-
The Cochrane Database of Systematic... Jan 2024Over 1.3 million people die each year as a result of traffic collisions and hundreds of thousands of others are permanently and seriously injured. Most of these deaths... (Review)
Review
BACKGROUND
Over 1.3 million people die each year as a result of traffic collisions and hundreds of thousands of others are permanently and seriously injured. Most of these deaths occur in low- and middle-income countries, where mortality rates can be up to 10 times higher than those of some high-income countries. Seat belts are designed to accomplish two key functions - to prevent the occupant from being ejected from the vehicle by the force of impact, and to extend the time that the decelerating force is applied to a person. Seat belts also spread the area of impact both to larger and less vulnerable parts of the body. Since the 1950s, seat belts have been factory-fitted to most vehicles, and today around 90% of high-income countries have adopted seat belt legislation that makes it mandatory for some, if not all, vehicle occupants to wear seat belts. However, the simple passing of laws is not sufficient to ensure seat belt use, and, while the enforcement of seat belt laws does increase seat belt use, other interventions have been developed to encourage voluntary - and hence sustainable - behaviour change.
OBJECTIVES
To evaluate the benefits of behavioural-change interventions (educational-based, incentive-based, engineering-based, or a combination, but not enforcement-based) that promote the use of seat belts, and to determine which types of interventions are most effective.
SEARCH METHODS
On 9 August 2022, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), OvidSP Embase, OvidSP MEDLINE, 14 other databases, and clinical trials registers. We also screened reference lists and conference proceedings, searched websites of relevant organisations, and contacted road safety experts. The search was performed with no restrictions in terms of language and date of publication.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), both individually randomised and cluster-randomised, that evaluated education, engineering, incentive-based interventions (or combinations) that promoted seat belt use.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the eligibility of RCTs, evaluated the risk of bias, and extracted data. We performed a narrative synthesis based on effect direction due to the heterogeneity observed between RCTs and reported the synthesis in accordance with reporting guidelines for systematic reviews without meta-analysis, as appropriate. We assessed the certainty of the evidence using the GRADE approach. We analysed data on the primary outcome, frequency of wearing a seat belt. None of the included RCTs reported the other primary outcome, crash-related injury rate or the secondary outcome, crash-related mortality rates of interest in this review.
MAIN RESULTS
We included 15 completed RCTs (12 individual, parallel-group, and three cluster) that enroled 12,081 participants, published between 1990 and 2022. Four trials were published between 2019 and 2022, and the remaining trials were published 10 or more years ago. We also identified four ongoing RCTs. Thirteen RCTs were conducted in the USA. Trials recruited participants from various sites (worksites, schools, emergency departments, a residential retirement community, and primary care settings) and different age groups (adults, late adolescents, early adolescents, and dyads). Thirteen trials investigated educational interventions, one of which used education in addition to incentives (one of the intervention arms) measured through participant self-reports (12) and observation (one), and two trials investigated engineering-based interventions measured through in-vehicle data monitor systems at various follow-up periods (six weeks to 36 months). We grouped RCTs according to types of education-based interventions: behavioural education-based, health risk appraisal (HRA), and other education-based interventions. The evidence suggests that behavioural education-based (four trials) interventions may promote seat belt use and HRA interventions (one trial) likely promote seat belt use in the short term (six weeks to nine months). Four of the six trials that investigated behavioural education-based interventions found that the intervention compared to no or another intervention may promote seat belt use. These effects were measured through participant self-report and at various time points (six-week to 12-month follow-up) (low-certainty evidence). One of the three trials investigating HRA only or with additional intervention versus no or another intervention showed observed effects likely to promote seat belt use (moderate-certainty evidence). The evidence suggests that engineering-based interventions using vehicle monitoring systems (with in-vehicle alerts and with or without notifications/feedback) may promote the use of seat belts. One trial showed that engineering interventions (in-vehicle alerts and feedback) may promote seat belt use while the other showed unclear effects in two of the three intervention groups (low-certainty evidence). Both trials had small sample sizes and high baseline seat belt use.
