Road safety knowledge exchange and capacity building between China and Australia

Road traffic injuries are one of the major public health burdens worldwide. The United Nations Decade of Action for Road Safety (2011-2020) implores all nations to work to reduce this burden. This decade represents a unique and historic period of time in the field of road safety. Information exchange and co-operation between nations is an important step in achieving the goal. The burden of road crashes, fatalities and injuries is not equally distributed. We know that low and middle-income countries experience the majority of the road trauma burden. Therefore it is imperative that these countries learn from the successes of others that have developed and implemented road safety laws, public education campaigns and countermeasures over many years and have achieved significant road trauma reductions as a result. China is one of the countries experiencing a large road trauma burden. Vulnerable road users such as pedestrians and cyclists make up a large proportion of fatalities and injuries in China. Speeding, impaired/drug driving, distracted driving, vehicle overloading, inadequate road infrastructure, limited use of safety restraints and helmets, and limited road safety training have all been identified as contributing to the problem. Some important steps have been taken to strengthen China’s approach, including increased penalties for drunk driving in May 2011 and increased attention to school bus safety in 2011/12. However, there is still a large amount of work needed to improve the current road safety position in China. This paper provides details of a program to assist with road safety knowledge exchange between China and Australia that was funded by the Australian Government which was undertaken in the latter part of 2012. The four month program provided the opportunity for the first author to work closely with key agencies in Australia that are responsible for policy development and implementation of a broad range of road safety initiatives. In doing so, an in-depth understanding was gained about key road safety strategies in Australia and processes for developing and implementing them. Insights were also gained into the mechanisms used for road safety policy development, implementation and evaluation in several Australian jurisdictions. Road traffic law and enforcement issues were explored with the relevant jurisdictional transport and police agencies to provide a greater understanding of how Chinese laws and practices could be enhanced. Working with agencies responsible for public education and awareness campaigns about road safety in Australia also provided relevant information about how to promote road safety at the broader community level in China. Finally, the program provided opportunities to work closely with several world-renowned Australian research centres and key expert researchers to enhance opportunities for ongoing road safety research in China. The overall program provided the opportunity for the first author to develop knowledge in key areas of road safety strategy development, implementation and management which are directly relevant to the current situation in China. This paper describes some main observations and findings from participation in the program.

Strategies for improving safety performance of repair, maintenance, minor alteration and addition (RMAA) works

Purpose Managing and maintaining infrastructure assets are one of the indispensible tasks for many government agencies to preserve the nations' economic viability and social welfare. To reduce the expenditures over the life-cycle of an infrastructure asset and extend the period for which the asset performs effectively, proper repair and maintenance are essential. While repair, maintenance, minor alteration and addition (RMAA) sector is expanding in many developed cities, occurrences of fatalities and injuries in this sector are also soaring. The purposes of this paper are to identify and then evaluate the various strategies for improving the safety performance of RMAA works. Design/methodology/approach Semi-structured interviews and two rounds of Delphi survey were conducted for data collection. Findings Raising safety awareness of RMAA workers and selecting contractors with a good record of safety performance are the two most important strategies to improve the safety performance in this sector. Technology innovations and a pay-for-safety scheme are regarded as the two least important strategies. Originality/value The paper highlights possible ways to enhance safety of the rather under-explored RMAA sector in the construction industry.

Developing and evaluating approaches for utilising injury data to support product safety initiatives

With increasing concern about consumer product-related injuries in Australia, product safety regulators need evidence-based research to understand risks and patterns to inform their decision making. This study analysed paediatric injury data to identify and quantify product-related injuries in children to inform product safety prioritisation. This study provides information on novel techniques for interrogating health data to identify trends and patterns in product-related injuries to inform strategic directions in this growing area of concern.

