A systematic review of the evidence for effectiveness of interventions to address transport and other unintentional injuries among adolescents

Farm Injury and Safety Practices Among Rural Adolescents: A Qualitative Analysis to Support the Development of a Gamified Educational Resource

OBJECTIVES

Little is known about adolescent experiences of injury and adoption of safe or unsafe practices on farms, despite adolescents being at-risk of fatal and non-fatal injuries in the farm setting. To enhance understanding and inform the co-design of farm safety educational materials for teens, we aimed to explore farm injury experiences, safety practices, and educational preferences for secondary school students and their teachers.

METHODS

Nine focus groups of mixed gender students (year 7 and 8) and five one-on-one teacher interviews were conducted at three high schools teaching agriculture in rural Australia, across the states of New South Wales and Tasmania. Inductive thematic analysis of session transcripts was undertaken.

RESULTS

Five overarching themes emerged: "safety is not always front of mind"; "farm injuries are commonplace and downplayed"; "learning opportunities"; "school has a role"; and "teach me, but make it realistic and fun". Students indicated injuries were inevitable, and widespread unsafe practices occurred. Farm safety information was received from parents or while on the job, although in some cases parents encouraged unsafe behaviors. Curriculum linked materials are important, yet teachers also saw the value in covering additional material outside of mandated content, as it is often relevant to students' real-life experiences on farms. Students expressed interest in game-based learning on this topic but were adamant it needed to be fun and realistic.

CONCLUSION

Farm injury is preventable, and opportunities exist to educate adolescents about farm injury prevention via fun and engaging materials delivered at school. Insights from students and teachers around preferred educational design and content have informed the development of the "Calm Your Farm" (www.calmfarm.education) online gamified educational resource and may also be helpful to others working to influence farm safety practices among a typically difficult to engage age group.

The national and provincial burden of transport injuries in Iran between 1990 and 2021

Transport injuries (TIs) are a major cause of mortality and morbidity worldwide, and Iran, with its rapid demographic transitions in recent decades, is no exception. This study aimed to assess the burden of TIs in Iran and its provinces from 1990 to 2021. Estimates from the Global Burden of Diseases (GBD) 2021 were used to report age-standardized rates (ASRs) for the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of TIs by sex, age group, injury type, province, and Socio-demographic Index (SDI). In 2021, Iran recorded 1.147 million (95% uncertainty interval (UI): 1.014 to 1.287 million) incident cases of TIs with an age-standardized incident rate of 1341.9 per 100,000 (95% UI: 1193.7 to 1495.1). Compared with 1990, its prevalence, incidence, death, and DALY rates decreased by - 52% (95% UI: - 54% to - 50%), - 52% (95% UI: - 55% to - 50%), - 62% (95% UI: - 65% to - 58%), and - 64% (95% UI: - 67% to - 61%), respectively. At the provincial level, Tehran (233.1; 95% UI: 191.3 to 304) had the lowest age-standardized DALY rate, while the highest DALY rate was for Sistan-Baluchistan (2155.3; 95% UI: 1866.2 to 2478.3). In addition, age-standardized DALY rates were mainly higher for males, the 20-24 age group, and provinces with a lower SDI. Despite a significant decrease in TIs in Iran since 1990, they still pose a significant burden, with notable disparities across provinces and demographic groups. Targeted prevention programs focusing on high-risk populations, such as young adults and lower-SDI provinces with lower SDI, are recommended.

A descriptive study of fatal drownings among children and adolescents in the United States, with a focus on retention pond deaths, 2004-2020

The objective of this study was to characterize fatal drownings among children and adolescents, with a focus on retention pond drownings, and identify risk factors for these fatalities using child death review data. We acquired 2004-2020 National Fatality Review-Case Reporting System data for drowning deaths among youth 0-19 years. Retention pond drownings were identified through case narratives. We analyzed demographics, primary caregiver, supervisor, death investigation, and drowning-related variables across age groups (<1, 1-4, 5-9, 10-14, and 15-19 years) using either the Chi-square test or Fisher's Exact test, as appropriate, with a p-value of <0.05 indicating statistical significance. Of 7,539 drowning deaths reported during the study duration, 265 deaths occurred in retention ponds. Children 1-4 years comprised a greater proportion of retention pond drowning deaths (59.3%) compared to overall drowning deaths (50.9%) in this age group. In 51.3% of retention pond drowning deaths among children <5 years, supervision was needed but not provided. Most (80.4%) retention pond-related deaths among children <5 years and 50.7% of deaths among children 5-19 years were attributed to child neglect, poor or absent supervision, or exposure to hazards. Among all decedents who drowned in retention ponds, 19.1% were found to have a disability or chronic illness. Most retention ponds lacked local ordinances regulating water access (83.5%) and did not have barriers or protection (66.1%) or warning signs (82.0%). Younger children with poor or absent supervision who cannot swim are at high risk of drowning. Retention pond drownings are not infrequent, and most locations lack ordinances regulating water access or requiring barriers, such as fences. Greater efforts are needed to address this common hazard and environmental and policy strategies should be implemented to prevent future deaths.