AUTHORS' CONCLUSIONS
The evidence suggests that behavioural education-based interventions may promote seat belt use and HRA (including incentives) with or without additional interventions likely promote seat belt use. Likewise, for engineering-based interventions using in-vehicle data monitor systems with in-vehicle alerts, with or without notifications/feedback the evidence suggests the interventions may promote the use of seat belts. Well-designed RCTs are needed to further investigate the effectiveness of education and engineering-based interventions. High-quality trials that examine the potential benefits of incentives to promote seat belt use, either alone or in combination with other interventions, as well as trials to investigate other types of interventions (such as technology, media/publicity, enforcement, insurance schemes, employer programmes, etc.) to promote the use of seat belts, are needed. Evidence from low- and middle-income economies is required to improve the generalisability of the data. In addition, research focused on determining which interventions or types of interventions are most effective in different population groups is needed.
Topics: Adolescent; Adult; Humans; Accidents, Traffic; Motivation; Schools; Seat Belts
PubMed: 38197528
DOI: 10.1002/14651858.CD011218.pub2 -
Current Nutrition Reports Mar 2024Falls are a major global public health issue and the second cause of unintentional injury death. Nutrition may be an important factor for falls prevention in adults, but... (Review)
Review
PURPOSE OF REVIEW
Falls are a major global public health issue and the second cause of unintentional injury death. Nutrition may be an important factor for falls prevention in adults, but most previous studies examined the associations between single nutrients and falls. The use of dietary patterns is an alternative method to measure whole diet and its relationship with health outcomes. Therefore, we aimed to systematically review all evidence relating to dietary pattern impacts on falls and/or falls risk in adults.
RECENT FINDINGS
This systematic review was registered on the PROSPERO (CRD42020171987). Four databases (Medline, Embase, Cochrane Library, CINAHL Complete) were used for searching potential articles on 18th December 2021 and updated the search on 10th July 2023. We included any quantitative study reporting associations between dietary patterns and falls and/or falls risk in healthy adults ≥ 18 years and publishing in English as full text and peer-reviewed. Of 2866 potential articles, five studies (two cross-sectional, three cohorts) were included for the evidence synthesis. The risk of bias was low in cohort studies. Dietary patterns were derived using both "a priori" or "empirical" approaches, and self-report questionnaires used for falls/falls risk in most studies. Associations between dietary patterns and falls/falls risk were inconsistent results by sex and study design. The effect of dietary patterns on reducing falls/falls risk is not clear in the included studies, so this association needs to be confirmed in future research.
Topics: Adult; Humans; Dietary Patterns; Cross-Sectional Studies; Diet; Accidental Falls; Research Design
PubMed: 38194079
DOI: 10.1007/s13668-023-00516-6 -
PLoS Neglected Tropical Diseases Jan 2024Currently, vaccination of livestock with attenuated strains of Brucella remains an essential measure for controlling brucellosis, although these vaccines may be...
BACKGROUND
Currently, vaccination of livestock with attenuated strains of Brucella remains an essential measure for controlling brucellosis, although these vaccines may be dangerous to humans. The aim of this study was to review the risk posed to humans by occupational exposure to vaccine strains and the measures that should be implemented to minimize this risk.
METHODS
This article reviewed the scientific literature indexed in PubMed up to September 30, 2023, following "the PRISMA guidelines". Special emphasis was placed on the vaccine strain used and the route of exposure. Non-occupational exposure to vaccine strains, intentional human inoculation, publications on exposure to wild strains, and secondary scientific sources were excluded from the study.