Biomechanical analyses of the performance of Paralympians: From foundation to elite level

Biomechanical analysis of sport performance provides an objective method of determining performance of a particular sporting technique. In particular, it aims to add to the understanding of the mechanisms influencing performance, characterization of athletes, and provide insights into injury predisposition. Whilst the performance in sport of able-bodied athletes is well recognised in the literature, less information and understanding is known on the complexity, constraints and demands placed on the body of an individual with a disability. This paper provides a dialogue that outlines scientific issues of performance analysis of multi-level athletes with a disability, including Paralympians. Four integrated themes are explored the first of which focuses on how biomechanics can contribute to the understanding of sport performance in athletes with a disability and how it may be used as an evidence-based tool. This latter point questions the potential for a possible cultural shift led by emergence of user-friendly instruments. The second theme briefly discusses the role of reliability of sport performance and addresses the debate of two-dimensional and three-dimensional analysis. The third theme address key biomechanical parameters and provides guidance to clinicians, and coaches on the approaches adopted using biomechanical/sport performance analysis for an athlete with a disability starting out, to the emerging and elite Paralympian. For completeness of this discourse, the final theme is based on the controversial issues on the role of assisted devices and the inclusion of Paralympians into able-bodied sport is also presented. All combined, this dialogue highlights the intricate relationship between biomechanics and training of individuals with a disability. Furthermore, it illustrates the complexity of modern training of athletes which can only lead to a better appreciation of the performances to be delivered in the London 2012 Paralympic Games

Communicating consequences with costs: A commentary on Corso et al's cost of injury

Estimating the economic burden of injuries is important for setting priorities, allocating scarce health resources and planning cost-effective prevention activities. As a metric of burden, costs account for multiple injury consequences—death, severity, disability, body region, nature of injury—in a single unit of measurement. In a 1989 landmark report to the US Congress, Rice et al1 estimated the lifetime costs of injuries in the USA in 1985. By 2000, the epidemiology and burden of injuries had changed enough that the US Congress mandated an update, resulting in a book on the incidence and economic burden of injury in the USA.2 To make these findings more accessible to the larger realm of scientists and practitioners and to provide a template for conducting the same economic burden analyses in other countries and settings, a summary3 was published in Injury Prevention. Corso et al reported that, between 1985 and 2000, injury rates declined roughly 15%. The estimated lifetime cost of these injuries declined 20%, totalling US$406 billion, including US$80 billion in medical costs and US$326 billion in lost productivity. While incidence reflects problem size, the relative burden of injury is better expressed using costs.

Submission on NSW Attorney-General's Discussion Paper on Amendment of Limitation of Actions Act 1969 to remove time limit for civil claims for child abuse

The New South Wales Attorney-General and Justice Policy Division released a Discussion Paper about reform of the Limitation of Actions Act 1969. The key question was whether and how to amend the statute to better provide access to justice for civil claimants in child abuse cases. This submission draws on published literature and multidisciplinary research to support the Discussion Paper's Option A, namely, to abolish the time limit for civil claims for injuries in criminal child abuse cases, and for this to be made retrospective.

Level of contribution of intrinsic risk factors to the management of patients with plantar heel pain

Introduction: Injuries in the lower extremity are considered to have multifactorial causes, whilst people with heel pain represent the most frequent cause of visits to health professionals. Managing these patients can be very difficult. The purpose of this research is to identify key variables which can influence foot health in patients with heel pain. Materials and method: A cross-sectional observational study was carried out with a sample of sixty-two participants recruited from the Educational Welfare Unit of the University of Malaga. The therapists, blinded for the study, fill in the data with anthropometric information and the FPI, while participants fill in the foot health status questionnaire, FHSQ. The most significant results reveal that there is a moderate relation between the clinical variables and the FHSQ commands. The most significant contribution is the BMI in the foot health status questionnaire. Conclusion: The variables which can help manage clinical subjects with heel pain are age, BMI, footwear and FPI (left foot).

