Ecological study of road traffic injuries in the eastern Mediterranean region: country economic level, road user category and gender perspectives

Background: The Eastern Mediterranean region has the second highest number of road traffic injury mortality rates after the African region based on 2013 data, with road traffic injuries accounting for 27% of the total injury mortality in the region. Globally the number of road traffic deaths has plateaued despite an increase in motorization, but it is uncertain whether this applies to the Region. This study investigated the regional trends in both road traffic injury mortality and morbidity and examined country-based differences considering on income level, categories of road users, and gender distribution. Methods: Register-based ecological study linking data from Global Burden of Disease Study with the United Nations Statistics Division for population and World Bank definition for country income level. Road traffic injury mortality rates and disability-adjusted life years were compiled for all ages at country level in 1995, 2005, 2015 and combined for a regional average (n = 22) and a global average (n = 122). The data were stratified by country economic level, road user category and gender. Results: Road traffic injury mortality rates in the Region were higher than the global average for all three reference years but suggest a downward trend. In 2015 mortality rates were more than twice as high in low and high income countries compared to global income averages and motor vehicle occupants had a 3-fold greater mortality than the global average. Severe injuries decreased by more than half for high/middle income countries but remained high for low income countries; three times higher for males than females. Conclusion: Despite a potential downward trend, inequalities in road traffic injury mortality and morbidity burden remain high in the Eastern Mediterranean region. Action needs to be intensified and targeted to implement and enforce safety measures that prevent and mitigate severe motor vehicle crashes in high income countries especially and invest in efforts to promote public, active transport for vulnerable road users in the resource poor countries of the Region.Institute for Social and Health Studies (ISHS

Enablers of psychosocial recovery in pediatric burns: perspectives from the children, parents and burn recovery support staff

Abstract Background Pediatric burn injuries are a major cause of death and injury, occurring mainly in resource poor environments. Recovery from burns is widely reported to be constrained by physical, psychological, relationship and reintegration challenges. These challenges have been widely described, but not the enablers of psychosocial recovery. This is especially true in pediatric burn research, with few multi- perspective studies on the recovery process. Methods This qualitative study involved 8 focus group discussions (four with 15 children post-burn injury, four with 15 caregivers) and 12 individual interviews with staff working in pediatric burns that explored the psychosocial needs of children after a burn and the enablers of their recovery. Purposive sampling was utilized and recruitment of all three categories of participants was done primarily through the only hospital burns unit in the Western Cape, South Africa. The interviews focused on factors that supported the child’s recovery and were sequentially facilitated from the child and the family’s experiences during hospitalization, to the return home to family and friends, followed by re-entry into school. Thematic analysis was used to analyze verbatim interview transcripts. Results The recovery enablers that emerged included: (i) Presence and reassurance; indicating the comfort and practical help provided by family and close friends in the hospital and throughout the recovery process; (ii) Normalizing interactions and acceptance; where children were treated the same as before the injury to promote the acceptance of self and by others especially once the child returned home; and (iii) Sensitization of others and protection; signifying how persons around the child had assisted the children to deal with issues in the reintegration process including the re-entry to school. Conclusions This study indicates that the psychosocial recovery process of children hospitalized for burns is enabled by the supportive relationships from family members, close friends and burn staff, present during hospitalization, the return home, and school re-entry. Support included comfort and physical presence of trusted others and emotional support; affirmation of the child’s identity and belonging despite appearance changes; and the advocacy and protection for the re-entry back into the school, and more generally the community

Neglected burden of injuries in Ethiopia, from 1990 to 2019: a systematic analysis of the global burden of diseases study 2019

BackgroundThe 2030 agenda for sustainable development goals has given injury prevention new attention, including halving road traffic injuries. This study compiled the best available evidence on injury from the global burden of diseases study for Ethiopia from 1990 to 2019.MethodsInjury data on incidence, prevalence, mortality, disability-adjusted life years lost, years lived with disability, and years of life lost were extracted from the 2019 global burden of diseases study for regions and chartered cities in Ethiopia from 1990 to 2019. Rates were estimated per 100,000 population.ResultsIn 2019, the age-standardized rate of incidence was 7,118 (95% UI: 6,621–7,678), prevalence was 21,735 (95% UI: 19,251–26,302), death was 72 (95% UI: 61–83), disability-adjusted life years lost was 3,265 (95% UI: 2,826–3,783), years of live lost was 2,417 (95% UI: 2,043–2,860), and years lived with disability was 848 [95% UI: (620–1,153)]. Since 1990, there has been a reduction in the age-standardized rate of incidence by 76% (95% UI: 74–78), death by 70% (95% UI: 65–75), and prevalence by 13% (95% UI: 3–18), with noticeable inter-regional variations. Transport injuries, conflict and terrorism, interpersonal violence, self-harm, falls, poisoning, and exposure to mechanical forces were the leading causes of injury-related deaths and long-term disabilities. Since 1990, there has been a decline in the prevalence of transport injuries by 32% (95% UI: 31–33), exposure to mechanical forces by 12% (95% UI: 10–14), and interpersonal violence by 7.4% (95% UI: 5–10). However, there was an increment in falls by 8.4% (95% UI: 7–11) and conflict and terrorism by 1.5% (95% UI: 38–27).ConclusionEven though the burden of injuries has steadily decreased at national and sub-national levels in Ethiopia over the past 30 years, it still remains to be an area of public health priority. Therefore, injury prevention and control strategies should consider regional disparities in the burden of injuries, promoting transportation safety, developing democratic culture and negotiation skills to solve disputes, using early security-interventions when conflict arises, ensuring workplace safety and improving psychological wellbeing of citizens

