20 Years of Research on Socioeconomic Inequality and Children's—Unintentional Injuries Understanding the Cause-Specific Evidence at Hand

Injuries are one of the major causes of both death and social inequalities in health in children. This paper reviews and reflects on two decades of empirical studies (1990 to 2009) published in the peer-reviewed medical and public health literature on socioeconomic disparities as regards the five main causes of childhood unintentional injuries (i.e., traffic, drowning, poisoning, burns, falls). Studies have been conducted at both area and individual levels, the bulk of which deal with road traffic, burn, and fall injuries. As a whole and for each injury cause separately, their results support the notion that low socioeconomic status is greatly detrimental to child safety but not in all instances and settings. In light of variations between causes and, within causes, between settings and countries, it is emphasized that the prevention of inequities in child safety requires not only that proximal risk factors of injuries be tackled but also remote and fundamental ones inherent to poverty

Alcohol environment, gender and nonfatal injuries in young people. An ecological study of fourteen Swedish municipalities (2000–2005)

BACKGROUND: Sweden has had a restrictive alcohol policy, but there are gender and geographical differences in alcohol consumption and injury rates within the country. Whether and how the Swedish alcohol environment influences gender differences in injuries in young people is still unclear. Thus, the aim of this study was to analyse the associations between the local alcohol environment and age- and gender-specific nonfatal injury rates in people up to 24 years in Sweden. METHODS: The local alcohol environment from 14 municipalities was studied using indicators of alcohol access, alcohol consumption and alcohol-related crimes. A comprehensive health care register of nonfatal injuries was used to estimate mean annual rates of nonfatal injuries by gender and age group (2000–2005). Pearson’s correlation coefficients were used to analyse linear associations. RESULTS: Associations were shown for both alcohol access and alcohol consumption with injury rates in boys aged 13–17 years; no other associations were observed between alcohol access or per capita alcohol consumption and nonfatal childhood injuries. The prevalence of crimes against alcohol laws was associated with injury rates in children of both genders aged 6–17 years. CONCLUSIONS: This study found no strong area-level associations between alcohol and age and gender specific nonfatal injuries in young people. Further, the strength of the area-level associations varied by age, gender and type of indicator used to study the local alcohol environment

Adolescents' encounters with public space : safety and mobility in relation to individual and contextual factors in Sweden

Background: Public space, areas to which everyone has access, is especially important for adolescents. Their mobility, e.g. when travelling to school, and perceived safety and security in that environment impacts on their health, safety, and development. Aim: The aim is to increase knowledge on adolescents’ perceived safety and mobility in public space, and, with the ecological model as a framework and from a gender perspective, examine how safety and mobility relate to individual and contextual factors. Research questions concern prevalence and correlates of walking and cycling to school and of fears in the neighbourhood; as well as patterns of interrelated factors and gendered ideas regarding safety and the perception of traffic as a threat. Material: The questions are studied in four articles, using data from two quantitative surveys and a qualitative study. During 2005/06 a survey on Adolescents’ Encounter with Traffic (AEwT) was conducted among 7th grade adolescents (n=1008) in Stockholm County, Sweden; and the WHO survey Health Behaviour in School-aged Children (HBSC) among a nationally representative sample of 5th, 7th and 9th graders in Sweden (n= 4144). The surveys included some identical or similar questions. In 2008/09, ten focus group discussions were conducted with 9th graders about their perception of safety in public space. Results: Data from HBSC and AEwT showed active commuting to school – walking or cycling – to be high (62.9%) but decreasing with age whereas public transport increased. It was associated with living in an apartment or row-house; in a medium-sized city (compared to metropolitan area), and, in urban areas, with manual worker households. Data from AEwT showed that fear, reported by 60% of girls and 40% of boys, was more common among girls; adolescents living in an apartment compared to a detached house; and respondents who had or knew of scary experiences in their neighbourhood. For boys it was more common to report fear if they thought their parents were negative towards adolescent independent mobility in the evening, and for girls with one or more parents born outside Sweden. To explore interrelations between factors, patterns were sought in sociodemographic variables, and variables concerning fears, coping with fear, traffic and parent/child opinions on mobility. Five consistent and distinct clusters were identified. In clusters where girls were overrepresented, different contextual factors were found with different fears and coping strategies; in clusters more typical for boys, housing and neighbourhood factors were more determining. In the qualitative study, lone rapists, mainly a threat to girls, and gangs of adolescent boys, threatening boys with violence and girls mainly with (sexual) harassment, were described as the most prominent threats. These threats were used to construct shared ideas of gendered behaviour. Traffic, though sometimes admitted to be a major safety risk, was perceived as much more manageable. Conclusion: A number of interacting factors influence adolescents’ mobility and perceived safety in public space. Where adolescents live, and to some extent household socioeconomic status, determines the extent to which they actively commute. Boys’ and girls’ perception of safety in public space differs, and context seems to have different impact on boys’ and girls’ fears. Threats are understood through ideas of gendered behaviour. Though causality cannot be determined due to cross-sectional design, findings are based on large and diverse samples and can be assumed to be generalizable to adolescents in similar settings