RESULTS
Nineteen primary reports were found and classified in three subgroups: safety accidents in vaccine factories that led to an outbreak (n = 2), survellaince studies on vaccine manufacturing workers with a serologic diagnosis of Brucella infection (n = 3), and publications of infection by vaccine strains during their administration, including case reports, records of occupational accidents and investigations of outbreaks in vaccination campaigns (n = 14). Although accidental exposure during vaccine manufacturing were uncommon, they could provoke large outbreaks through airborne spread with risk of spread to the neighboring population. Besides, despite strict protection measures, a percentage of vaccine manufacturing workers developed positive Brucella serology without clinical infection. The most frequent type of exposure with symptomatic infection was needle injury during vaccine administration. Prolonged contact with the pathogen, lack of information and a low adherence to personal protective equipment (PPE) use in the work environment were commonly associated with infection.
CONCLUSIONS
Brucella vaccines pose occupational risk of contagion to humans from their production to their administration to livestock, although morbidity is low and deaths were not reported. Recommended protective measures and active surveillance of exposed workers appeared to reduce this risk. It would be advisable to carry out observational studies and/or systematic registries using solid diagnostic criteria.
Topics: Animals; Humans; Brucella Vaccine; Brucellosis; Brucella; Vaccination; Occupational Exposure; Livestock; Vaccines, Attenuated
PubMed: 38190394
DOI: 10.1371/journal.pntd.0011889 -
Cureus Nov 2023Opioid-related fatalities are a leading cause of accidental death in the United States. Appendicitis is a common cause of abdominal pain in children and adolescents. The... (Review)
Review
Opioid-related fatalities are a leading cause of accidental death in the United States. Appendicitis is a common cause of abdominal pain in children and adolescents. The management of pain throughout the laparoscopic appendectomy (LA) in the pediatric population is a critical concern. This study aimed to evaluate trends in analgesic use and patient satisfaction following LA, with a focus on reducing the reliance on opioids for pain management. From 2003 to 2023, 18258 articles were filtered for all types of analgesic use with LA. The publications were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 19 studies were included for analysis and review. The study included peer-reviewed experimental and observational studies involving individuals under 18 years. Pain management strategies varied across studies, involving a combination of analgesics, nerve blocks, and wound infiltrations. Analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids were administered before and after surgery. Some studies implemented patient-controlled analgesia (PCA) pumps. Other studies explored non-pharmacological interventions like magnetic acupuncture. The results showed a reduction in the need for postoperative analgesics in patients treated with LA, particularly when using non-opioid medications and novel analgesic techniques. Pediatric patients who received gabapentin reported lower opioid use, shorter hospital stays, and high satisfaction rates. However, the reliance on opioids remained significant in some cases, particularly among patients with peritonitis who required more morphine. Pain management in pediatric patients is multifaceted, involving preoperative and postoperative analgesics, nerve blocks, and PCA pumps. Efforts to improve pain management following pediatric LA while reducing opioid reliance are essential in the context of the ongoing opioid epidemic. The findings from this study highlight the potential benefits of non-opioid analgesics, nerve blocks, and alternative methods for managing postoperative pain in <18 appendectomy patients. Further research and standardization of pain management protocols are needed to ensure optimal patient outcomes and minimize the risk of opioid-related complications.
PubMed: 38156159
DOI: 10.7759/cureus.49581 -
Iranian Journal of Public Health Sep 2023Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of... (Review)
Review
BACKGROUND
Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of TBI can be helpful for policy making in health care management. Therefore, this study aimed to examine the epidemiology of TBI in Iran.
METHODS
PubMed, Web of Science, Scopus, Google scholar, and internal databases including, SID, Magiran, and IranMedex were searched to identify the relevant published studies up to Feb 2022. Moreover, the references list of key studies was scanned to find more records. The Joanna Briggs Institute (JBI) tool was used to assess the quality of included studies. The Excel and Comprehensive Meta-Analysis software were to analyze the data.
RESULTS
Overall, 23,446 patients from 15 studies were included in the study. The overall mean age of the patients was 31.36 ± 0.13 yr (95%CI: 31.10 to 31.61). The majority of the patients were male (74.37%), with a male to female ratio of 3:1. The incidence rate of TBI was 15.3 to 144 per 100,000 population. The mortality rate of TBI was estimated to be 10.4% (95%CI: 5% to 19%). The most common causes of injury were road traffic accidents (RTAs) (60%; 95%CI: 49% to 70%), and falling (20%; 95%CI: 16% to 26%), respectively. The most frequent type of head injury was subdural hematoma.
