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.     

Self-reported injury and physical activity levels: United States 2000 to 2002

PURPOSE: The aim of the study is to compare national estimates of the incidence of self-reported all-cause and activity-specific injuries in adults with differing leisure-time physical activity levels. METHODS: Data were analyzed from the 2000 to 2002 National Health Interview Survey. Leisure-time physical activity levels were categorized as active, insufficiently active, and inactive. RESULTS: Age-adjusted incidences of all-cause injury did not differ by leisure-time physical activity level (active, 89.3/1000; 95% confidence interval [CI], 81.8-96.8; insufficiently active, 81.6/1000; 95% CI, 73.1-90.1; and inactive, 86.3/1000; 95% CI, 78.6-93.9). Active respondents (29.4/1000; 95% CI, 25.2-33.6) had a greater incidence of injury related to sport and leisure-time activities than inactive respondents (15.2/1000; 95% CI, 12.1-18.3), whereas inactive respondents (71.1/1000; 95% CI, 63.9-78.2) had a greater incidence of injury related to nonsport and non-leisure-time activities than active respondents (59.9/1000; 95% CI, 53.6-66.2). Results were unchanged after multivariate control for confounding factors. CONCLUSIONS: Although the incidence of sport and leisure-time injuries is associated with participation in leisure-time physical activity, no association was observed between leisure-time physical activity and overall injuries.     

Impact of social standing on injury prevention in a World Health Organization Safe Community--intervention outcome by household employment contract

BACKGROUND: Although social inequality in health has been an argument for community-based injury prevention programmes, intervention outcomes with regard to differences in social standing have not been analysed. The objective of this study was to investigate rates of injuries treated in health-care among members of households at different levels of labour market integration before and after the implementation of a WHO Safe Community programme. METHODS: A quasi-experimental design was used with pre- and post-implementation data collection covering the total populations <65 years of age during one year in the programme implementation municipality (population 41 000) and in a control municipality (population 26 000). Changes in injury rates were studied using prospective registration of all acute care episodes with regard to social standing in both areas during the study periods. RESULTS: Male members of households categorized as not vocationally active displayed the highest pre-intervention injury rates. Also after the intervention, males in households classified as not vocationally active displayed notably elevated injury rates in both the control and study areas. Households in the study area in which the significant member was employed showed a post-intervention decrease in injury rate among both men (P < 0.001) and women (P < 0.01). No statistically significant change was observed in households in which the significant member was self-employed or not vocationally active. In the control area, only an aggregate-level decrease (P < 0.05) among members of households in which the significant member was employed was observed. CONCLUSIONS: The study displayed areas for improvement in the civic network-based WHO Safe Community model. Even though members of non-vocationally active households, in particular men, were at higher pre-intervention injury risk, they were not affected by the interventions. This fact has to be addressed when planning future community-based injury prevention programmes.     

Occurrence and Risk Factors of Unintentional Injuries among 12- to 18-Year-Old Finns – A Survey of 8219 Adolescents

The aim of this study was to evaluate the incidence, nature, and risk factors of unintentional injuries among 12-, 14-, 16- and 18-year-old Finnish adolescents. Of the 8219 respondents (response rate 75%) 5.5% reported an injury that had required medical attention during the past month. The total number of injuries was 506 and the incidence of injuries 62 per 1000 person-months. Boys had a slightly higher injury occurrence rate than girls (OR: 1.33; 95% CI: 1.13-1.59). The most common injuries were sprains (27%), fractures (26%) and wounds (16%) of the upper and lower limbs. In multivariate logistic regression analysis the strongest risk factors of injury were: having experienced violence during past month (OR: 3.6; 95% CI: 2.8-4.6), daily leisure time exercise in sports club (OR: 3.3; 95% CI: 2.3-4.6), having several somatic health complaints weekly (OR: 2.2; 95% CI: 1.7-2.9) and having chronic disease (OR: 2.0; 95% CI: 1.5-2.6). In conclusion, injuries were an important cause of morbidity among our 12-18-year-old adolescents. Adolescents' school success and their parents' education, occupation and employment status were not associated with injuries. The finding that several health and health behaviour variables are important risk factors for injuries challenges the researchers and the society to identify and treat the risk factors that can be modified to reduce the number of adolescent injuries.     

