bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a standardised evaluation grid for trauma center accreditation process
Authors: Lavoie A , Moore L , Murat V , Bamvita J M , Lapointe J , Bourgeois G 
Published: March 2011

Regionalised and integrated trauma systems are effective in reducing mortality. Following initial designation of 59 trauma centres in the province of Quebec, Canada, each centre was evaluated in situ twice over a period of 10 years by an external panel of experts according to American College of Surgeons criteria.ProblemReports do not reflect a systematic approach as they are focusing on major strengths and flaws. This hinders their usefulness in measuring performance.ObjectiveTest the reliability and validity of a standardised evaluation grid.MethodsA retrospective review of 115 accreditation reports (three were missing) on 59 designated trauma centres was performed. A systematic grid containing 84 elements grouped under three themes (commitment, program and procedures) was applied to all reports by a single reviewer to calculate performance scores. Two analyses were performed: (1) a random sample of 12 reports was duplicated to measure intra-rater agreement, and (2) content validity was assessed by comparing median scores of the 115 reports by accreditation results (accreditation positive, revisit required and designation postponement).ResultsThe scoring system demonstrated excellent intra-rater agreement as 76 of the 84 elements showed strong or close to perfect agreement (weighted κ>0.60). Median scores decreased significantly when a revisit was requested or postponement of accreditation occurred (Spearman's rho=–0.71, p<0.0001).ConclusionA more systematic approach is required for trauma centre accreditation site visits. An evaluation grid may help by providing a more reliable and valid assessment of their performance.
Key factors associated with the high burden of injuries in the Canadian forces
Authors: Payne E 
Published: March 2011

BackgroundMilitary populations are particularly vulnerable to injury due the nature of their work and the required levels of physical training. The Canadian Forces Health and Lifestyle Information Survey (HLIS) is a regularly conducted population health survey on health status, risk factors and demographics from a stratified random sample of Canadian Forces (CF) personnel. The 2008/9 HLIS indicated that in the preceding year 23% of Canadian Forces (CF) personnel had sustained an activity limiting repetitive strain injury (RSI) and 21% an activity limiting acute injury. Among CF personnel unable to deploy, 32% identified musculoskeletal injury as the reason.MethodsHLIS sampling methods are described in detail elsewhere. The 2008/2009 version of the HLIS included more detailed questions about risk taking behaviours, specific types of physical training activities, and reasons CF members were unable to deploy for active duty. There were three separate outcomes of interest, acute injury, RSI and deployment prohibitive musculoskeletal injury. Multivariate logistic regression models were developed to investigate which injury risk factors remained significant when adjusted for other parameters in the model.FindingsBivariate analysis identified several military and physical training variables significantly associated with acute, RSI and deployment prohibitive injuries. Multivariate logistic regression revealed more complex relationships; the association between training and injury was mediated by the inclusion of lifestyle and demographic variables in the models. This exploratory approach provides a more comprehensive description of injuries leading to more effective surveillance and prevention planning in the CF.
Fatal road traffic injuries at age 16–20 years among 611 654 persons born in Norway 1967–1976: multilevel cohort study
Authors: Kristensen P , Kristiansen T , Rehn M , Gravseth H Magne , Bjerkedal T 
Published: March 2011

BackgroundRoad traffic injury is a major cause of death in adolescence. The study objective was to investigate influences of individual and area factors on fatal injuries among motor vehicle occupants, 16–20 years old.MethodsAll persons born in 1967–1976 in Norway were followed up in several national registries. Associations were analysed in multilevel Poisson regression.ResultsRoad traffic deaths (N=676) constituted a major cause of death, 621 (rate 20.4 per 100 000) were motor vehicle occupants. Boys had higher mortality than girls (adjusted rate ratio (RR) 3.34, 95% CI 2.79 to 4.01). Risk patterns of motor vehicle occupant deaths after non-collision crashes due to loss of control on the road (N=316) and collision crashes showed distinctive differences. Most striking was a strong gradient according to parental education level for boys in the non-collision category (adjusted population preventive fraction 0.83, CI 0.48 to 0.95). A similar gradient was not evident for girls or for collision crashes. Non-collision deaths were associated with residence in less central municipalities (RR 1.61, CI 1.17 to 2.20). Collision deaths were negatively associated with degree of municipal road illumination (RR of 1SD increase 0.66, CI 0.54 to 0.81).ConclusionsHigh mortality among male occupants and the strong socioeconomic gradient in non-collision crashes are alarming. High risk prevention strategies are worth considering. Municipal characteristics of concern were identified but had modest independent impact.
Sexual violence against children and adolescents: importance of interview medical-legal
Authors: de Souza S L Barbosa , e Silva M C Maia 
Published: March 2011