Road traffic crash circumstances and consequences among young unlicensed drivers: A Swedish cohort study on socioeconomic disparities

<p>Abstract</p> <p>Background</p> <p>Young car drivers run a higher risk of road traffic crash and injury not only because of their lack of experience but also because of their young age and their greater propensity for adopting unsafe driving practices. Also, low family socioeconomic position increases the risk of crash and of severe crash in particular. Whether this holds true for young unlicensed drivers as well is not known. Increasing attention is being drawn to the prevalence and practice of unlicensed driving among young people as an important contributor to road traffic fatalities.</p> <p>Methods</p> <p>This is a population-based cohort study linking Swedish national register data for a cohort of 1 616 621 individuals born between 1977 and 1991. Crash circumstances for first-time road traffic crash (RTC) were compared considering licensed and unlicensed drivers. The socioeconomic distribution of injury was assessed considering household socioeconomic position, social welfare benefits, and level of urbanicity of the living area. The main outcome measure is relative risk of RTC.</p> <p>Results</p> <p>RTCs involving unlicensed drivers were over-represented among male drivers, suspected impaired drivers, severe injuries, crashes occurring in higher speed limit areas, and in fair road conditions. Unlicensed drivers from families in a lower socioeconomic position showed increased relative risks for RTC in the range of 1.75 to 3.25. Those living in rural areas had an increased relative risk for a severe RTC of 3.29 (95% CI 2.47 - 4.39) compared to those living in metropolitan areas.</p> <p>Conclusions</p> <p>At the time of the crash, young unlicensed drivers display more risky driving practices than their licensed counterparts. Just as licensed drivers, unlicensed young people from low socioeconomic positions are over-represented in the most severe injury crashes. Whether the mechanisms lying behind those similarities compare between these groups remains to be determined.</p

Changes in trauma-related emergency medical services during the COVID-19 lockdown in the Western Cape, South Africa

Abstract Background To limit virus spread during the COVID pandemic, extensive measures were implemented around the world. In South Africa, these restrictions included alcohol and movement restrictions, factors previously linked to injury burden in the country. Consequently, reports from many countries, including South Africa, have shown a reduction in trauma presentations related to these restrictions. However, only few studies and none from Africa focus on the impact of the pandemic restrictions on the Emergency Medical System (EMS). Methods We present a retrospective, observational longitudinal study including data from all ambulance transports of physical trauma cases collected during the period 2019–01-01 and 2021–02-28 from the Western Cape Government EMS in the Western Cape Province, South Africa (87,167 cases). Within this timeframe, the 35-days strictest lockdown level period was compared to a 35-days period prior to the lockdown and to the same 35-days period in 2019. Injury characteristics (intent, mechanism, and severity) and time were studied in detail. Ambulance transport volumes as well as ambulance response and on-scene time before and during the pandemic were compared. Significance between indicated periods was determined using Chi-square test. Results During the strictest lockdown period, presentations of trauma cases declined by > 50%. Ambulance transport volumes decreased for all injury mechanisms and proportions changed. The share of assaults and traffic injuries decreased by 6% and 8%, respectively, while accidental injuries increased by 5%. The proportion of self-inflicted injuries increased by 5%. Studies of injury time showed an increased share of injuries during day shift and a reduction of total injury volume during the weekend during the lockdown. Median response- and on-scene time remained stable in the time-periods studied. Conclusion This is one of the first reports on the influence of COVID-19 related restrictions on EMS, and the first in South Africa. We report a decline in trauma related ambulance transport volumes in the Western Cape Province as well as changes in injury patterns, largely corresponding to previous findings from hospital settings in South Africa. The unchanged response and on-scene times indicate a well-functioning EMS despite pandemic challenges. More studies are needed, especially disaggregating the different restrictions

A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care

Background Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. Methods and Results The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. Conclusions In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine acute clinical care and thereby promote equity in injury emergency care, a growing public health burden.Peer reviewe

Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

BACKGROUND: Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in low- and middle-income countries (LMICs) with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. METHODS: A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. RESULTS: Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1) administration and organization, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organizations, (6) laypeople and (7) infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. CONCLUSIONS: Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process

The Signal of Regard: William Godwin’s Correspondence Networks

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. The letter is a gift of attention, in which the writer seeks to communicate regard by means of a signal crafted uniquely for the recipient. The concept of regard, as developed by the economic historian Avner Offer, indicates both attention and approbation. Adam Smith took it to be the driver of human exchange in emotions as much as in commerce. The exchange of regard captures the logic of a prodigious correspondent like William Godwin. The personalization of the gift signal is an attempt to convey an obligation to reciprocate. Godwin was attuned to this obligation and worked hard to fulfil it—with varying degrees of success. His correspondents encompassed almost every significant literary and political figure on the political left from the era of the French Revolution to the 1832 Reform Act. The children of the Godwin household were nourished by bonds of reciprocity, which they developed and extended when, in adulthood, they dispersed across Europe. The letters of Godwin and his correspondents embody a larger conversation, allowing intimacy to be preserved at a distance. The signals they once created for each other may now be received by us