cases were identified. No cases were recorded prior to 2012, the year the first indoor trampoline park opened. At least half occurred among those aged 10–14 years. In Victoria, 58% were male, with 52% in Queensland and 60% in Western Australia being male, respectively. Hospital admission rates in these states were 15%, 11.7% and 14.5%, respectively. The most frequent injury types were dislocations, sprains and strains, followed by fractures, with some head and spinal injuries. Conclusions : Across several states in Australia, the incidence of indoor trampoline park related injuries is concerning, as these venues are increasing in number. Some injuries can be serious and result in lifelong disability for children or adolescents. Implications for public health : National safety standards that apply to indoor trampoline park operators are not currently mandatory; injury prevention efforts would be assisted if such standards were mandatory.