IntroductionSexual violence against children and adolescents, due to their physical, emotional, cognitive and social, has become recognised in recent decades as a public health problem. However, its diagnosis is considered a difficult task, because not always the physical signs of their occurrence are evident. The forensic interview is a feature whereby the personal history and clinical and behavioural changes of the victim are valued in the entire peer review, assisting in the elucidation of cases in which no physical evidence found.ObjectiveThis study investigated the interview forensic as an additional tool to physical examination expert in identifying sexual violence against children and adolescents at Institute of Forensic Medicine, Recife.MethodExploratory, descriptive study conducted from November 2008 to March 2009. Were interviewed 22 forensics doctors, using a questionnaire to investigate clinical and legal aspects of the sexological exam of children and adolescents.ResultsThe analysis revealed that 100% of medical examiners conduct interviews with victims, based on clinical experience gained in working life, without using a specific protocol for management of children and adolescents.ConclusionThe absence of an interview protocol for medico-legal approach to child and adolescent victims of sexual violence is reflected in the reports of the sexological examination, which prioritise the physical evidence rather than behavioural change, recognised in the scientific literature as related consequences sexual violence. It is necessary to investigate and propose procedures and routines for the care of victims, their families and early intervention programs.
Burden and factors associated with work-zone crashes on an interurban highway in Pakistan
Authors: Bhatti J A , Razzak J A , Lagarde E , Salmi L 
Published: March 2011

IntroductionHighway work zones (HWZ) may lead to an increased road traffic crash (RTC) risk. Little is known about such crashes in low-income countries (LICs).ObjectiveTo assess burden and factors associated with HWZ crashes on a highway in Pakistan.MethodsPolice reported crashes occurring on Karachi-Hala road-section from Jan 2006 to Dec 2008 were included in this study. We compared crash and death risk between work and normal traffic zones for a 50-km-long road-section for which data was available on work zone dates and average daily traffic. Crash locations were described for a further 146-km-long section on which we assessed factors associated with HWZ crashes.ResultsOf 180 crashes, 27 (15%) occurred in HWZs accounting for 30.8% of road fatalities (N=91). HWZ exposition was one-sixth of the whole traffic exposition on the selected road section. Rates were higher in HWZ compared to other parts of the road for crash (RR)=2.28, (95% CI 1.14 to 4.56), attributable risk (AR)=18.5%) and death (RR=4.56, 95% CI 2.05 to 10.16, AR=39.0%). Opposite-direction (adjusted OR (aOR)=8.01, 95% CI 2.34 to 27.68) and RTCs on wet surfaces (aOR=10.43, 95% CI 1.38 to 79.15) were significantly associated with HWZ crashes.ConclusionThese results indicate that traffic separation in work-zones should be prioritised to reduce the increased burden of crashes in LICs.
Road hazard perception of high risk sites in voluntary Pakistani drivers
Authors: Bhatti J A , Razzak J A , Lagarde E , Salmi L 
Published: March 2011

IntroductionRoad traffic crashes (RTCs) tend to concentrate on certain road sites. Our hypothesis is that these sites are not perceived as dangerous by drivers.ObjectiveTo compare the hazard perception of sites involved in RTCs to those not involved in RTCs.MethodsStudy settings were two interurban road-sections. Cases were sites involved in at least three police reported RTCs over 3 years. Matched control sites of same length were randomly selected on the same road. Video films of 26 case and 26 control sites were shown to 100 randomly chosen voluntary Pakistani drivers. Participants reported their perceived road hazardousness on a Likert scale (1 certainly safe to 4 certainly dangerous) and preferred speed. Ability to discriminate cases and controls was assessed by area under receiver operating curve (AUC). The inter-observer reliability among driver ratings was assessed by intra-class correlation coefficient (ICC).ResultsOn average, participants rated 19.9% of case and 10.2% of control sites as certainly dangerous. They rated 36.8% of case and 47.5% of control sites as certainly safe. Out of 100 participants, nine were able to discriminate between high risk and control sites (0.66 ≤ AUC ≤ 0.71; p≤0.04). A high agreement among drivers was observed for ranking all sites (ICC=0.98; 95% CI 0.97 to 0.99).ConclusionResults were compatible with our hypothesis. Further work will focus on evaluating factors associated with the level of discrimination to orient preventive measures in resource limited settings.
Trend analysis of drug-related motor vehicle crashes in the United States
Authors: Zhu M , Zhao S , Rice T M , Coben J H 
Published: March 2011

