Down but not out: incidence and estimated costs to society of road casualties in Strathclyde,Scotland

Objectives

To investigate the recent epidemiological patterns and costs of road traffic casualties (RTCs) in Strathclyde, Scotland.

Study design

Retrospective record-linkage epidemiological study using routine data sources.

Methods

A linked police-hospital database was analysed to describe the epidemiology of RTCs from 2004 to 2009. Using UK government methodology, the costs of road casualties to the National Health Service (NHS) and society were assessed.

Results

RTC rates declined over the study period. Males were at higher risk than females as were those residing in more socially deprived addresses. The estimated costs of RTCs in Strathclyde amounted to £400 million annually. Of this, around one twentieth (£20 million per year), was attributable to direct NHS costs.

Conclusions

Road casualties remain a major public health threat in Strathclyde, and contribute to health inequalities. RTC costs to society amount to almost a tenth of NHS revenue expenditure. Cost-effective road safety measures should be deployed more widely.     

辽宁省城乡老年人意外伤害流行病学调查

目的了解辽宁省城乡老年人意外伤害的发生水平和分布特征,为老年人的意外伤害预防提供依据。方法采用多阶段分层整群随机抽样方法在辽宁省内3个城市3个县抽取2877名老年人,对其过去1年中的伤害情况进行回顾性调查。结果辽宁省60岁以上老人意外伤害发生率为13.69%,调整率为15.48%,标化率13.98%,农村(17.94%)高于城市(11.16%),女性(15.04%)高于男性(12.19%),70～79岁老年人意外伤害发生率最高(15.16%)。发生率排前5位的伤害依次为跌倒(6.05%)、锐器割刺伤(3.96%)、撞击挤压伤(0.83%)、机动车交通事故(0.66%)和运动伤(0.52%);伤害性质的前4位为开放性伤口、扭伤、浅表伤和骨折,分别占38.07%,25.38%,19.29%,11.42%。跌倒的发生率随年龄增高而上升(χ2=9.59,P0.01)。结论辽宁省老年人意外伤害发生率较高,跌倒是老年伤害预防控制的重点,农村老年女性是高危人群。     

2006-2008年蓬莱市伤害监测分析

[目的]掌握蓬莱市伤害发生情况,为针对性地开展伤害预防控制提供科学依据。[方法]对蓬莱市2006—2008年开展伤害监测5家医院的资料进行分析。[结果]3年共上报伤害35 619例;35~49岁者最多(33.9%);男性伤害数是女性的2.5倍;8~10时和14~16时为伤害发生的高峰时段;发生地点主要在路/街道(35.3%)、工业和建筑场所(22.3%)和家中(18.0%);前4位伤害原因是跌落(26.0%)、机动车车祸(25.3%)、钝器伤(23.5%)和刀/锐器伤(10.7%)。[结论]青壮年及男性是伤害防治的重点,对伤害尤其是道路交通伤害应采取必要的干预措施。     

Childhood injuries and deaths due to falls from windows

Background Unintentional injuries are the leading cause of death in children, and falls are the most common type of unintentional injury in the US. The incidence of falls from windows, a common cause of death in urban areas, has not been described outside major cities such as New York and Chicago, and rates in urban and suburban areas have not been compared. Objective To estimate the incidence and identify the population at risk for falls from windows among children in Hamilton County, Ohio. Design Retrospective case series identified using Cincinnati Children's Hospital Medical Center (CHMC) Trauma Registry. Setting Hamilton County, Ohio, which has urban and nonurban areas. Participants Children less than 15 years old residing in Hamilton County, Ohio, presenting to CHMC in Cincinnati, Ohio, after a fall from a window between January 1, 1991, and December 31, 1997. Outcome Measure Annual incidence by age, race, gender, and residence of those who fell from windows. Results Over the 7-year study period, 86 (6.3%) of 1,363 falls were from windows. The mortality rate for falls from windows was 4.7%, compared to 0.07% for all other falls presenting to CHMC (P<.0001). Children 0–4 years old had a higher rate of falls than children aged 5–14 (14.6/100,000 vs. 2.0/100,000) (P<.0001). Males were twice as likely to fall as females (P<.016), and black children were three times more likely to fall than non-black children (P<.002). The incidence of falls in the city of Cincinnati was four times that of the non-urban area (P<.0002). Conclusions Injuries from falls from windows are a public health problem in Hamilton County, Ohio, especially for young, urban children.     

