Letter to the editor Pless, Ivan Barry
Injury prevention,
04/2021, Volume:
27, Issue:
2
Journal Article
Peer reviewed
Correspondence to Dr Ivan Barry Pless, Retired, Westmount, QC H3Y2V2, Canada; barry.pless@mcgill.ca To the editor I was delighted to read the excellent state-of-the-art review on child pedestrian ...injury prevention (Cloutier et al, Inj Prev 2021; 27:77–84) and pleased that among the authors were many former colleagues. Valuable as these approaches may be, in the end I firmly believe that health departments must press for a leadership role in injury prevention. ...this happens, our efforts will continue to be fragmented and ineffective. Health must meet with Justice departments that resist lowering blood alcohol concentration (BAC) limits or resist strengthening gun control.
There is limited evidence as to how to facilitate health care providers (HCPs) addressing firearm injury prevention during routine visits. The purpose of this project was to examine whether including ...a screening question about firearms in the home in the routine care template increases the screening of youth access to firearms.
A pre-post approach chart review was conducted for youth 12-21 years old. Outcomes included HCP documentation of screening for the presence of firearms and whether counseling caregivers on safer storage practices was delivered.
HCPs documented screening adolescents for firearms 85% after the addition of the prompt compared to 25% prior to the change (p < .001). The presence of the screening prompt also led to an increase in the delivery of safe storage counseling (p = .035).
Altering the EMR template increased HCP documentation of the presence of firearms in the home while also increasing firearm injury prevention counseling delivered to caregivers.
Monitoring the load placed on athletes in both training and competition has become a very hot topic in sport science. Both scientists and coaches routinely monitor training loads using ...multidisciplinary approaches, and the pursuit of the best methodologies to capture and interpret data has produced an exponential increase in empirical and applied research. Indeed, the field has developed with such speed in recent years that it has given rise to industries aimed at developing new and novel paradigms to allow us to precisely quantify the internal and external loads placed on athletes and to help protect them from injury and ill health. In February 2016, a conference on "Monitoring Athlete Training Loads-The Hows and the Whys" was convened in Doha, Qatar, which brought together experts from around the world to share their applied research and contemporary practices in this rapidly growing field and also to investigate where it may branch to in the future. This consensus statement brings together the key findings and recommendations from this conference in a shared conceptual framework for use by coaches, sport-science and -medicine staff, and other related professionals who have an interest in monitoring athlete training loads and serves to provide an outline on what athlete-load monitoring is and how it is being applied in research and practice, why load monitoring is important and what the underlying rationale and prospective goals of monitoring are, and where athlete-load monitoring is heading in the future.
BackgroundHamstring injury incidence remains high among male soccer players. One of the reasons is low adherence for effective hamstring injury prevention programs. Insight in injury risk can ...contribute to better adherence for injury prevention measures. The hamstring outcome score (HaOS) might provide an insight in injury risk.ObjectiveTo determine the relation between the HaOS and both previous and new hamstring injuries in male amateur soccer players, and to determine the prognostic value of the HaOS to predict the risk of hamstring injuries.DesignData was collected during a large cluster-RCT investigating a hamstring injury prevention program.SettingThis study was executed during one competition (2016–2017) in 32 first class amateur soccer teams.Participants400 adult male amateur soccer players started the study.Assessment of risk factorsThe participants filled in a baseline-questionnaire consisting of injury history and the HaOS. During one full competition hamstring injuries were registered prospectively.Main outcome measurementsPrevious hamstring injuries, new hamstring injuries and the HaOS (total score and subdomains) were considered in this study.ResultsIn 356 players, a significant relation was found between the HaOS (total score and all HaOS subdomain scores) and previous and new hamstring injury (F=17,4; p<0.0001 and T=3.59, p=0.001, respectively). This indicated that more hamstring injuries during the previous season was related to lower scores on the HaOS and lower HaOS scores correspond with more new hamstring injuries. With a cut-off score of 80% on the HaOS, logistic regression models showed a probability of 11%, 18% and 28% on a new hamstring injury in players with 0,1 or 2 previous injuries, respectively.ConclusionThe HaOS is significantly associated with both previous and new hamstring injury and might be a useful tool to provide insight in players’ hamstring injury risk when used in combination with injury history.