CONCLUSION
Our findings highlight that appropriate control and prevention strategies should be focused on male, road traffic accidents, and the group under 40 yr.
PubMed: 38033848
DOI: 10.18502/ijph.v52i9.13565 -
International Journal of Injury Control... Jun 2024Road traffic injuries (RTIs) are a significant cause of death and disability among young people worldwide. Programs that use injury prevention strategies have been shown... (Review)
Review
Road traffic injuries (RTIs) are a significant cause of death and disability among young people worldwide. Programs that use injury prevention strategies have been shown to effectively reduce the number of injuries. This systematic review aims to present the available evidence on the effectiveness of intervention programs in preventing RTIs among adolescents and young adults. Articles were identified and retrieved from databases including PubMed, Embase, Web of Science, Scopus, Science Direct, Magiran, SID, and Iran Medex. Two reviewers independently screened the articles. Articles published from the first year of publication until January 2018 that met the eligibility criteria were included in the review. These articles covered randomized controlled trials, pretest/post-test interventions, and controlled pretest/post-test interventions aimed at reducing RTIs among adolescents and young people aged 12-26 years. The framework, provided by Murphy and Haddon, were used to categorize the interventions. According to this framework, the interventions were categorized into five groups including education/behavior change, incentive, engineering/technology, legislation/enforcement, and multifaceted programs. The methodological quality of the studies was assessed using the Effective Public Health Practice Project. Of the initial 3165 findings, 13 studies met the inclusion criteria. Eleven of these studies used educational/behavioral approaches, while two employed multifaceted programs. In the educational/behavioral approach, participants' behaviors were considered as outcome variables. Only one of these studies was not successful. Multifaceted interventions were successful in changing behaviors. No studies were found on the effectiveness of other interventions. Eight studies were assessed as having moderate quality. The systematic review shows that educational/behavioral strategies and multifaceted programs are effective in reducing RTIs among young adults and adolescents. However, there is a lack of studies on other potential interventions. The quality of the included studies was moderate, suggesting a need for more rigorous research.
Topics: Humans; Adolescent; Accidents, Traffic; Wounds and Injuries; Young Adult; Program Evaluation
PubMed: 38015239
DOI: 10.1080/17457300.2023.2286639 -
Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review.Indian Journal of Community Medicine :... 2023Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood... (Review)
Review
Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children.
PubMed: 37970167
DOI: 10.4103/ijcm.ijcm_887_22 -
Transplantation Proceedings Dec 2023Yellow phosphorus or metal phosphide (YP-MP) rodenticide poisoning has been a known cause of acute liver failure (ALF) in many countries of Asia and North and South...
Yellow phosphorus or metal phosphide (YP-MP) rodenticide poisoning has been a known cause of acute liver failure (ALF) in many countries of Asia and North and South America over the last decade. It is a highly toxic compound and is a well-known cause of intentional or accidental poisoning in both adults and children. In lower doses, it causes gastrointestinal symptoms and mild hepatic injury, and patients may spontaneously recover. In higher doses, hepatic necrosis and fatty infiltration may cause significant injury and may even lead to ALF, characterized by hepatic encephalopathy, coagulopathy, and lactic acidosis. Cardiotoxicity, rhabdomyolysis, and neutropenia are other well-documented complications. If untreated, it may lead to multi-organ dysfunction and death. Plasmapheresis and continuous renal replacement therapy (CRRT) have been used with limited success in patients who do not recover spontaneously. However, patients who develop ALF often need liver transplantation (LT). Liver transplantation has been successfully performed in ALF due to YP-MP poisoning in several countries, with good results in both adult and pediatric patients. Separate criteria for LT are important to ensure early and rapid listing of critical patients on the waiting list. The success rates of LT for ALF due to YP-MP rodenticide poisoning are very promising, provided there are no contra-indications to transplant. Plasma exchange, CRRT, or cytosorb can be used as a bridge to transplant in selected patients. In the long term, only with an increase in public awareness and sale restrictions can we prevent the intentional and accidental poisoning caused by this easily available, highly toxic compound.