2004-2005年山东省0-14岁儿童伤害死亡流行病学分析

[目的]通过对0～14岁儿童死亡资料的分析,掌握山东省儿童伤害的死亡特点,为制定干预政策提供依据。[方法]利用山东省第三次死因调查资料,对山东省2004-2005年0～14岁儿童伤害的死亡特点进行描述和分析。[结果]2004-2005年山东省0～14岁儿童伤害的死亡率为16．09／10万,标化死亡率为15．95／10万,意外伤害死亡率为15．19／10万,标化死亡率为14．78／10万。伤害死亡率总体趋势为随年龄增高而开始降低（P〈0．05）．前五位的死因分别为淹溺、公路交通事故、意外窒息、自杀和意外跌落。0～岁年龄组伤害的主要死因是意外窒息,1～岁年龄组伤害的主要死因是交通事故和淹溺,5～岁及以上年龄组伤害的主要死因是淹溺和交通事故。[结论]淹溺和交通事故死亡是我省伤害的最主要原因,要根据不同年龄的伤害特点,采取有针对性的预防措施,降低其发病率和死亡率。     

2000～2004年廊坊市道路交通伤害时间流行病学与相关因素的研究

目的通过对2000~2004年廊坊市道路交通伤害(简称车祸)时间流行病学相关因素分析,为今后预防和降低车祸发生提供科学依据。方法采用伤害流行病学调查方法,对2000~2004年廊坊市发生车祸的时间、天气、主要道路、驾驶员的驾龄、机动车类型、死亡人员年龄等资料进行回顾性调查和分析。结果2000~2004年,廊坊市共发生20289起车祸,死亡1445人,受伤8370人,经济损失2764万元。5年间,2001年车祸次数和死亡人数最多,分别占35.93%和26.71%;5年间车祸发生率有显著性差异(χ2=11073.86,P<0.001);每年第四季度车祸发生次数和死亡人数最高,分别占28.84%和28.03%;每年9月车祸次数和受伤人数最多,分别占10.63%和10.97%,死亡人数以11月份最多,占10.93%;每日24小时车祸以14:00~16:00车祸发生次数和受伤人数最高,分别占12.84%和13.03%,死亡人数以20:00~22:00时最多,占14.60%;省道和国道发生车祸次数最多,分别占38.39%和34.37%;雨天车祸占51.40%;驾龄在5年以下的司机车祸发生次数占63.94%,死亡人数占61.99%;操作不当、违章、超速行驶、不按规定让行4个原因占车祸的68.08%;小型客车、重型车、二轮摩托车、四轮农用车4种机动车车祸占73.79%;车祸死亡者年龄以17~35岁为主,占39.87%。结论预防和降低车祸不仅是各级政府和道路交通主管部门的责任,而且也是全社会的责任,要齐抓共管。通过采取改善道路设施,加强监督管理提高驾驶员和社会人群的安全意识和教育等措施,可有效降低车祸的发生和死亡。     

2000～2009年桂林市道路交通伤害的流行病学分析

目的 探讨桂林市道路交通伤害(RTI)流行特点、发生原因及其分布规律,为预防和减少道路交通伤害的发生提供科学依据.方法 通过市交警总队收集2000～2009年桂林市发生的RTI数据,对发生RTI的时间、道路情况、交通方式、交通控制方式、主要原因等资料进行回顾性分析.结果 (1) 2000～2009年桂林市发生RTI共3 603起,死亡506人,受伤2 911人,直接经济损失1 011万元,万车死亡率呈下降趋势:(2)十年中发生的RTI以1月份最多:每日RTI发生高峰主要在20:00 ～24:00及14:00～16:00:(3) RTI伤亡人员主要是行人、乘车者和摩托车驾驶员,年龄主要集中在21 ～45岁,男性为主:(4)普通路段、平直道路和城市主干路的RTI发生率较高:(5) RTI的主要原因中人的因素占97.06％,其中机动车驾驶员的原因占89.04％.结论 10年来,桂林市RTI万车死亡率呈下降趋势,RTI主要是由机动车驾驶员的因素造成,是青壮年的主要死因,应引起社会及政府的重视,并针对其特点采取相应的预防控制措施.     