BackgroundThere is currently limited evidence identifying the mechanism of Achilles tendon rupture (ATR). Identification of this mechanism would aid rehabilitation and injury prevention ...strategies.ObjectiveDetermine the movement pattern (mechanism of injury) for ATRs.DesignA systematic video search was completed of all publicly available videos capturing ATR. Identified videos were then analysed in slow motion by three blinded reviewers.SettingSubjects of any athletic level participating in sporting events where included.Patients (or Participants)Any subject suffering a verifiable ATR captured on video. Ruptures were verified either by self-report or media release in the case of athletes. A total of 495,120 eligible videos where identified, with 57 separate ATR events being retained for data analysis.Interventions (or Assessment of Risk Factors)An initial review was used to develop an understanding of important variables. These included Ankle, knee, Hip and trunk movements, Plantar flexor muscle activity (eccentric/concentric), contact/non-contact, sporting activity, age, gender and where possible activity duration prior to rupture.Main Outcome MeasurementsIdentification of the mechanism (description of the movement pattern associated) ATR.ResultsA total of 57 subjects with confirmed ATR were identified. Various sports were associated with ATR’s, field sports accounted for 27 whilst other sports accounted for 30. High load eccentric activity of the plantarflexor muscles was identified as occurring in all injuries. This was associated with dorsiflexion of the ankle and concurrent knee extension in 100% of subjects. Hip extension was only identified in 86% of subjects and 91% of ATR’s were non-contact.ConclusionsThe injury mechanism for Achilles tendon rupture involves dorsiflexion of the foot with knee extension, whilst the plantarflexor muscles are eccentrically contracting. Further research is required to determine if the addition of a similar movement/motor control task would improve rehabilitation or serve as an injury prevention strategy.
BackgroundUsing Activate, a rugby-specific injury prevention exercise programme, has been shown to reduce injury risk in school rugby; however, implementing such programmes is challenging and ...adherence is often suboptimal. The Health Action Process Approach (HAPA) model is a promising theory for identifying modifiable determinants of programme uptake.ObjectiveTo evaluate the utility of the HAPA model when predicting coaches’ intentions to use Activate,and to explore the relationship between intention and programme adoption.DesignProspective cohort study.SettingEnglish schools rugby (under-12 to under-18).ParticipantsRugby coaches and support staff (n=38).InterventionsAll coaches attended a pre-season Activateworkshop. Coaches completed a questionnaire pre- and post-workshop, assessing HAPA predictors: risk perception, outcome expectancies, task self-efficacy, intention, action and coping planning, maintenance self-efficacy and recovery self-efficacy.Main outcome measuresStandardized regression coefficients (β) were used to measure the association between HAPA variables. Goodness-of-fit was assessed using the Comparative Fit Index (CFI), Tucker Lewis Index (TLI) and root mean square error of approximation (RMSEA). Programme adoption was self-reported at post-season.ResultsCoaches’ outcome expectancies(β=0.33, p<0.05) and task self-efficacy (β=0.40, p<0.01) were significantly associated with intention to use Activate(r2=0.28). The model demonstrated good fit to predict intention (CFI=0.95, TLI=1.00, RMSEA=0.00). Task self-efficacy (β=0.49, p<0.01) and intention(β=0.27, P<0.05) were significantly associated with action and coping planning (r2=0.43), though the relationship between intention and adoption was not significant (β=0.09, p=0.63).ConclusionsAs hypothesised by the HAPA model, outcome expectancies and task self-efficacy were significant predictors of intention, and behaviour change strategies should focus on improving these. Predicted pathways between task self-efficacy, intention, and planning were also supported, though the model was underpowered to assess relationships between post-intentional variables and programme adoption. The model’s utility beyond intention needs further exploration with larger sample sizes to identify additional intervention targets.
To evaluate whether exposure to the United States' discriminatory housing practice of redlining, which occurred in over two-hundred cities in the 1930s, is associated with modern-day, community-level ...incidence of firearm injury.
Firearm violence is a public health epidemic within the United States. Federal policies are crucial in both shaping and reducing the risk of firearm violence; identifying policies that might have contributed to risks also offers potential solutions. We analyzed whether 1930s exposure to the discriminatory housing practices that occurred in over two-hundred U.S. cities was associated with modern-day, community-level incidence of firearm injury.
We performed a nationwide retrospective cohort study between 2014-2018. Urban Zip Code Tabulation Areas (ZCTAs) historically exposed to detrimental redlining (grades C and D) were matched to unexposed ZCTAs based on modern-day population-level demographic characteristics (i.e., age, Gini index, median income, percentage Black population, education level). Incidence of firearm injury was derived from the Gun Violence Archive and aggregated to ZCTA level counts. Our primary outcome was the incidence of firearm injury, modeled using zero inflated negative binomial regression.