Using Large Language Models to Extract Core Injury Information From Emergency Department Notes

BACKGROUND

Injuries pose a significant global health challenge due to their high incidence and mortality rates. Although injury surveillance is essential for prevention, it is resource-intensive. This study aimed to develop and validate locally deployable large language models (LLMs) to extract core injury-related information from Emergency Department (ED) clinical notes.

METHODS

We conducted a diagnostic study using retrospectively collected data from January 2014 to December 2020 from two urban academic tertiary hospitals. One served as the derivation cohort and the other as the external test cohort. Adult patients presenting to the ED with injury-related complaints were included. Primary outcomes included classification accuracies for information extraction tasks related to injury mechanism, place of occurrence, activity, intent, and severity. We fine-tuned a single generalizable Llama-2 model and five distinct Bidirectional Encoder Representations from Transformers (BERT) models for each task to extract information from initial ED physician notes. The Llama-2 model was able to perform different tasks by modifying the instruction prompt. Data recorded in injury registries provided the gold standard labels. Model performance was assessed using accuracy and macro-average F1 scores.

RESULTS

The derivation and external test cohorts comprised 36,346 and 32,232 patients, respectively. In the derivation cohort's test set, the Llama-2 model achieved accuracies (95% confidence intervals) of 0.899 (0.889-0.909) for injury mechanism, 0.774 (0.760-0.789) for place of occurrence, 0.679 (0.665-0.694) for activity, 0.972 (0.967-0.977) for intent, and 0.935 (0.926-0.943) for severity. The Llama-2 model outperformed the BERT models in accuracy and macro-average F1 scores across all tasks in both cohorts. Imposing constraints on the Llama-2 model to avoid uncertain predictions further improved its accuracy.

CONCLUSION

Locally deployable LLMs, trained to extract core injury-related information from free-text ED clinical notes, demonstrated good performance. Generative LLMs can serve as versatile solutions for various injury-related information extraction tasks.

Rates and ratios of fatal and nonfatal drowning attended by ambulance in New South Wales, Australia between 2010 and 2021

INTRODUCTION

Drowning is a preventable cause of mortality, with 279 unintentional drowning deaths per year in Australia. Despite larger estimated numbers, less is known about nonfatal drowning compared to fatalities. This study aimed to examine the burden of fatal and nonfatal drowning in the Australian state of New South Wales using pre-hospital case capture.

METHODS

A cross-sectional analysis of individuals attended by an ambulance in NSW for drowning between 2010 and 2021 was conducted. Ambulance data (paper-based and electronic medical records) were linked to emergency department and death registry. Ratios of fatal to nonfatal drowning were constructed overall, by sex, age, and remoteness of incident and residential locations.

RESULTS

3,973 ambulance-attended drowning patients were identified (an annual rate of 4.16/100,000 persons). Six percent (6.1%; n = 243) died within 30 days, 82.7% (n = 201) of which died on the day of incident, including at the scene. Mean survival time for those who died between 2 and 30 days was 4.6 days. The overall ratio of fatal to nonfatal incidents was 1:15. Ratios were highest for 10-19 year-olds (1:77), females (1:22), and in metropolitan incident (1:20) and residential (1:23) locations. Across the study drowning declined by 14 incidents and 0.18 fatalities per year.

DISCUSSION

Temporal trends indicate declining drowning incidents and fatalities. However, this study highlights significant numbers of nonfatal incidents among those traditionally seen as lower risk, such as adolescents and females, necessitating a widened focus on improving water safety among these groups.

CONCLUSIONS

Nonfatal drowning results in significant, yet preventable health system burden in New South Wales.

PRACTICAL APPLICATIONS

This study highlights the importance of documenting the full burden of drowning, including health system impacts of a preventable cause of injury and death. Such data may be used to encourage further investment in primary prevention efforts.