辽宁省城乡居民1973-1975年与2004-2005年伤害死亡率变化分析

目的 分析1973-1975年与2004-2005年间辽宁省城乡居民伤害死亡率的变化特点,为制定有效的预防措施,降低伤害死亡提供科学依据.方法 使用1973-1975全国死因回顾调查和2004-2005年辽宁省城乡居民病伤死因登记报告系统资料,计算不同年代、地区、性别和年龄别伤害死亡率和变化幅度.结果 30年间,城市居民伤害标化死亡率由51.03/10万降至28.36/10万,农村由44.55/10万升至55.43/10万,城乡呈相反的变化趋势;男性伤害死亡率明显高于女性,农村明显高于城市,目前农村居民溺水、自杀、机动车交通事故和火灾的死亡率分别为城市的4.03倍、3.66倍、2.90倍和2.75倍.结论 30年间城乡伤害死亡率的变化趋势相反,农村亟待加强道路安全意识教育及加大必要的监管力度,同时关注农村老年居民的生存环境问题,从而采取有针对性的干预措施降低农村伤害死亡率.     

电动自行车道路伤害危险因素的病例对照研究

目的探讨浙江省城区电动自行车道路交通伤害危险因素。方法收集2008年5—11月杭州市上城区、下城区、宁波市海曙区和舟山城区医院急诊室电动自行车道路交通伤害病例。以1∶2的配对原则,选择社区对照。采用单因素和多因素非条件Logistic回归分析。结果受伤病例中男性占47.06%,女性占52.94%;年龄以30~60岁组居多;职业以工人与农民为主。病例与对照均以已婚者居多,分别占91.91%和89.38%;文化程度:病例多为高中及中专,占35.29%;对照为大专及以上,占35.90%。病例男性平均身高167.28 cm,女性为161.37 cm;对照男性平均身高167.93 cm,女性158.81 cm。病例男性体重平均67.40 kg,女性为56.19 kg;对照男性平均体重66.82 kg,女性55.74 kg。多因素分析结果显示,文化程度(OR=0.54~4.48)和道路类型(OR=1.99~8.69)是浙江省城区电动自行车道路交通伤害危险因素。结论文化程度和道路类型是电动自行车道路交通伤害的危险因素。     

Speed Kills: The Complex Links Between Transport,Lack of Time and Urban Health

Road safety experts understand the contribution of speed to the severity and frequency of road crashes. Yet, the impact of speed on health is far more subtle and pervasive than simply its effect on road safety. The emphasis in urban areas on increasing the speed and volume of car traffic contributes to ill-health through its impacts on local air pollution, greenhouse gas production, inactivity, obesity and social isolation. In addition to these impacts, a heavy reliance on cars as a supposedly ‘fast’ mode of transport consumes more time and money than a reliance on supposedly slower modes of transport (walking, cycling and public transport). Lack of time is a major reason why people do not engage in healthy behaviours. Using the concept of ‘effective speed’, this paper demonstrates that any attempt to ‘save time’ through increasing the speed of motorists is ultimately futile. Paradoxically, if planners wish to provide urban residents with more time for healthy behaviours (such as exercise and preparing healthy food), then, support for the ‘slower’ active modes of transport should be encouraged.     

天津市伤害监测分析与控制措施的探讨

目的分析天津市伤害流行的特点和分布,为开展伤害干预奠定基础。方法由全市各级各类临床医院每日填写急、门诊和住院伤害病例报告卡,辖区防病站每月收集、录入上报,天津市疾病预防控制中心进行全市监测数据的整理分析及信息发布。结果启动伤害监测的前6个月,共报告伤害病例33 924人,男性为22 996例,占67.79%;女性10 928例,占32.21%;天津市伤害原因的前5位是跌倒、机动车交通事故、暴力(斗殴)、撞伤(击伤)和坠落。结论伤害在不同年龄、不同性别均有发生,但各种伤害具有不同的高危人群,应在伤害监测的基础上,针对性的开展预防控制。     