Preterm Birth and Surgical Treatment of the Uterine Cervix

Cervical cancer is the second most common cancer among women globally. Most, probably all cases, arise through a precursor, cervical intraepithelial neoplasia (CIN). Effective cytological screening programmes and surgical treatments of precancerous lesions have dramatically reduced its prevalence and related mortality. Although these treatments are effective, they may have adverse effects on future fertility and pregnancy outcomes. The aim of this study was to evaluate the effects of surgical treatment of the uterine cervix on pregnancy and fertility outcomes, with the focus particularly on preterm birth. The general preterm birth rates and risk factors during 1987–2005 were studied. Long-term mortality rates of the treated women were studied. In this study, information from The Medical Birth Register (MBR), The Hospital Discharge Register (HDR), The Cause-of-Death Register (CDR), and hospital records were used. Treatments were performed during 1987–2003 and subsequent deliveries, IVF treatments and deaths were analyzed. The general preterm birth rate in Finland was relatively stable, varying from 5.1% to 5.4% during the study period (1987 to 2005), although the proportion of extremely preterm births had decreased substantially by 12%.The main risk factor as regards preterm birth was multiplicity, followed by elective delivery (induction of delivery or elective cesarean section), primiparity, in vitro fertilization treatment, maternal smoking and advanced maternal age. The risk of preterm birth and low birth weight was increased after any cervical surgical treatment; after conization the risk of preterm birth was almost two-fold (RR 1.99, 95% CI 1.81– 2.20). In the conization group the risk was the highest for very preterm birth (28–31 gestational weeks) and it was also high for extremely preterm birth (less than 28 weeks). In this group the perinatal mortality was also increased. In subgroup analysis, laser ablation was not associated with preterm birth. When comparing deliveries before and after Loop conization, we found that the risk of preterm birth was increased 1.94-fold (95% CI 1.10–3.40). Adjusting for age, parity, or both did not affect our results. Large or repeat cones increased the risk of preterm birth when compared with smaller cones, suggesting that the size of the removed cone plays a role. This was corroborated by the finding that repeat treatment increased the risk as much as five-fold when compared with the background preterm birth rate. We found that the proportion of IVF deliveries (1.6% vs. 1.5%) was not increased after treatment for CIN when adjusted for year of delivery, maternal age, or parity. Those women who received both treatment for CIN and IVF treatment were older and more often primiparous, which explained the increased risk of preterm birth. We also found that mortality rates were 17% higher among women previously treated for CIN. This excess mortality was particularly seen as regards increased general disease mortality and alcohol poisoning (by 13%), suicide (by 67%) and injury death (by 31%). The risk of cervical cancer was high, as expected (SMR 7.69, 95% CI 4.23–11.15). Women treated for CIN and having a subsequent delivery had decreased general mortality rate (by -22%), and decreased disease mortality (by -37%). However, those with preterm birth had increased general mortality (SMR 2.51, 95% CI 1.24–3.78), as a result of cardiovascular diseases, alcohol-related causes, and injuries. In conclusion, the general preterm birth rate has not increased in Finland, as in many other developed countries. The rate of extremely preterm births has even decreased. While other risk factors of preterm birth, such as multiplicity and smoking during pregnancy have decreased, surgical treatments of the uterine cervix have become more important risk factors as regards preterm birth. Cervical conization is a predisposing factor as regards preterm birth, low birth weight and even perinatal mortality. The most frequently used treatment modality, Loop conization, is also associated with the increased risk of preterm birth. Treatments should be tailored individually; low-grade lesions should not be treated at all among young women. The first treatment should be curative, because repeat treatments are especially harmful. The proportion of IVF deliveries was not increased after treatment for CIN, suggesting that current treatment modalities do not strongly impair fertility. The long-term risk of cervical cancer remains high even after many years post-treatment; therefore careful surveillance is necessary. In addition, accidental deaths and deaths from injury were common among treated women, suggesting risk-taking behavior of these women. Preterm birth seems be associated with extremely high mortality rates, due to cardiovascular, alcohol-related and injury deaths. These women could benefit from health counseling, for example encouragement in quitting smoking.

Fiabilidad de diferentes pruebas que se utilizan para evaluar el riesgo de lesión del miembro inferior en mujeres deportistas

233 p. : il. + anexo (247 p.)