National trends in pediatric drowning - insights from the Israeli Ministry of Health registry-based cohort

This study analyzes the epidemiology of pediatric drowning in Israel from 2010 to 2022, focusing on differences across age groups, sex, and regions. We conducted a retrospective cohort study using data from the Ministry of Health's administrative databases, covering all children aged 0-17 years who were seen in the emergency department, discharged after hospitalization, or died at the scene due to drowning, excluding cases of intentional harm or suicide. The primary outcome was the annual drowning rate per 100,000 children, categorized by age, sex, and region, along with hospitalization duration, intensive care unit admissions, and mortality rates. A total of 2101 drowning incidents were identified, with 9% resulting in death. Higher drowning rates were found in younger children (1-4 years) and teenagers (15-17 years), with notable differences by sex. Drowning rates were higher in coastal regions and more frequent during winter and spring. An increase in drowning rates was observed over the last 3 years of the study (2020-2022). Children hospitalized for more than 3 days had significantly higher mortality rates, both in general wards and intensive care units.

CONCLUSIONS

Pediatric drowning is a persistent public health concern in Israel, with distinct seasonal, regional, age-specific, and sex-specific patterns in incidence and mortality. This study underscores the need for a comprehensive prevention strategy that includes year-round public education, environmental safety measures, and targeted interventions for high-risk groups to reduce drowning incidents and fatalities among children effectively.

WHAT IS KNOWN

• Pediatric drowning represents a significant public health challenge globally, with varying rates. • In Israel, pediatric drowning is the second leading cause of death from all injury-related deaths. Thus far, the measures and interventions to reduce fatalities were not proven effective enough.

WHAT IS NEW

• Pediatric drowning in Israel, with a 9% mortality rate, revealed a biphasic rate varied by sex and is higher in coastal regions and during winter and spring. • There was a notable increase in drowning incidents during the last 3 years of the study period (2020-2022), coinciding with the COVID-19 pandemic.

Pilot Evaluation of a Co-Designed Gamified Farm Injury Prevention Educational Resource for Adolescents

OBJECTIVES

Adolescents are at-risk of fatal and non-fatal injuries in the farm environment. School-based agricultural safety and farm injury prevention education is likely to be more effective when utilizing co-designed and gamification principles; however, this needs to be tested. This study examined data from a pilot evaluation of a co-designed farm injury prevention gamified educational resource for adolescents.

METHODS

Online, anonymous surveys were conducted with students studying agriculture in regional Australia who had previously participated in the co-design process to develop "Calm Your Farm". Three courses were developed (vehicles, workshop, and water safety) and before and after playing each of the courses for the first time, students completed survey questions regarding self-reported knowledge on the course topic, and assessment of content, design, ease of play, and how much they learned. Survey data were analyzed using descriptive statistics, chi square tests of association, and independent sample t tests.

RESULTS

We analyzed 66 responses (66.7% male; 60.6% aged 13 years). Staged course release meant all respondents assessed the vehicle and workshop courses, while 58% assessed the water safety course. Vehicle and workshop courses were rated 7.64 out of a possible 10 (SD = 1.85) and 7.65 (SD = 1.78), respectively, for the information presented, slightly higher than water safety (7.47 [SD = 1.91]). Statistically significant improvements in self-reported knowledge post play were seen among boys for the water safety course (63% said knowledge improved; X2 = 4.98; p = .026) and 13-year-olds for vehicles (35%; X2 = 4.31; p = .038) and workshop safety (50%; X2 = 4.29; p = .038). Respondents indicated being more likely to replay the game at school (M = 6.62 [SD = 2.96]) than at home (M = 5.57 [SD = 3.07]). Of respondents, 61% (n = 40) agreed that "Calm Your Farm" taught them more about farm safety and was more fun than other farm safety education previously received. Tractor safety (62%), chemical safety (58%), and firearm safety (58%) were the most popular topics suggested to be added to the game.

CONCLUSION

The co-design and gamification approach taken with "Calm Your Farm" appeared to be successful in improving self-reported knowledge around farm injury prevention and was perceived by 62% of the respondents as being fun and educational. Future expansion should incorporate student suggested topics.

Auditing learner driver information about floodwaters: An environmental scan of government issued resources in Australia

INTRODUCTION

Vehicles driving, or being swept, into floodwaters is a leading cause of flood-related death. Establishing safe behaviors among learner drivers may reduce risk throughout their driving lifetime.

METHODS

An environmental scan of publicly available government issued learner and driver handbooks across the eight Australian jurisdictions was conducted to identify information provided regarding floodwaters. Search terms included 'flood,' 'rain,' 'water,' and 'wet.' A visual audit of flood-related signage was also conducted.