ObjectiveDrugs other than alcohol contributed to 17% of 19 220 driver fatalities in the USA in 2008. The specific drugs involved in these cases, and changes in their use over time, have not been previously reported. We examined trends of drug use by drivers in fatal crashes from 1999 through 2008.MethodsWe analysed the Fatality Analysis Reporting System, which contains information on all fatal traffic crashes occurring on public roads in the United States. The following drug categories and specific drugs were identified using the first listed drug: narcotics (hydrocodone/oxycodone, methadone, heroin, morphine), depressants (benzodiazepines, barbiturates), stimulants (cocaine, amphetamines, methamphetamine) and cannabis. Negative binomial regression was used to examine the rate of driver fatal crash involvement.ResultsThe overall drug-related fatal crash rate increased from 1.28 per 100 000 in 1999 to 1.88 per 100 000 in 2008, an average annual increase of 3.9%. The most rapid increases were seen with hydrocodone/oxycodone (17.7% per year, 95% CI 14.4% to 21.0%) and methadone (17.4% per year, 95% CI 13.1% to 21.9%). Annual increases were also found with benzodiazepines (5.0%, 95% CI 3.5% to 6.2%), cocaine (2.5%, 95% CI 0.5% to 4.5%), cannabis (5.1%, 95% CI 4.0% to 6.1%). Heroin, morphine, amphetamines, or methamphetamines were not associated with significant trends. Barbiturates were found to decrease an average of 5.7% per year (95% CI to 2.6% to 8.7%).ConclusionsThis study found notable increases in drug use by drivers involved in fatal collisions. Substances with the significant increases included prescription drugs (hydrocodone/oxycodone, methadone, benzodiazepines) and cannabis.
The unwritten organisational rules of engagement
Authors: Furst P G 
Published: March 2011

Henri Feyol proposed fundamental precepts of management, since then many different theories & interventions have been tried to improve results but with mixed outcomes. The question is what is it that occurs within our organisations that creates barriers to achieving stellar results?If you think about it, in every realm of our lives there are rules of engagement. These rules apply at work, in our social as well as family life. If we further think about it, these rules come in two varieties, a written & an unwritten form. The written rules are how we are supposed to act & the unwritten ones are the way we actually do act. These unwritten rules help employees cope & successfully function within complex organisations. Unwritten rules tend to have side effects some of which are undesirable (accidents & losses).The undesirable side effects result from the interaction of the written rules, managements actions & behaviours as well as the employees reaction to them. In understanding this fundamental process one is able to identify the organisational drivers of accidents & losses. This understanding allows for the modification of systems, processes & procedures that affect, structural changes that permanently eliminate the core drivers of loss, & enhance the company's bottom line.Attendees will be able to take away an outline of how to link the undesirable side effects to some of the inputs and thereby achieve a tailored, integrated, multi-strategy initiative that will result in a high performance safety management system, resulting in lower losses & improved profitability.
Traffic regulation learning course for guilty drivers: the future safety drivers
Authors: Amornpetchsathaporn A 
Published: March 2011

BackgroundIn Thailand; road traffic accident is one of the most important causes of injuries and deaths. Its easy to get diver license without driving skill and knowledge and there are small number of driver teaching schools, most of drivers learnt and gained experience from daily driving. Nakhonsawan provincial committee of road traffic accident prevention introduced a pilot project of learning course for new guilty drivers in every district since September 2009.The purpose is to teach drivers of knowledge and skill of safety driving and to decrease the number of injuries and deaths from road traffic accident.MethodNakhonsawan policemen set a law-enforcement check point units at main streets and law-enforcement patrol unit in municipal area day and night time. Drivers must be inspected and were given a ticket for illegal driving, if it was not drunken driving and the first time they could choose to pay or come to take a 2 h of traffic regulation learning course which was organised every Wednesday at district police stations in 1 week.ResultThe 520 out of 19 791 guilty drivers; 2.63% only came to take the course in the first 3 month of these project. Most of them were satisfied and felt of getting more confidence in safety driving.DiscussionThe majority of guilty drivers chose to pay because they were busy and didn't have time to return to police station, they should be advised and conducted to the course with more incentive.
Operation Headway: a multifaceted bike helmet promotion program
Authors: Lockhart S , Fenerty L , Walling S 
Published: March 2011