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.     

Long-term effects of community-based injury prevention on the island of Vaerøy in Norway: a 20-year follow up

AIM: A multifactorial injury prevention programme started in 1981 and ran for about 10 years in an island community in Norway with a population of about 1,000. A study was undertaken to evaluate effects of the programme over a period of 20 years. METHODS: Injuries were recorded by the one medical doctor on the island for several years during the period 1970-2001. The programme was carried out very intensively from 1981 to 1987. The intensity gradually decreased to a medium level that lasted until about 1994, when it was further reduced to a low level. RESULTS: The injury incidence rate was reduced from 17.7% in 1980 (n = 188) to 9.7% in 1987 (n = 97) with relative risk reduced to 0.55 (95% CI 0.44-0.70, p < 0.0001). In 2001, an incidence rate of 9.6% was observed (n = 91). An even higher reduction was observed for serious injuries. The age groups 15-24 and 65+ showed the most distinct reductions from 1980 to 2001 while minor reduction was observed in children (0-14 years). The incidence rate of traffic injuries was reduced by 77% in spite of an increase in the number of motor vehicles. Occupational, home, and other injuries were reduced by 38%, 35%, and 49% respectively. The incidence rates were 2.6-3.0 times higher for men than for women through the 20-year observation period. CONCLUSION: This study indicates that a long-lasting multifactorial community-based intervention in a small community with defined aims may lead to a considerable and long-lasting reduction in injuries.     

Evaluation of potential reduction in blood and body fluid exposures by use of alternative instruments

BACKGROUND: Injuries from needlestick, sharps injuries and splashes lead to exposure to blood and body fluids with the potential for transmission of blood-borne viruses. AIMS: To identify alternative instruments, which if used would improve worker safety. METHODS: Retrospective review of 161 injuries with identification of safer alternative products for instruments that caused injury. The proportion of injuries that could be prevented was calculated [with 95% confidence intervals (CI)]. RESULTS: The average rate of injury was 7.8/1000 employees per annum (95% CI, 6.8-9.4/1000). In the 2 years the highest rates of injury occurred in pre-registration house officers (164/1000; 95% CI, 64-264/1000), phlebotomists (154/1000; 95% CI, 15-291/1000) and senior house officers (45/1000; 95% CI, 13-77/1000). An upper estimate of 65% (95% CI, 58-72%) of incidents would have been preventable with a change to alternative devices. CONCLUSIONS: Change to the use of intrinsically safer instrumentation has the potential to prevent injury to healthcare workers.     

An ecologic study of protective equipment and injury in two contact sports

BACKGROUND: Contact sports have high rates of injury. Protective equipment regulations are widely used as an intervention to reduce injury risk. The purpose of this study was to investigate the injury prevention effect of regulations governing protective equipment in two full-body contact sports. METHODS: Injury rates in US collegiate football were compared to New Zealand club Rugby Union. Both sports involve significant body contact and have a high incidence of injury. Extensive body padding and hard-shell helmets are mandated in collegiate football but prohibited in Rugby Union. RESULTS: The injury rate in football was approximately one-third the rugby rate (rate ratio [RR] = 0.35; 95% CI: 0.31-0.40). The head was the body site with the greatest differential in injury incidence (RR = 0.11; 95% CI: 0.08-0.16). Rugby players suffered numerous lacerations, abrasions, and contusions to the head region, but the incidence of these injuries in football was almost zero (RR = 0.01; 95% CI: 0.01-0.03). Injury rates were more similar for the knee (RR = 0.61; 95% CI: 0.43-0.87) and ankle (RR = 0.72; 95% CI: 0.46-1.13), two joints largely unprotected in both sports. CONCLUSIONS: The observed differences are consistent with the hypothesis that regulations mandating protective equipment reduce the incidence of injury, although important potential biases in exposure assessment cannot be excluded. Further research is needed into head protection for rugby players.     

Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg

OBJECTIVES: To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities. STUDY DESIGN: Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months. METHODS: In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances. RESULTS: Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35-59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.     

