Potential of using existing injury information for injury surveillance at the local level in developing countries: experiences from Bangladesh

Although injury is a major public health problem in Bangladesh, as in other low income countries in the world, it has gained very little attention from policy makers, or even health professionals, mainly due to the lack of valid injury information in these countries. To address the injury problem, there is an urgent need to develop injury surveillance activities, based on existing sources of potential interest for obtaining injury information. This study is an evaluation of existing injury data sources in terms of prevention orientation representativeness, and sustainability with respect to the use of these sources in injury surveillance at the local level in Bangladesh. The regular injury information sources that have been used in this study include hospital records, post-mortem reports, newspaper reports, and police reports. In addition, 60 health practitioners in the area, representing various categories, were interviewed according to questionnaire, and ten others were interviewed in-depth about their opinions regarding their participation in the injury surveillance system. The information sources were then assessed for their potential to be included in the surveillance system. The validity was estimated by means of comparisons of the different sources. All the existing sources of injury information suffer from certain deficiencies such as, lack of representativeness, low prevention orientation and poor sustainability. Post-mortem reports and police reports have been found to be potential sources of mortality data but not morbidity data. Hospital records can be seen as potential sustainable sources of injury morbidity data but suffer from low prevention orientation and representativeness. The injury information was not consistent from source to source and failed to depict the true picture of injury in the area. To develop an injury surveillance system, a combination of data obtained from several different sources is necessary to compensate for inadequacies in the individual sources and to improve the overall usefulness of the system. Updated with E-codes, hospital discharge records could be used for injury morbidity surveillance, and updated police and post-mortem data can be used for mortality data in injury surveillance systems at the local level in developing countries.     

Integrating Agricultural Injury Prevention with Rural Pediatrics: A Pilot Assessment

ABSTRACT

Background: Childhood agricultural injuries are an important public health problem. Pediatricians are a trusted source of expertise in children’s health and safety and could serve as a sphere of influence to augment child agricultural injury prevention efforts. The purpose of this pilot study was to begin to explore the perspectives of pediatricians in a large rural health clinic about addressing child agricultural injury prevention within their practice. Methods: Structured interviews were conducted with nine pediatricians who maintain a clinical practice of at least 2 days a week and care for newborns through adolescents. Detailed interviewer notes were reviewed and summarized. Results: Rural pediatricians readily acknowledge substantial numbers of farm children in their practice. In general, these providers: (1) recognize farming environments as a safety risk and see agricultural injury prevention as an important topic to be addressed with their patients, (2) are comfortable discussing the topic, but seldom actually initiate such conversations, and (3) doubt farm parents would be receptive to integrating agricultural injury prevention into a rural pediatric practice. Conclusion: While rural pediatricians recognize child safety risks in farm environments, they are reluctant to actually initiate this conversation with parents. Future research should explore both pediatricians’ hesitancy to discuss agricultural injury prevention and farm parents’ readiness for integrating the topic into pediatric primary care visits. Such would help to assess the viability of pediatricians as a sphere of influence for augmenting child agricultural injury prevention efforts.     

2007-2008年北京市0~6岁儿童伤害社区监测结果分析

【目的】 通过社区监测了解儿童伤害特点,制定有针对性的干预措施。 【方法】 采用分层整群抽样方法抽取北京市城市2个街道和农村3个乡镇,通过社区卫生服务中心和幼儿园监测0~6岁儿童伤害发生情况。 【结果】 2007-2008年平均每年监测0~6岁儿童8 085人,2年中,0~6岁儿童伤害发生率从2.09%下降至1.75%。儿童主要伤害原因为跌伤(49.51%)、钝器伤(12.30%)、动物伤害(10.36%)、烧烫伤(10.03%)和道路交通伤害(8.09%);城市儿童以跌伤、钝器伤为主,农村儿童以跌伤、动物伤害和道路交通伤害为主。儿童伤害主要发生地点为家中(32.04%)、幼儿园(22.98%)、院子/楼梯/楼道(14.24%)、道路(13.59%)和休闲活动场所(11.33%);主要伤害部位为头部(50.81%)、上肢(28.80%)和下肢(14.24%);以无意伤害、轻度伤害为主。 【结论】 社区伤害监测为儿童伤害预防提供了一个切实可行的数据收集途径。跌伤、钝器伤是城市儿童防范的重点,犬咬伤和自行车辐条伤是农村儿童防范重点。     

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.     