RESULTS

Twelve documents, across eight jurisdictions, were analyzed. Four jurisdictions' documents provided no information on flooding. Of the four jurisdictions that provided information, content varied. This included highlighting risks and discouraging entering floodwaters in a vehicle, including penalties associated with travel on closed roads, to advising depth and current checks if crossing a flooded roadway, with recommendations based on vehicle size (preference given to bigger vehicles, i.e., 4wds). Information on flood-related signage was found in one jurisdiction.

DISCUSSION

Learner and driver handbooks represent a missed opportunity to provide flood safety information. Currently, information is not provided in all jurisdictions, despite flood-related vehicle drowning deaths of drivers and passengers being a national issue. Where information is presented, it is limited, often lacks practical guidance on how to assess water depth, current, and road base stability, and could better use evidence regarding the psychological factors underpinning, and behavioral prompts for performing, or avoiding, risky driving behavior during floods.

CONCLUSIONS

The provision and content of information in learner driver and driver handbooks must be improved, particularly within the context of increasing flooding and extreme weather associated with the effects of climate change.

PRACTICAL APPLICATIONS

We encourage all jurisdictions to provide practical information that draws on evidence-based risk factors and empirically established psychological factors for behavioral change to help establish safe driver behaviors around floods in the formative years of learning to drive.

Child drowning mortality in Israel: Trends and measures for prevention

INTRODUCTION

In this study, we use the media-based database of Beterem-Safe Kids Israel, to provide a 15-year review of unintentional fatal childhood drowning in Israel, between 2008 and 2022.

METHOD

It total, we identified 257 cases of child mortality due to drowning during this period.

RESULTS

Our results demonstrate a gradual rise in childhood mortality due to drowning, from 72 cases in 2008-2012, to 85 cases in 2013-2017, and to 100 cases in 2018-2022. Especially worth noting is the increase in childhood drowning in domestic swimming pools. We point to a link between low socioeconomic status and cases of drowning, showing that the risk of drowning extends beyond a mere matter of caregiver inattention. We recommend a series of regulatory and legislative steps to reduce fatal childhood drowning, including fencing built around domestic swimming pools, extending lifeguard activity hours, adding declared beaches, forming programs of safe behavior in water environments for adolescents, and establishing swimming lessons during the 2nd grade, for all populations. We further recommend that a special focus will be put in municipalities situated at the bottom of the socioeconomic index.

The burden, risk factors and prevention strategies for drowning in Türkiye: a systematic literature review

INTRODUCTION

Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies.

METHODS

Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design.

RESULTS

From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions.

DISCUSSION

There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning.

PRACTICAL APPLICATIONS

There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry.

TRIAL REGISTRATION

#CRD42022382615.

The effect of the 'Swim Reaper' program on water safety awareness, drowning mortality and morbidity among males aged 15-34 years in Aotearoa, New Zealand

BACKGROUND AND OBJECTIVE

To increase water safety awareness among young males New Zealand introduced the Swim Reaper program in 2016. The program ran annually over summer and in 2018/19 an evaluation was conducted. The objective of this study was to evaluate the impact of the 2018/19 Swim Reaper social media-based campaign on self-reported water safety awareness and identify changes in fatal and nonfatal drowning rates for New Zealand resident males aged 15-34 years before and after the 2016 Swim Reaper program.

METHODS

Online surveys pre (December-2018) and post (February-March-2019) Swim Reaper campaign were used to estimate water safety awareness post-campaign relative to pre-campaign using negative binomial regression adjusted for potential confounders. Interrupted time series (ITS) analysis, adjusted for seasonality, explored changes in drowning mortality, hospital admissions and Accident Compensation Corporation (ACC) claims pre and post program introduction (2016).

RESULTS

A total of 518 males responded (50.6% post-campaign). There were significant improvements (post vs. pre-campaign) in self-reported water safety awareness. ITS analysis showed a reduction in drowning related hospital admissions post relative to pre-program (RR = 0.47; [95%CI: 0.24-0.90]; p = 0.02).

DISCUSSION

Young males are an at-risk cohort for drowning and creating behavior change among this group can be challenging. Using a unique, humor-based approach the Swim Reaper program appears to be having some impact on self-reported water safety behaviors, as well as unintentional drowning-related hospitalization rates. Further evaluation, more clearly linked to campaign themes, is required to ascertain direct impact of the program.

CONCLUSION

The novelty and reach of the campaign within the context of a prevailing downward trend in drownings may provide support for social media-based programs targeting this hard-to-reach demographic.