Soccer Injuries in Female Youth Players

A cross-sectional survey of injuries among female youth soccer players found 44.6% (95% confidence interval 34.9%–54.8%) had ever been injured. The injury incidence rate for the current season was 2.2/1000 soccer exposure hours (95% CI 1.5–3.1). Future studies should evaluate modifiable risk factors in youth to identify injury prevention strategies.     

Effect of transfer, lifting, and repositioning (TLR) injury prevention program on musculoskeletal injury among direct care workers

Musculoskeletal injuries among health care workers is very high, particularly so in direct care workers involved in patient handling. Efforts to reduce injuries have shown mixed results, and strong evidence for intervention effectiveness is lacking. The purpose of our study was to evaluate the effectiveness of a Transfer, Lifting and Repositioning (TLR) program to reduce musculoskeletal injuries (MSI) among direct health care workers. This study was a pre- and post-intervention design, utilizing a nonrandomized control group. Data were collected from the intervention group (3 hospitals; 411 injury cases) and the control group (3 hospitals; 355 injury cases) for periods 1 year pre- and post-intervention. Poisson regression analyses were performed. Of a total 766 TLR injury cases, the majority of injured workers were nurses, mainly with back, neck, and shoulder body parts injured. Analysis of all injuries and time-loss rates (number of injuries/100 full-time employees), rate ratios, and rate differences showed significant differences between the intervention and control groups. All-injuries rates for the intervention group dropped from 14.7 pre-intervention to 8.1 post-intervention. The control group dropped from 9.3 to 8.4. Time-loss injury rates decreased from 5.3 to 2.5 in the intervention group and increased in the control group (5.9 to 6.5). Controlling for group and hospital size, the relative rate of all-injuries and time-loss injuries for the pre- to post-period decreased by 30% (RR = 0.693; 95% CI = 0.60-0.80) and 18.6% (RR = 0.814; 95% CI = 0.677-0.955), respectively. The study provides evidence for the effectiveness of a multifactor TLR program for direct care health workers, especially in small hospitals.     

Safe Communities in China as a Strategy for Injury Prevention and Safety Promotion Programmes in the Era of Rapid Economic Growth

Due to its rapid economic development, China is facing a huge health, social, and economic burden resulting from injuries. The study’s objective was to examine Safe Communities in China as a strategy for injury prevention and safety promotion programmes in the era of rapid economic growth. Literature searches in English and Chinese, which included grey literature, were performed on the Chinese Journal Full-text Search System and Medline, using the words “Safe Community”, “injury”, “economics”, and “prevention”. The results showed that the existing 35 recognized members of the International Safe Community Network have not placed due emphasis on suicide prevention, which is one of the leading problems in both rural and urban China. A few groups, such as children, the elderly, cyclists, and pedestrians, have received due emphasis, while other vulnerable groups, such as migrant workers, motorcyclists, students, players, and farmers have not received the necessary attention from the Safe Community perspective. As the evidence describes, Safe Communities in China can be a very effective strategy for injury prevention, but four aspects need to be strengthened in the future: (1) establish and strengthen the policy and regulations in terms of injury prevention at the national level; (2) create a system to involve professional organizations and personnel in projects; (3) consider the economic development status of different parts of China; and (4) intentional injury prevention should receive greater attention.     

Incidence and pattern of unintentional injuries and resulting disability among children under 5 years of age: results of the National Health Survey of Pakistan