Exploring Social and Financial Hardship, Mental Health Problems and the Role of Social Support in Asylum Seekers Using Structural Equation Modelling

Asylum seekers are exposed to a range of social and financial difficulties suggested to adversely impact mental health. Uprooted social networks and living conditions during the asylum seeking process potentially predispose this population to low access to social support. The aim of this study was to examine the relationship between social and financial hardship and mental health problems, and assess the potential mediating role of social support among asylum seekers. Cross sectional survey data from a cohort of asylum seekers in Sweden (N = 455) were subjected to structural equation modelling for examining hypothesized pathways between social and financial hardship, common mental health problems (CMHPs) and social support. Fit indices showed adequate to excellent fit of the examined models with CMHPs as the outcome (all CFI ≥ 0.951, RMSEA < 0.05, SRMR < 0.056). CMHPs were positively regressed on social and financial hardship (B = 0.786, S = 0.102, p < 0.001) and negatively regressed on social support (B = −0.103, SE = 0.032, p = 0.001). Social support mediated the association between social and financial hardship and CMHPs (effect estimate = 0.075, 95% CI = 0.032–0.136). The results point to the importance of social and living conditions of asylum seekers and indicate that social support is both socially patterned and may act as a mitigating resource to inform interventions and policies

Post-Migration Stressors and Health-Related Quality of Life in Refugees from Syria Resettled in Sweden

The link between post-migration stressors and mental ill health is well documented in refugees resettled in high-income host countries, but the consequences of these stressors on refugees’ health-related quality of life (HRQoL) are less known. This study examined the association between post-migration stressors and HRQoL among Syrian adult refugees resettled in Sweden using a preference-based value set obtained from the general Swedish population. A total of 1215 Syrian adults, ages 18–64 years, granted residency in Sweden, responded to a postal questionnaire in 2016 regarding various aspects of their resettlement. The European Quality of Life Five Dimensions Five Level (EQ–5D–5L) questionnaire was used to assess HRQoL through an EQ–5D–5L index score (range; 0=dead to 1=full health). The index score was preference weighted using a Swedish population value set. Predictors were four self-reported post-migration stressors related to daily living in the host country: financial strain, social strain, competency strain and perceived discrimination divided into low, medium and high levels of experienced stress. Multivariable linear regression models were employed to assess the association between post-migration stressors and HRQoL index score, adjusting for potentially traumatic events in the pre- and peri-migration phase as well as sociodemographic confounders/covariates (sex, age, education, civil status, immigration year). The Syrian refugees had a mean EQ–5D–5L index score of 0.863 (SD = 0.145). There was strong evidence of a negative dose-response association in both unadjusted and adjusted models between HRQoL and the post-migration stressors financial strain and social strain—i.e., there was a stepwise, and statistically significant, decrease in HRQoL when going from low to medium to high strain. Competency strain and discrimination were only associated with lower HRQoL when experienced at high levels in fully adjusted models. High exposure to potentially traumatic experiences before or during flight was also associated with lower HRQoL. Syrian refugees resettled in Sweden reported a lower HRQoL than the general Swedish population and lower than age-matched Swedish adults. The present study results point to the possible adverse effects of post-migration stressors on HRQoL

The global burden of child burn injuries in light of country level economic development and income inequality