Occupational Agricultural Injury Surveillance in California

SUMMARY

The objective of the California Nurses Using Rural Sentinel Events (NURSE) is to prevent occupational agricultural injuries. This active surveillance and health education project obtains incident reports of injuries from sources in two California counties. Over 5000 of these reports are in a database, coded by cause and na-ture of injury using the International Classification of Dis-eases- 9-CM. From these, 35 illustrative incidents have been investi-gated and summarized in widely disseminated prevention strategy reports. Health and safety education outreach is provided by bi-lin-gual field staff several times monthly. The NURSE project has de-veloped valuable database and educational resources for research and promotion of safety in agriculture.     

部分省份农业伤害现况及其影响因素

[目的]了解农业伤害的发生率、流行特征及其影响因素,为制订农业伤害干预措施提供科学依据。[方法]2010年2月至2010年8月,采用整群与分层相结合的抽样方法,从全国随机抽取6个省份,再从每个省份中抽取1个村,共调查1623名从事农业劳动的农民,由经过培训的调查员进行问卷调查。[结果]2009年6个省份农业伤害的总发生率为43.9%（95%CI为41.5%~46.3%）,居前5位的分别是刀或锐器伤、扭伤、跌倒或坠落、农业机械伤、烧烫伤。单因素及多因素logistic回归分析结果显示：文化程度、身体状况、心情状态、是否使用防护用品为本次调查农业伤害发生的影响因素。[结论]目前我国农业伤害已经成为危害农村居民健康的重要因素和突出的公共卫生问题,有必要针对农业伤害的危险因素,采取科学的干预措施予以控制。     

Hospitalized nonfatal injuries in the Alaskan construction industry

BACKGROUND: Construction industry workers are exposed to many hazards leading to fatal and nonfatal injuries. Information for nonfatal work-related injury surveillance may be vague and come from a variety of sources. METHODS: The Alaska Trauma Registry (ATR) is used as an injury surveillance tool to focus on hospitalized nonfatal injuries in the Alaskan construction industry. RESULTS: During 1991-1999, 717 workers in the Alaskan construction industry were hospitalized due to occupational injuries, with an average annual injury rate of 0.39 injuries/100 workers. Leading causes of injury included falls (48%) and machinery (15%). Thirty-four percent of the falls were from a building or structure, followed by falls from a ladder (24%). A fractured bone was the most common type of injury (57%). CONCLUSIONS: Information on hospitalized patients from the ATR focuses on the more severe and debilitating injuries, and provides valuable information for prioritizing injury prevention efforts in Alaska.     

Effectiveness of source documents for identifying fatal occupational injuries: a synthesis of studies.

BACKGROUND: The complete and accurate identification of fatal occupational injuries among the US work force is an important first step in developing work injury prevention efforts. Numerous sources of information, such as death certificates, Workers' Compensation files, Occupational Safety and Health Administration (OSHA) files, medical examiner records, state health and labor department reports, and various combinations of these, have been used to identify cases of work-related fatal injuries. Recent studies have questioned the effectiveness of these sources for identifying such cases. METHODS: At least 10 studies have used multiple sources to define the universe of fatal work injuries within a state and to determine the capture rates, or proportion of the universe identified, by each source. Results of these studies, which are not all available in published literature, are summarized here in a format that allows researchers to readily compare the ascertainment capabilities of the sources. RESULTS: The overall average capture rates of sources were as follows: death certificates, 81%; medical examiner records, 61%; Workers' Compensation reports, 57%; and OSHA reports 32%. Variations by state and value added through the use of multiple sources are presented and discussed. CONCLUSIONS: This meta-analysis of 10 state-based studies summarizes the effectiveness of various source documents for capturing cases of fatal occupational injuries to help researchers make informed decisions when designing occupational injury surveillance systems.     

Agricultural Youth Injuries: A Review of 2015-2017 Cases from U.S. News Media Reports

Background: The hazardous nature of the agricultural environment, reflected in the numerous injuries and deaths to children who live, work and play on farms, coupled with the lack of a comprehensive national surveillance system in the United States, highlights the need for making the best use of publicly available youth agricultural injury data.

Objective: The purpose of this study was to describe a 3-year collection of youth agricultural injuries using the publicly available injury and fatality data from AgInjuryNews.org and present recommendations for future injury prevention strategies.

Methods: Data were obtained from AgInjuryNews.org, a web-based collection of U.S. news reports of agricultural injuries. We analyzed cases from 2015 to 2017 for youth aged 0–17. We classified injuries as occupational and non-occupational related, based on the Farm and Agricultural Injury Classification (FAIC) code. Each case was also coded for source and event using the Occupational Injury and Illness Classification System (OIICS).