National estimates of injuries for children under 5 years based on population representative surveys are not readily available globally and have not been reported for developing countries. This study estimated the annual incidence, pattern and distribution of unintentional injuries according to age, gender, socio‐economic status, urban/rural residence and disability caused among children aged under 5 years in Pakistan. The National Health Survey of Pakistan (NHSP 1990–94) is a nationally representative survey of households to assess the health profile of the country. A two‐stage stratified design was used to select 3223 children under 5 years of age for interview and examination. Data were used for boys and girls in urban and rural areas over the preceding year. A community development index was developed to assess the relationship between socio‐economic status and injuries. Weighted estimates were computed adjusting for complex survey design using surveyfreq and surveylogistic option of SAS 9.1 software. Post hoc power calculations were made for each variable keeping the design effect at 3.0. The overall annual incidence of unintentional injuries was 47.8 [95% CI 36.6, 59.0] per 1000 per year; 50.2 [95% CI 37.0, 63.4] and 45.2 [95% CI 29.4, 61.0] per 1000 per year among boys and girls under 5 years of age respectively. An estimated 1.1 million unintentional injuries occur in Pakistan annually among these children. Injury rates increase with age among the under‐5s. Urban and rural injuries were 56.1 [95% CI 33.5, 78.7] and 44.1 [95% CI 31.1, 57.1] per 1000 per year respectively. The children living in least developed communities had almost 3 times higher risks of injuries than most developed communities. The annual incidence of types of injuries were: falls 28.7 [95% CI 19.5, 37.9], cuts/bruises 9.7 [95% CI 5.3, 14.1] and burns 6.6 [95% CI 3.0, 10.2] per 1000 per year. Falls were the most common type of injury (60%) followed by cuts/bruises (21%) and burns (14%). The majority of injuries occur at home (85%), with just 10% due to road traffic. Road traffic injuries and injuries to the female child were more likely to result in disability. There is a high burden of unintentional injuries and disability among children under 5 in Pakistan. These results are useful for planning further research and for prioritising prevention programmes nationally and in other developing countries with similar situation.     

Prevention of fall injuries requiring hospital treatment among community-dwelling elderly

Background: To reduce the number of fall injuries requiringhospital treatment among community-dwelling elderly a community-basedintervention programme was set up. The study was designed asa prospective intervention study with the intervention consistingof information and home visits with follow-up, removing physicalhazards, treating somatic and psychiatric illnesses and dealingwith improper drug consumption, diet insufficiencies and physicaland mental inactivity. The setting was five municipalities ofthe county of Vejle, Denmark (intervention area) with 12,905community-dwelling elderly (65 years) and four other municipalitiesin the same county (control area) with 11,460 community-dwellingelderly (65 years) from 1 January 1986 to 31 March 1988. Method:A separate injury register at hospitals, with catchment areasfor the above study population, was established to collect informationon fall-related injuries among the community dwelling elderlywho were referred to out-patient treatment or hospitalization.The fall injuries requiring treatment were registered for ninemonths prior to the intervention and for 18 months during theimplementation of the intervention programme. Results: The preventedfraction was estimated for all fractures, lower extremity fracturesand hip fractures. A non-significant reduction of 14% in thenumber of all fractures was found in the intervention groupcompared with the control group. The reduction of lower extremityfractures in the intervention group was found to be significantlygreater: 33% (95% CI: 3–63%), due to a highly significantreduction among women: 46% (95% CI: 8–84%), but withoutreduction among men. Similarly a high, although non-significant,reduction of hip fractures among women was found: 43% (95% CI:-2 - 88%). The reductions appeared to be highest in the lastnine months of the intervention period and highest among womenliving alone. Conclusion: It is possible to reduce the numberof major fall-related fractures among elderly with a well-integrated,community-based intervention programme having information, homevisits and follow-up as major components and utilizing existinghealth personnel in a municipality.     

Evaluation of an inter-organizational prevention program against injuries among the elderly in a WHO Safe Community

The aim of the study was to evaluate the outcome of a participatory community-based prevention program against injuries among the elderly. A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on cross-sectoral participation in detecting and taking action against injuries among the elderly. Change in the relative risk of injury was estimated by the odds ratio. Morbidity in moderately (AIS 2) severe injury in the study area was reduced from 46 per 1000 population years to 25 per 1000 population years (odds ratio 0.55; 95% confidence interval 0.46-0.65), while the minor (AIS 1) injuries increased (odds ratio 1.55; 95% confidence interval 1.21-1.91). The risk of severe or fatal (AIS 3-6) injuries remained constant. In the study area, only a slight decrease in the total morbidity rate was observed (odds ratio 0.87; 95% confidence interval 0.77-0.99). In the control area, there was no evident change in the total morbidity rates. Falls decreased or showed a tendency to decrease in the age groups 65 to 79-y-old in the study area, while they increased in the older age group. The results indicate that no sharp boundaries should be drawn between safety education, physical conditioning, environmental adjustments and secondary prevention measures when planning safety promotion among the elderly. Future studies should address these issues along with the methodological complexity associated with assessment of participatory community-based safety promotion programs.     