Child burn mortality differs widely between regions and is closely related to material deprivation, but reports on their global distribution are few. Investigating their country level distribution in light of economic level and income inequality will help assess the potential for macro-level improvements. We extracted data for child burn mortality from the Global Burden of Disease study 2013 and combined data into 1-14 years to calculate rates at country, region and income levels. We also compiled potential lives saved. Then we examined the relationship between country level gross domestic product per capita from the World Bank and income inequality (Gini Index) from the Standardized World Income Inequality Database and child burn mortality using Spearman coefficient correlations. Worldwide, the burden of child burn deaths is 2.5 per 100,000 across 103 countries with the largest burden in Sub Saharan Africa (4.5 per 100 000). Thirty-four thousand lives could be saved yearly if all countries in the world had the same rates as the best performing group of high-income countries; the majority in low-income countries. There was a negative graded association between economic level and child burns for all countries aggregated and at regional level, but no consistent pattern existed for income inequality at regional level. The burden of child burn mortality varies by region and income level with prevention efforts needed most urgently in middle-income countries and Sub-Saharan Africa. Investment in safe living conditions and access to medical care are paramount to achieving further reductions in the global burden of preventable child burn deaths.Institute for Social and Health Studies (ISHS

Are There Changes in Inequalities in Injuries? A Review of Evidence in the WHO European Region

Decreases in injury rates globally and in Europe in the past decades, although encouraging, may mask previously reported social inequalities between and within countries that persist or even increase. European research on this issue has not been systematically reviewed, which is the aim of this article. Between and within-country studies from the WHO European Region that investigate changes in social inequalities in injuries over time or in recent decades were sought in PubMed, Scopus, and Web of Science. Of the 27 studies retained, seven were cross-country and 20 were country-specific. Twelve reported changes in inequalities over time and the remaining 15 shed light on other aspects of inequalities. A substantial downward trend in injuries is reported for all causes and cause-specific ones—alongside persisting inequalities between countries and, in a majority of studies, within countries. Studies investigate diverse questions in different population groups. Depending on the social measure and injury outcome considered, many report inequalities in injuries albeit to a varying degree. Despite the downward trends in risk levels, relative social inequalities in injuries remain a persisting public health issue in the European Region

Exploring Social and Financial Hardship, Mental Health Problems and the Role of Social Support in Asylum Seekers Using Structural Equation Modelling

Asylum seekers are exposed to a range of social and financial difficulties suggested to adversely impact mental health. Uprooted social networks and living conditions during the asylum seeking process potentially predispose this population to low access to social support. The aim of this study was to examine the relationship between social and financial hardship and mental health problems, and assess the potential mediating role of social support among asylum seekers. Cross sectional survey data from a cohort of asylum seekers in Sweden (N = 455) were subjected to structural equation modelling for examining hypothesized pathways between social and financial hardship, common mental health problems (CMHPs) and social support. Fit indices showed adequate to excellent fit of the examined models with CMHPs as the outcome (all CFI ≥ 0.951, RMSEA < 0.05, SRMR < 0.056). CMHPs were positively regressed on social and financial hardship (B = 0.786, S = 0.102, p < 0.001) and negatively regressed on social support (B = -0.103, SE = 0.032, p = 0.001). Social support mediated the association between social and financial hardship and CMHPs (effect estimate = 0.075, 95% CI = 0.032-0.136). The results point to the importance of social and living conditions of asylum seekers and indicate that social support is both socially patterned and may act as a mitigating resource to inform interventions and policies

Utilisation of real-world data from heart failure registries in OECD countries - A systematic review

Background: Heart failure represents a major public health issue that impacts 26 million people globally. Currently, real-world data represents a key instrument for providing the verification of both internal and external validity, yet there is still a lack of understanding regarding its scope in complementing evidence of treatments for heart failure. This study aims to increase understanding of the utilisation of real-word data from heart failure registries in Organisation for Economic Co-operation and Development (OECD) countries. Method: This was a systematic review of existing observational studies from heart failure registries in 35 OECD member countries. Studies from 2000 to March 2017 were identified through electronic databases (MEDLINE (Ovid), EMBASE, Web of Science Core Collection, CINAHL (Ebsco), Cochrane CENTRAL) and appraised according to eligibility criteria. Results: Two-hundred and two studies met the inclusion criteria, in which the majority were published from 2013 to 2016. All 202 studies were observational, among which 98% were cohort studies (198). The median sample size of all studies was 5152 (2417 to 32,890) and median study period 55 months (33.0 to 72.0). Swedish heart failure registry had the most publications (24, 12%). Conclusion: Since 2000 there has been an upward trend in the number of published observational studies on heart failure registries in OECD countries with increasingly diverse outcomes and advanced statistical methods to improve their validity and reliability. This indicates that the utilisation of real-world data has experienced a significant upsurge in complementing the findings of clinical trials for improved research of heart failure treatments. Keywords: Systematic review, Heart failure, Registry, Real-world data, Observational study, OEC