Results: Of the 348 injury reports reviewed, 51% were fatal, and about one-third of the victims were 6 years old or younger. Most injuries were non-occupational, and the most frequent injury sources were vehicles (includes tractors and all-terrain vehicles) and machinery. Youth operators, extra riders, roadway operations, and unsupervised youth playing near or in a worksite were four key contributing factors associated with vehicle and machinery related injuries.

Conclusions: This study reaffirms that youth agricultural-related injuries and fatalities are still a persistent problem in the United States. The hypothesis generating AgInjuryNews system can provide more current data than traditional surveillance datasets as a tool for understanding the sources of youth agricultural injuries, monitoring injury trends, and informing policy efforts and prevention strategies. Future studies should continue to explore and evaluate the comprehensiveness of this system’s data and the impact of its dissemination, as well as similar rural health informatics solutions for integration into sustainable interventions that can be customized and delivered domestically and abroad.     

农业伤害定义的研究现况

作为一个重要的公共卫生问题,伤害日益引起了全球的关注。对于农业领域,由于每年会发生大量的农业生产引起的职业伤害,农业被称之为世界上最危险的职业之一。本文对全球关于农业伤害的定义进行综述,为商榷中国农业伤害定义提供背景材料与科学依据。     

Farm-related injury event, social consequences and injury reporting in the Land Lantbruk newspaper in Sweden: a retrospective study of farm-related injury reporting during 2000-2005

Objective: The aim of the present study was to detect how a leading news paper, the Land Lantbruk in Stockholm, Sweden, informs the public and specifically the rural sector in Sweden and the Scandinavian countries concerning injury events (farm‐related injury event) and the use of injury prevention and control. Injury reporting in the Land Lantbruk has been studied from the point of injury prevention and control. A study of injury prevention and rural health and safety in Australia shows that the newspaper The Land that serves Australia’s rural community should ‘be an under‐utilised vehicle for news and commentary on rural health and safety issues’. Design: The study period was from January 2000 to February 2005. A total of 178 articles were reviewed and analysed. The articles were available on a newspaper database in the Land Lantbruk newspaper. Articles that addressed farm‐related injury event and rural health and safety were chosen and organised into subgroups. Results: Tractor and motor vehicle safety (35%) was most common among the injury reporting. Although the newspaper Land Lantbruk provided excellent coverage of the causes of these events, the reports tended to focus on circumstances and did not provide information on injury prevention or the advantages of also coverage of the social and psychosocial long‐term consequences of accidents. Conclusion: In the prevention work of reducing farm‐related injuries in the rural sector in the Scandinavian countries and decreasing the human suffering represented by this health problem, rural politicians, insurance companies, rural authorities and also handicap organisations should listen more to the injured individuals and their own experiences relative to the difficulty of life after an accident. The reaction of family and relatives, and experiences of the long‐term social consequences, have not been included in the media coverage. Journalists at the Land Lantbruk could also share experiences of the Swedish coverage of rural health and safety from Australian journalists from The Land.     

Use of employer administrative databases to identify systematic causes of injury in aluminum manufacturing

BACKGROUND: Employer administrative files are an underutilized source of data in epidemiologic studies of occupational injuries. METHODS: Personnel files, occupational health surveillance data, industrial hygiene data, and a real-time incident and injury management system from a large multi-site aluminum manufacturer were linked deterministically. An ecological-level measure of physical job demand was also linked. This method successfully created a database containing over 100 variables for 9,101 hourly employees from eight geographically dispersed U.S. plants. RESULTS: Between 2002 and 2004, there were 3,563 traumatic injuries to 2,495 employees. The most common injuries were sprain/strains (32%), contusions (24%), and lacerations (14%). A multivariable logistic regression model revealed that physical job demand was the strongest predictor of injury risk, in a dose dependent fashion. Other strong predictors of injury included female gender, young age, short company tenure and short time on current job. CONCLUSIONS: Employer administrative files are a useful source of data, as they permit the exploration of risk factors and potential confounders that are not included in many population-based surveys. The ability to link employer administrative files with injury surveillance data is a valuable analysis strategy for comprehensively studying workplace injuries, identifying salient risk factors, and targeting workforce populations disproportionately affected.     