Provision of health counseling in office-based practices and hospital outpatient clinics

OBJECTIVE: To compare the rates of health counseling provided during primary care visits in two different types of ambulatory care settings. METHODS: Secondary analysis of the 2000 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). RESULTS: Of the estimated 722 million adult ambulatory care visits during 2000, 90.8% were made to office-based physician practice settings and 9.2% to hospital-based outpatient departments. Consistent with previous reports, the demographic profile of patients who seek primary care in hospital outpatient departments differs from those seen in office-based practices. Provision of health counseling for exercise [OR = 1.4; 95% confidence intervals (CI): 1-1.8], diet (OR = 1.6; 95% CI: 1.2-2.3), breast self-exam (OR = 2; 95% CI: 1.1-3.6) and stress management (OR = 1.7; 95% CI: 1-2.7) during patient visits was more likely to be reported in the office-based practices than in hospital outpatient clinics. The visit-based rates of health counseling for HIV/STD prevention, tobacco use, mental health or injury prevention were low in both settings. CONCLUSIONS: There is opportunity to improve rates of preventive counseling in primary care settings and to reduce disparities that exist. Identifying the reasons for these disparities and effective interventions will be important steps in providing equitable care in the area of preventive health counseling.     

Effects of a participatory ergonomics team among hospital orderlies

BACKGROUND: High rates of work-related injuries are seen among health care workers involved in lifting and transferring patients. We studied the effects of a participatory worker-management ergonomics team among hospital orderlies. METHODS: This prospective intervention trial examined work injuries and other outcomes before and after the intervention, with other hospital employees used as a concurrent control. All orderlies in a 1,200-bed urban hospital were studied using passively collected data (mean employment during study period 100-110 orderlies); 67 orderlies (preintervention) and 88 orderlies (postintervention) also completed a questionnaire. The intervention was the formation of a participatory ergonomics team with three orderlies, one supervisor, and technical advisors. This team designed and implemented changes in training and work practices. RESULTS: The 2-year postintervention period was marked by decreased risks of work injury (RR = 0.50, 95% CI 0.35-0.72), lost time injury (RR = 0.26, 95% CI 0.14-0.48), and injury with three or more days of time loss (RR = 0.19, 95% CI 0.07-0.53). Total lost days declined from 136.2 to 23.0 annually per 100 full-time worker equivalents (FTE). Annual workers' compensation costs declined from $237/FTE to $139/FTE. The proportion of workers with musculoskeletal symptoms declined and there were statistically significant improvements in job satisfaction, perceived psychosocial stressors, and social support among the orderlies. CONCLUSION: Substantial improvements in health and safety were seen following implementation of a participatory ergonomics program.     

Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system.

OBJECTIVE: Preventing hospital falls and injuries requires knowledge of fall and injury circumstances. Our objectives were to determine whether reported fall circumstances differ among hospitals and to identify predictors of fall-related injury. DESIGN: Retrospective cohort study. Adverse event data on falls were compared according to hospital characteristics. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for risk factors for fall-related injury. SETTING: Nine hospitals in a Midwestern healthcare system. PATIENTS: Inpatients who fell during 2001-2003. RESULTS: The 9 hospitals reported 8,974 falls that occurred in patient care areas, involving 7,082 patients; 7,082 falls were included in our analysis. Assisted falls (which accounted for 13.3% of falls in the academic hospital and 9.8% of falls in the nonacademic hospitals; P<.001) and serious fall-related injuries (which accounted for 3.7% of fall-related injuries in the academic hospital and 2.2% of fall-related injuries in the nonacademic hospitals; P<.001) differed by hospital type. In multivariate analysis for the academic hospital, increased age (aOR, 1.006 [95% CI, 1.000-1.012]), falls in locations other than patient rooms (aOR, 1.53 [95% CI, 1.03-2.27]), and unassisted falls (aOR, 1.70 [95% CI, 1.23-2.36]) were associated with increased injury risk. Altered mental status was associated with a decreased injury risk (aOR, 0.72 [95% CI, 0.58-0.89]). In multivariate analysis for the nonacademic hospitals, increased age (aOR, 1.007 [95% CI, 1.002-1.013]), falls in the bathroom (aOR, 1.46 [95% CI, 1.06-2.01]), and unassisted falls (aOR, 1.83 [95% CI, 1.37-2.43]) were associated with injury. Female sex (aOR, 0.83 [95% CI, 0.71-0.97]) was associated with a decreased risk of injury. CONCLUSION: Some fall characteristics differed by hospital type. Further research is necessary to determine whether differences reflect true differences or merely differences in reporting practices. Fall prevention programs should target falls involving older patients, unassisted falls, and falls that occur in the patient's bathroom and in patient care areas outside of the patient's room to reduce injuries.     