Operation Headway is a multi-partner program that combines enforcement of bike helmet legislation, education, rewards for wearing and economic penalty for non-wearing, that takes place in two Canadian provinces. The program also offers helmets for those who can't afford them. Partners include police, government (Health/Health Promotion, Emergency Services and Transportation) and non-government organisations – particularly injury prevention, brain injury and cycling organisations. The program has demonstrated positive results regarding increased helmet wearing and increased knowledge and awareness. The program is now being considered for national distribution by ThinkFirst Canada, one of the partners.Program goalTo reduce bike related head injuries by increasing bike helmet use among all age groups.Objectives▶Increase awareness of provincial bike helmet legislation▶Increase compliance with helmet legislation▶Increase awareness of bike-related head injuriesStrategies▶Reward people wearing helmets when cycling▶Ticket those not wearing helmets when cycling▶Offer a ‘diversion program’: instead of paying the fine or going to court, offenders were offered a 2 h education program, delivered by health professionals and injury survivors, after which the ticket was voided.▶Conduct a media campaignResults▶Increased wearing rates (pre and post intervention observations)▶Increased knowledge and commitment to wear a helmet (education session evaluation)▶Increased public awareness of the law and the effectiveness of helmets (media tracking)▶Increased positive relationship between police officers and the public, particularly children (anecdotal).
Nineteen years of prevention policies: the impact of the targets on non intentional injuries established in the health plan for Catalonia
Authors: Martinez-Beneyto V , Suelves J M , Brugulat P , Tresserras R , Plasencia A , Medina A , Cabezas C 
Published: March 2011

ContextIn 1991, the Department of Health of the Government of Catalonia (autonomous region in Spain, population 7.3 million), following the recommendations of the WHO European Regional Office, started an innovative health planning scheme, with well established health and risk reduction targets for two main periods, 1991–2000 and 2001–2010. In Catalonia, as in other European countries, injuries produced by non intentional causes are one of the main public health problems, account for a substantial proportion of morbidity and avoidable mortality.ObjectivesTo analyse the evolution of the selected indicators in order to evaluate the impact of the policies implemented and assess the targets of the periodical Health Plans on injury prevention and control in Catalonia.Methods and productsTo present the main strategies on injury prevention and control, the elements of the 12 health and risk reduction targets, with the quantification of their indicators, previously established. It shows, also, the 47 operative targets developed during the five periods of the Health Plan. The values of the indicators used to know the evolution and the attainment of each formulated target are detailed by tables and figures.DiscussionDuring a wide planning period, interventions developed have contributed to the attainment of the health targets on non intentional injuries, measured and assessed. The trends of mortality and morbidity due to non intentional injuries evolved positively during this period. The four targets established for the year 2000 were achieved, and five of the eight targets for 2010 evolves positively.
Lean Six Sigma innovative safety performance management
Authors: Furst P G 
Published: March 2011

Six Sigma is a widely used data driven, quality improvement process. Manufacturing uses a discipline called Lean to focus on process speed & efficiency. Lean Six Sigma combines the best of these two processes. It combines the use of data to drive improvement as well as streamlining internal processes & procedures to maximise efficiency. Lean six sigma has another major advantage, it provides management data driven information to effectively manage the ES&H aspect of the business. This information can be used to set achievable as well as realistic goal & objectives, measure progress towards these goals, develop talent, & effectively drive organisational behaviour.The foundation of Lean Six Sigma is facts, data & information. The three key elements of Lean Six Sigma are customer focus, internal processes & the organisations staff. Each element is supported by two pillars. The customer focus element has speed & quality internal processes element has flow & variation control, &the people element has teamwork & learning as its pillars. This results in 360° integration & alignment.One needs the creativity of the people, working on the internal processes with data & understanding to create solutions that will delight the customer by meeting and exceeding its expectations.Applying Lean Six Sigma thinking to safety has tremendous possibility & potential. It can become a framework to drive safety performance by seamlessly integrating safety procedures into internal processes, using 360° relevant information to create integrates solutions that meet the needs of all the stakeholders while meeting or exceeding both the organisational goals & customer expectations.
Demography of patients presenting to the provincial Otorhinolaryngology unit following assault over Head and neck in North Central Sri Lanka
Authors: Zaffarullah M W , Karunaratne H M A H 
Published: March 2011

The purpose of the study was to describe the injury pattern of assault over head and neck and to identify the factors associated with those assaults. Prospective Study on 144 patients presenting to ENT ward following assault over Head and neck for a period of 5 months. Data collected using interviewer administered questionnaires, clinical examination and investigation findings. The mean age of the victims was 29.25 years and 63.9 % were males. The commonest area that was assaulted were ears (80.6%), followed by nose (22%), scalp (11%), cheeks (8.3%), eyes (5.6%), neck (5.6%) 83.3% of victims were assaulted with hand, 16.7% with a blunt object and 2.8% with a sharp object. 94.4 % of the assailants were males, 94.4 % were known to the victim, 86.1% were single assailants and 60% were under the influence of alcohol. Personal disputes were the cause in 47.2% of assaults, followed by Domestic violence (25%) and occupation related assaults (25%). 30.6% of the study population refused any legal action against the assailants. 22.2% f the victims had history of previous assaults.ConclusionAssailants had male preponderance and were known to victim in most cases. Ears were the most affected. Major cause for assault was personal disputes. Closer liaison with police, social services and general practitioners will help prevent further attacks.