2006-2008年四川城乡学生伤害发生流行特征分析

目的了解四川城乡学生伤害发生流行特征,为伤害的预防控制提供科学依据。方法对四川省2006-2008年到6个伤害哨点医院就诊首诊为伤害的大中小学生患者,填写统一的调查表,分析伤害发生的时间、地点、原因等特征。结果3年学生伤害患者共11271例,男女性别比为1.41∶1,小学生占54.30%;伤害原因前3位为跌倒/坠落、动物伤、车祸,城乡同一性别学生之间伤害的原因构成不同,差异具有统计学意义（χ男^2=317.35,P〈0.01;χ女^2=166.97,P〈0.01）;伤害发生地点前3位为家中、学校与公共场所、公共居住场所或公路街道;全年伤害发生时间以3～5月、9～11月较多,1d中以19：00点、9：00点左右较多;伤害动机以非故意伤害占多数,城市为91.32%、农村为89.34%,但自残、自杀分别占0.80%、0.69%。结论跌倒/坠落、动物咬伤、车祸成为四川城乡学生伤害的主要因素,家中和学校为主要伤害地点。     

青岛市黄岛区伤害住院患者流行特征及其住院费用分析

目的分析2009年青岛市黄岛区伤害住院患者的流行特征及其住院费用,了解伤害疾病负担,为制定有效的干预措施提供科学依据。方法收集全部青岛市黄岛区6家监测医院(二级以上公立医疗机构)2009年伤害住院病例资料1844例,建立SPSS15.0数据库进行分析。结果在1844例符合要求病例中,男性占79.94%,25~44岁的占46.42%;本市/县户籍的占57.01%;发生在3~10月的占89.05%;发生在公路/街道、工业和建筑场所、家中的分别占46.58%、28.69%、13.29%;发生的主要原因是钝器伤、机动车车祸、跌倒/跌落的分别占33.89%、28.58%、23.81%;人均住院费用5299.84元,日人均住院费用353.79元。结论男性、青壮年是伤害住院的主要人群,钝器伤、机动车车祸和跌倒/跌落为主要伤害原因,公路/街道、工业和建筑场所、家中为伤害发生的主要场所。伤害对黄岛区造成的经济负担严重,应采取有效措施加以预防。     

2007--2009年十堰市城区居民死因分析

目的了解十堰市城区居民疾病谱和死亡谱的特点及威胁该市居民健康的主要疾病,为制订疾病预防控制策略提供科学依据。方法利用2007--2009年十堰市城区疾病监测点死因监测系统数据和公安、民政部门提供的人口资料,根据疾病和有关健康问题的国际统计分类ICD-10编码手册进行根本死因分类,对十堰市城区居民死因进行分析。结果2007--2009年十堰市城区居民总死亡率为504．66／10万,男性死亡率高于女性,差异有统计学意义（P〈0．05）。前10位死因分别是循环系统疾病、肿瘤、损伤与中毒、呼吸系统疾病、传染病和寄生虫病、消化系统疾病、内分泌营养和代谢性疾病、泌尿生殖系统疾病、神经系统疾病、围生期疾病。损伤与中毒的减寿年数为16189人·年,减寿率为14．26‰,在全死因减寿顺位中居第一位。结论慢性非传染性疾病是该市居民的主要死亡原因,损伤与中毒导致的寿命损失最大。     

2003年～2007年潍坊街道伤害住院病人状况分析

目的统计医院外骨科收治伤害病例的伤害状况,分析伤害的危害性和预防伤害的重要性。方法对浦东新区二级以上综合性医院外骨科2003年～2007年收治潍坊街道伤害病例的疾病状况和致病因素等资料进行统计分析。结果2003年～2007年,浦东新区二级以上医院外骨科共收治潍坊街道伤害病例909例,其中,男性530例,女性379例;年龄为9岁～94岁;占伤害因素种类较多的是跌伤(占42.9%)和交通伤(占24.7%);住院后的死亡率为1.2%,致残率为11.4%,治愈率为64.4%,好转率为23.0%。结论伤害对人类健康的危害比较大,应引起重视,加强伤害预防工作。     

脑池造瘘术及控制性引流在重型颅脑损伤治疗中的临床研究

目的:探究重型颅脑损伤(sTBI)患者接受脑池造瘘术与控制性引流治疗的效果。方法:2017年1月~2018年1月期间的本病患者100例,随机分为对照组(脑池造瘘术)与观察组(脑池造瘘术+控制性引流)各50例,对比两组疗效。结果:观察组术后同期颅内压均优于对照组,P均<0.05。观察组术后同期GCS评分均优于对照组,P均<0.05。结论:sTBI患者接受脑池造瘘术+控制性引流能有效改善颅内压,改善患者的昏迷状态,有助于改善预后。     