Health and safety implications of injury in professional rugby league football

BACKGROUND: Professional sport is characterized by high injury rates but is also covered by health and safety legislation. AIM: To examine the incidence of injury in professional rugby league as defined by the Reporting of Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR 95). METHODS: All injuries received during playing and training to both first-team and 'academy' (<19 years old) players during two playing seasons at one professional club were recorded. The length of time a player was unable to take part in full training and playing was used as a measure of severity. Injuries were classified into minor injuries (0-3 days), over 3 day injuries or major injuries, in which the final two categories corresponded with RIDDOR 95. RESULTS: Thirty-two per cent (95% confidence interval=26-39%) of all injuries received satisfied the RIDDOR 95 criteria. The overall injury rate was 8.5 per 1000 h (7.2-9.9) for the first team and 4.1 per 1000 h (3.2-5.4) for the academy team. During match play the first-team injury rate was 157.7 per 1000 h (133.5-185.1) and 67.7 (51-81.1) for the academy team. Training injury rates were lower, at 0.5 per 1000 h (0.2-1.0) and 0.3 per 1000 h (0.1-0.8), respectively. CONCLUSION: The injury rate for professional rugby league is much higher than reported in other high-risk occupations such as mining and quarrying. The large differences in injury rates between first and academy teams have implications for young players likely to progress to first-team status.     

Incidence and outcome of first syncope in primary care: A retrospective cohort study

ABSTRACT: BACKGROUND: Assessment of risk for serious cardiovascular outcome after syncope is difficult. OBJECTIVES: To determine the incidence of first syncope in primary care. To investigate the relation between syncope and serious cardiovascular (CV) outcome and serious injury. METHODS: Retrospective cohort study using data from the Intego general practice-based registration network, collecting data from 55 general practices (90 GP's). All patients with a first syncope from 1994 to 2008 were included; five participants without syncope were matched for age and gender for every patient with syncope. The main outcome measures were incidence of first syncope by age and gender and one year risk of serious CV outcome or injury after syncope. RESULTS: 2785 patients with syncope and 13909 matched patients without syncope were included. The overall incidence of a first syncope was 1.91 per 1000 person-years (95% CI 1.83-1.98). The incidence was higher in females (2.42 (95% CI 2.32-2.55) per 1000 person-years) compared to males (1.4 (95% CI 1.32-1.49) per 1000 person-years) and follows a biphasic pattern according to age: a first peak at the age of 15-24 years is followed by a sharp rise above the age of 45. One year serious outcome after syncope was recorded in 12.3% of patients. Increasing age (HR 1.04 (1.03-1.04)), CV comorbidity (HR 3.48 (95% CI 2.48-4.90) and CV risk factors (HR 1.65 (95% CI 1.24-2.18) are associated with serious outcome. Cox regression, adjusting for age, gender, CV comorbidity and risk factors, showed that syncope was an independent risk factor for serious CV outcome or injury (HR 3.99 (95% CI 3.44-4.63)). The other independent risk factors were CV comorbidity (HR 1.81 (95% CI 1.51-2.17)) and age (HR 1.03 (95% CI 1.03-1.04)). CONCLUSIONS: Incidence rate of first syncope in primary care was 1.91 per 1000 person-years. One year risk of serious outcome after syncope was 12.3%. Increasing age, CV comorbidity and risk factors are associated with serious outcome. Compared to a control group, syncope on itself is an independent risk factor for serious outcome (adjusted for age, gender, CV comorbidity and risk factors).