Prevenção da úlcera de pressão: resultados da ação educativa junto à equipe de enfermagem

Os pacientes hospitalizados, acamados ou restritos ao leito, apresentam uma gama de fatores de risco para o desenvolvimento das úlceras por pressão, diante disso, necessitam de uma assistência de enfermagem qualificada e eficaz na prevenção dessas lesões, a fim de evitar o desenvolvimento das mesmas. Desta forma, a pesquisa teve como objetivo investigar a influência da ação educativa junto à equipe de enfermagem das enfermarias de Clínica Médica na prevenção das úlceras por pressão. Tratou-se de um estudo quantitativo com delineamento descritivo com dispositivo de intervenção do tipo antes e depois, tendo como cenário as enfermarias de Clínica Médica de um hospital universitário na cidade do Rio de Janeiro. Os sujeitos foram os enfermeiros (n=15) e técnicos de enfermagem (n=18) da Clínica Médica e a unidade de medida do estudo foi o número de vezes que as ações de enfermagem, referentes à prevenção das úlceras por pressão e desempenhadas pelos sujeitos, foram observadas pela pesquisadora. Obtivemos 396 observações antes da ação educativa e 204 depois da ação educativa. A pesquisa apresentou três etapas: observação sistematizada antes da ação educativa, realização da ação educativa e observação sistematizada depois da ação educativa. Os resultados foram obtidos através da análise dos Check list antes e depois da ação educativa e constatamos, por meio de valores percentuais, melhoras significativas. A categoria sempre, considerada o valor ideal para todas as variáveis, apresentou aumento de 20 pontos percentuais entre as observações; a categoria frequentemente apresentou aumento de 07 pontos e a categoria raramente apresentou decréscimo de 27 pontos. Isso demonstra que a ação educativa atingiu o objetivo de sensibilizar a equipe de enfermagem quanto a prevenir as úlceras por pressão de forma qualificada. Concluímos que as úlceras por pressão continuam sendo um grande problema de saúde pública, merecendo atenção especial por parte da equipe de enfermagem. Acreditamos que a ação educativa é capaz de sensibilizar a equipe de enfermagem e motivar a transformação das ações e condutas, porém, ela é pontual e é apenas uma parte do processo educacional. Para alcançarmos a mudança comportamental e proporcionar uma assistência qualificada e eficiente aos pacientes em risco de desenvolver as úlceras por pressão, sugerimos o desenvolvimento de uma prática educativa contínua e permanente, capaz de manter a equipe de enfermagem em constante aperfeiçoamento.

Variabilidade ventilatória durante exercício dinâmico em indivíduos saudáveis e com insuficiência cardíaca

A presença de ventilação periódica durante o exercício confere pior prognóstico a pacientes com insuficiência cardíaca. Existem divergências quanto aos critérios para identificação deste fenômeno. Além disso, a interpretação dicotômica (presença ou ausência) quanto a este fenômeno dificulta a estratificação de risco mais detalhada dos pacientes com insuficiência cardíaca. Desta forma, esta tese avalia a utilização de técnicas estabelecidas para análise de variabilidade de sinais para quantificar as oscilações ventilatórias que ocorrem durante o teste cardiopulmonar de exercício, em indivíduos saudáveis, atletas e com insuficiência cardíaca. Um protocolo mais curto para realização de teste cardiopulmonar de exercício em cicloergômetro de braço foi proposto e validado. Tal protocolo foi utilizado em estudo posterior, onde se comprovou que, apesar dos tempos respiratórios não serem influenciados pelo tipo de exercício realizado, a variabilidade ventilatória é maior durante a realização de exercício dinâmico com membros superiores do que com membros inferiores. A capacidade aeróbica de indivíduos sadios também influencia a variabilidade ventilatória durante o teste cardiopulmonar de exercício. Isto foi comprovado pela menor variabilidade ventilatória no domínio do tempo em atletas do que sedentários durante exercício. A análise destes voluntários com o método da análise dos componentes principais revelou que em atletas a variabilidade do volume corrente é a principal responsável pela variabilidade da ventilação-minuto durante o exercício, ao passo que em sedentários a variabilidade da freqüência respiratória apresenta-se como principal responsável por tais variações. Em estudo randomizado e controlado comprovamos que, mesmo indivíduos sadios apresentam redução da variabilidade ventilatória ao exercício após 12 semanas de treinamento físico. Comprovamos que a reabilitação cardíaca reverteu a ocorrência de ventilação periódica em um paciente com insuficiência cardíaca e, finalmente, encontramos que a variabilidade ventilatória correlaciona-se inversamente com a fração de ejeção ventricular esquerda em pacientes com insuficiência cardíaca. Estudos futuros deverão analisar o poder prognóstico da variabilidade ventilatória nestes pacientes.