Toward a Research and Action Agenda on Urban Planning/Design and Health Equity in Cities in Low and Middle-Income Countries

The importance of reestablishing the link between urban planning and public health has been recognized in recent decades; this paper focuses on the relationship between urban planning/design and health equity, especially in cities in low and middle-income countries (LMICs). The physical urban environment can be shaped through various planning and design processes including urban planning, urban design, landscape architecture, infrastructure design, architecture, and transport planning. The resultant urban environment has important impacts on the health of the people who live and work there. Urban planning and design processes can also affect health equity through shaping the extent to which the physical urban environments of different parts of cities facilitate the availability of adequate housing and basic infrastructure, equitable access to the other benefits of urban life, a safe living environment, a healthy natural environment, food security and healthy nutrition, and an urban environment conducive to outdoor physical activity. A new research and action agenda for the urban environment and health equity in LMICs should consist of four main components. We need to better understand intra-urban health inequities in LMICs; we need to better understand how changes in the built environment in LMICs affect health equity; we need to explore ways of successfully planning, designing, and implementing improved health/health equity; and we need to develop evidence-based recommendations for healthy urban planning/design in LMICs.     

2008年济南市城区部分小学生伤害发生及其影响因素分析

[目的]了解济南市城区小学生伤害发生及其影响因素,为制订预防和控制对策提供科学依据。[方法]2009年1月,在济南市槐荫区抽取3所小学,调查2 212名城市小学生2008年1~12月伤害发生情况,并对全部调查对象进行影响伤害发生因素的非条件Logistic回归分析。[结果]调查2 212人,过去1年中伤害发生率为15.01%。发生的437人次伤害中,跌倒/坠落占34.32%,碰撞/挤压伤占27.69%,扭伤占12.36%。多因素非条件Logistic回归分析结果,影响小学生伤害发生的因素有学生性别为女性、监护人非在婚、监护人嘱咐学生注意安全、家庭人均月收入高、家中喂养宠物,其OR值分别为0.778、0.566、0.738、2.198、1.571。[结论]槐荫区城市小学生伤害发生率较高。女生、监护人非在婚、监护人嘱咐学生注意安全、家庭收入较低、家中未养宠物的小学生不容易发生伤害。     

Child Injury Risks are Close to Home: Parent Psychosocial Factors Associated with Child Safety

Objective: In several populations, maternal depression has been associated with reduced child safety. In an urban pediatric Emergency Department, we examined the relationship between parental depression, social support, and domestic conflict and child safety behaviors. Methods: We studied consecutive patients in an Emergency Department. Trained interviewers used a structured instrument to assess patient, primary caregiver, and household demographics, socio-economic status, psychosocial factors, child safety behaviors (whether a gun was in the home, poisons were locked, a functioning smoke detector was present, and use of carseats or seatbelts), and whether the home was smoke-free. 1,116 patients provided adequate data. Results: Depression was associated with a modest and not statistically significant reduction in child safety behaviors in this population. Lack of social support and the presence of domestic conflict were robustly, independently, and statistically significantly associated with less safe homes. Domestic conflict was associated with more smoking in the home. Conclusion: In our population, child safety was associated less with depression and more with parental lack of social support and domestic conflict. These can be assessed in a Emergency Department and may be amenable to intervention.     

贵阳市城区2193例学龄前儿童意外伤害及影响因素的研究

目的：了解贵阳市城区学龄前儿童意外伤害现况和影响因素,方法：采用描述性流行病学和例一对照研究的方法,对贵阳性市城区15所幼儿园的学龄前儿童在1998年4月1日－1999年3月31日期间发生的意外伤害情况和影响因素进行了研究。结果：贵阳市地区学前儿童意外伤害发生率为24．76％,男童高于女童（P＜0．05）,意外伤害发生率随年龄增长而上升（P＜0．05）。伤害类型前三位为：跌伤、撞伤、动物伤;96．32％的伤害为轻度,3．68％为中度,无1例伤残和死亡。单因素和多因素回归分析表明儿童意外伤害的发生受下列因素的影响;父亲年龄、父母文化程度,母亲职业、家庭宠物、儿童民族、儿童看护人,居住楼层、家庭人均收入等。结论：贵阳市学龄前儿童意外伤害发生率高,意外伤害的发生受多种因素的影响,意外伤害是贵阳市儿童健康不可忽视的问题。．