When controlling for urban firearm risk factors, neighborhoods with detrimental redlining were associated with 2.6 additional firearm incidents annually, compared to non-redlined areas with similar modern-day risk factors. Over our study period, this accounts for an additional 23,000 firearm injuries.
Historic, discriminatory Federal policy continue to impact modern-day firearm violence. Policies aimed at reversing detrimental redlining may offer an economic means to reduce firearm violence.
BackgroundUnintentional Injuries comprise the fifth leading cause of death in Nepal in 2017, an increase of 23% compared to 1990. In Nepal, there is minimal community-derived evidence of home or ...occupational injuries. Our aim was to describe the epidemiology of injuries in the Makwanpur district, including the causes and risk factors associated with those injuries.MethodsA cross-sectional, household survey was undertaken in three administrative areas of Nepal between April-June, 2019. Data were collected electronically about non-fatal and fatal injuries in the previous three months and five years, respectively.Results17,593 individuals from 3,327 households were surveyed; 394 people were injured. 136/394 (34.5%) injuries occurred in homes, 109 (27.7%) were work-related. 225 (55.8%) were males, the age range was 0–87 years, 123 (30.7%) were child injuries, (0–17 yrs). The most commonly reported injury was falls (n=173, 43.9%), stumbling and tripping were the most common reasons and 73 (42.2%) occurred at home. More injuries occurred in rural administrative areas than urban areas, especially occupational injuries (occupational: chi-square=22.05, p=0.000; home: chi-square=13.89, p<0.001).ConclusionsHome and occupational fall injuries are common, especially in rural areas. Understanding the context of falls, especially identifying and working with particular occupational groups where they are prevalent, may identify risk factors and help target messages about primary falls prevention and interventions.Learning OutcomesUsing hand-held computers and local enumerators for data collection in sample areas resulted in minimal missing data and monitoring of data quality during the collection period.
ContextNepal Injury Research Centre (NIRC) is dedicated to injury-related studies in Nepal. One of the key objectives of NIRC is to conduct standardized research additional to building the capacity ...of local researchers in adopting a robust Electronic Data Capture (EDC) system.ProcessA NIRC data manager was appointed and trained by a REDCap expert from the University of Bristol, UK who then supported implementation of the system. Local data collectors were trained to use the REDCap mobile application allowing them to collect data offline and synchronize the collected data to the server when a good internet connection was available. We surveyed 24 data collectors involved in NIRC studies to gather their feedback.AnalysisData collectors were largely positive regarding REDCap as a tool in comparison with other methods and reported the interface to be user-friendly. Data collected could be monitored remotely which helped in maintaining data quality and preparing data for analysis. It allowed sharing of data collection tools within different projects, reducing duplication of effort. However, the main reported challenge was adapting to the periodic updates in the REDCap system.OutcomesREDCap was used successfully to capture data electronically across five studies. The few issues encountered were mitigated using available system functionalities. An in-country server was established, with potential for NIRC to offer EDC services to other researchers in Nepal.Learning OutcomesUsing collaborative approach to reflect on opportunities and challenges of using EDC is crucial to strengthen and expand local ownership of research tools and data.
ContextAgriculture, forestry and fishing industries are among the most dangerous industries in which to work, in Australia and internationally. Australia and its states & territories have robust work ...health and safety regulation, enforcement and prosecution systems outlined via Work Health and Safety (WHS) Acts (and Regulations), in Queensland the new regulations came into effect in 2011. The acts require employers to provide a safe place of work, to protect workers (via procedures and other mechanisms) and to train workers in matters relating to WHS.ProcessIn Queensland, details of WHS and electrical safety law breaches, against which a prosecution and conviction have occurred, are made publicly available.AnalysisA review of the agriculture, forestry and fishing prosecutions in this public registry was performed focused on incident type, industry and outcomes. Suggestions for system-related improvements are outlined.OutcomesSince 2014 (at 27 February 2020), 33 prosecutions have been successfully brought against defendants of which a third were due to a death. Penalty costs ranged from $5k to $400k. The common injuries from the incidents included amputation, fractures and crush injuries. Prevention options will be discussed.Learning OutcomesThe public register exists to serve as a deterrent to others, concurrently discouraging non-compliance and promoting improvements in safety practices and systems. A key consideration when trying to promote safety practice and system improvements is to create meaningful change, whilst also balancing the onerous nature of change. This is particularly pertinent as many agriculture-related ventures in Queensland are small to medium sized enterprises.
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