茂名市6371名中小学生伤害发生现况的调查分析

为预防与控制中小学生伤害的发生 ,于 1 999年 5月采用随机整群抽样 ,以一人一表问卷的方式对茂名市 63 71名中小学生进行伤害流行病学调查。一年间发生一种 (次 )以上伤害者 3 2 60人 ,伤害发生率为 51 1 7%。学生最常发生的前 5项伤害为跌伤、刀或锐器伤、碰伤、交通伤及烧烫伤。初中学生是伤害发生的高峰段 ,伤害发生率达 65 6% ,男生发生率高于女生 ,独生子女比非独生子女发生率低 ,父母文化程度低、无固定职业或从商者的伤害发生率较高。显示除学生生理及心理发育不成熟、活动量及范围增大与伤害发生率有关外 ,家长对保护子女安全的认识、关心及能否实施保护是学生发生伤害的重要影响因素     

Incidence Rates and Trend of Serious Farm-Related Injury in Minnesota, 2000–2011

ABSTRACT

Only about 2% of Minnesota’s workers were employed in agriculture for the years 2005–2012, this small portion of the workforce accounted for 31% of the 563 work-related deaths that occurred in Minnesota during that same time period. Agricultural fatalities in Minnesota and elsewhere are well documented; however, nonfatal injuries are not. To explore the burden of injury, Minnesota hospital discharge data were used to examine rates and trends of farm injury for the years 2000–2011. Cases were identified through the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), injury codes and external cause of injury codes (E codes). Probable cases were defined as E code E849.1 (occurred on a farm) or E919.0 (involving agricultural machinery). Possible cases were based on five less specific E codes primarily involving animals or pesticides. Multiple data sources were used to estimate the agricultural population. An annual average of over 500 cases was identified as probable, whereas 2,000 cases were identified as possible. Trend analysis of all identified cases indicated a small but significant average annual increase of 1.5% for the time period 2000–2011. Probable cases were predominantly male (81.5%), whereas possible cases were predominantly female (63.9%). The average age of an injury case was 38.5 years, with the majority of injuries occurring in late summer and fall months. Despite the undercount of less serious injuries, hospital discharge data provide a meaningful data source for the identification and surveillance of nonfatal agricultural injuries. These methods could be utilized by other states for ongoing surveillance for nonfatal agricultural injuries.     

The WHO safe community program for injury prevention: evaluation of the impact on injury severity

Despite the fact that injuries consume a considerable amount of health care resources world-wide, 3.5 million people die from unintentional injuries each year. To handle this central public health problem, WHO has introduced the Safe Community accreditation for injury prevention programs. This study was to investigate the impact from a Safe Community program with regard to injury severity. Data were collected in Motala municipality (population = 41 000), Östergötland county, Sweden, during one year before and one year after program intervention, from two sources: registration of trivial (AIS 1) and non-trivial (AIS 2–6) unintentional injuries from all acute care episodes in the area and recollection of hospital bed days from discharge registers. The incidence of non-trivial injuries treated in health care was found to have decreased by 41% (95% confidence interval, 37–45%), while the trivial injuries increased by 16% (9–22%). The larger decrease of non-trivial injuries was observed in all ages and injury event environments. The total number of bed days at emergency hospitals due to injuries decreased by 39% (37–41%) from 1983–84 to 1989, while the hospital bed utilization for other reasons decreased by 9% (8–9%). The study showed that implementation of a WHO Safe Community program led to the harm from unintentional injuries within the community being considerably more reduced than that of the injury incidence. In future assessments of injury prevention programs, classification of injury severity should be included to increase the validity of inter-program comparisons.     

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.     

Injury risks in children of California migrant Hispanic farm worker families

BACKGROUND: Few data are available addressing occupational and other injury risks among children of migrant Hispanic farm workers. METHODS: We conducted the U.C. Davis Farm Worker Injury Study (UCD-FWIS), a longitudinal follow-up study of injury among migrant Hispanic farm worker families living in six Northern California Migrant Housing Centers (MHCs). Nine hundred forty-one children (age < 18 years) were interviewed through parental proxy. RESULTS: Fifty-one injuries resulting in medical care or at least one-half day of lost or restricted work or school time occurred among 49 children (3.8 injuries/100 person-years). Open wounds (31.4%) and fractures (29.4%) were most common. Falls comprised over one-third of the cases, followed by being struck and bicycle injuries. Over three-quarters of subjects never use a helmet when riding a bicycle. Seventy-eight (8.3%) children reported employment in the preceding year, typically involving manual agricultural tasks. Two injury cases were occupational and involved agricultural work. CONCLUSIONS: Occupational injury was uncommon in this group of children in migrant Hispanic farm worker families. Injury prevention in this population should include a focus on the home and surrounding environment as well as the work place.