Topics: Adult; Child; Humans; Hepatic Encephalopathy; Liver Failure, Acute; Liver Transplantation; Phosphorus; Rodenticides
PubMed: 37880024
DOI: 10.1016/j.transproceed.2023.09.028 -
Health Promotion International Oct 2023Little is known about unintentional drowning deaths in Indonesia, the world's fourth most populous and largest archipelagic country. This study aimed to describe the... (Review)
Review
Little is known about unintentional drowning deaths in Indonesia, the world's fourth most populous and largest archipelagic country. This study aimed to describe the epidemiology and risk factors of unintentional drowning in Indonesia and explore existing health promotion and drowning prevention approaches in Indonesia within a socio-ecological health promotion framework. A scoping review, guided by PRISMA-ScR, was conducted to locate peer-reviewed studies and government reports/policy documents published until May 2023, in English or Indonesian language, using MEDLINE (Ovid), CINAHL, Informit, PsycINFO (ProQuest), Scopus, SafetyLit, BioMed Central and Google Scholar, Indonesian journal databases (Sinta, Garuda) and government agencies websites around the terms: drown, swim, flood, hurricane, cyclone, disaster, water rescue and maritime/boat safety. This review identified 32 papers. However, a paucity of information on unintentional drowning rates, risk factors and prevention in Indonesia was noted. The unavailability of a coordinated national drowning data collection system in Indonesia, from which national and subnational subcategory data can be collected, underlines the possibility of under-representation of drowning mortality. The association between various exposures and drowning incidents has not been fully investigated. An over-reliance on individual-focused, behaviour-based, preventive measures was observed. These findings highlight the need for improving drowning surveillance to ensure the availability and reliability of drowning data; and strengthening research to understand the risk factors for drowning and delivery of drowning prevention programs. Further policy development and research focusing on health promotion approaches that reflect a socio-ecological approach to drowning prevention in Indonesia is imperative.
Topics: Humans; Drowning; Indonesia; Reproducibility of Results; Risk Factors; Health Promotion
PubMed: 37851464
DOI: 10.1093/heapro/daad130 -
Journal of Forensic and Legal Medicine Oct 2023Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature... (Meta-Analysis)
Meta-Analysis Review
Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature of post-mortem findings obtained through classical autopsy methods. Our manuscript addresses this issue by focusing on the emerging use of paranasal sinus fluid as a valuable tool in determining the cause of death, specifically in distinguishing drowning from non-drowning cases. The study provided a comprehensive summary of available evidence from observational studies that compared findings in the paranasal sinuses between drowning and non-drowning victims, analyzing parameters such as the presence of fluid, fluid volume, and density. The study encompassed a total of 14 selected studies involving 1044 subjects and utilized rigorous risk of bias assessment and data synthesis techniques. The meta-analysis demonstrated a strong association between the presence of fluid in the paranasal sinuses and drowning (OR = 17.1; 95% CI 7.2 to 40.5; p < 0.001). In addition, drowning victims had a significantly greater volume of fluid (SMD = 0.8; 95% CI 0.5 to 1.2; p < 0.001) and lower fluid density (SMD = -1.4; 95% -2.5 to -0.4; p = 0.008) compared to non-drowning cases. The results support the utility of paranasal sinus fluid analysis as a valuable diagnostic method in cases where drowning is suspected but cannot be definitively confirmed through traditional approaches.
Topics: Humans; Drowning; Cause of Death; Tomography, X-Ray Computed; Paranasal Sinuses; Autopsy
PubMed: 37717366
DOI: 10.1016/j.jflm.2023.102591