Avaliação da intervenção terapêutica com produto natural na cicatrização de ferida cutânea: o uso de óleo de capivara

A cicatrização de feridas cutâneas visa restaurar a integridade da pele, objetivando um fechamento rápido da lesão e a formação de uma cicatriz funcional e esteticamente satisfatória. Diversos modelos in vivo têm sido estudados a fim de caracterizar diversos componentes e mecanismos envolvidos no reparo tecidual e avaliar os efeitos de potenciais compostos terapêuticos que aceleram o processo de cicatrização. O óleo extraído da gordura subcutânea de capivara possui certas propriedades, entre elas está o seu uso em ferimentos externos com o intuito de acelerar o processo cicatricial, embora tal evento não seja confirmado em pesquisas experimentais. O presente estudo teve como objetivo investigar os possíveis efeitos da aplicação tópica de óleo de capivara em feridas cutâneas induzidas em camundongos Swiss, avaliando sua interferência macro e microscópica no processo de cicatrização das lesões. A lesão foi realizada no dorso dos animais, que receberam aplicação tópica do óleo de capivara (0,1 ml) durante 3, 7, 14 e 21 dias de pós-operatório (PO), conforme protocolo estabelecido. Ao final dos dias, foi realizada eutanásia dos animais e fragmentos de lesão e pele adjacente foram coletados e processados para a microscopia de luz. Cortes histológicos da amostra foram corados com hematoxilina e eosina, azul de toluidina, picro sirius red, resorcina fucsina de Weigert, e imunomarcadas para detecção de antígeno nuclear de proliferação celular. Foram analisados macroscopicamente o aspecto geral da lesão, contração da lesão e reepitelização, e microscopicamente a espessura da neoepiderme, quantidade de leucócitos polimorfonucleares (PMN) e mastócitos, proliferação celular na epiderme e derme, e avaliação das fibras de colágeno e do sistema elástico-microfibrilar na matriz extracelular da derme cicatricial. Os animais tratados topicamente com o óleo de capivara mostraram, comparados ao grupo controle que não recebeu tratamento, melhor desenvolvimento da crosta de fibrina nas fases iniciais da cicatrização e desaparecimento da mesma antes do 14 dia PO; maior contração e reepitelização da área da lesão, bem como neoepiderme mais espessa em 7 dias PO; aumento do número de leucócitos PMN em 3 dias PO e sua gradativa redução nos dias subsequentes e diminuição do número de mastócitos em 21 dias PO. Além disso, no grupo tratado com óleo de capivara foi observada uma benéfica modulação das fibras colágenas e elásticas presentes na matriz extracelular da derme, apresentando aceleração da deposição de fibras de colágeno do tipo I e melhor organização dessas fibras no tecido, bem como aceleração da elastogênese com o aparecimento das fibras do sistema elástico-microfibrilar a partir do 7 dia PO. O presente trabalho demonstrou que o emprego tópico do óleo de capivara em feridas cutâneas de camundongos interfere favoravelmente no processo de cicatrização, acelerando o fechamento da ferida e a reparação da epiderme e derme

Utilização de marcadores salivares para avaliação e controle do desempenho físico e cognitivo em atletas de futebol

A elaboração de um programa de treinamento físico depende do controle de diferentes parâmetros bioquímicos, que se relacionam com fatores como a intensidade do exercício, imunidade e com o estado redox. Além disso, estudos recentes também começaram a apontar a relevância da função executiva como componente determinante para o alcance de um alto nível de desempenho esportivo. Por outro lado, poucos estudos foram realizados em atletas até o momento utilizando estes marcadores na saliva juntamente com os testes de função cognitiva. O objetivo desse trabalho foi estudar a capacidade discriminatória das análises bioquímicas realizadas em saliva para avaliação do desempenho físico e sua relação com a função cognitiva em atletas de futebol. Trinta e dois atletas foram submetidos ao Bangsbo Sprint Test (BST) para avaliação da capacidade física e 48 horas depois ao Teste de Stroop (TSt) e Torre de Hanoi (ToH) para avaliação da função executiva. Os níveis de lactato na saliva aumentaram quando comparados aos valores Pré-BST (6,9 vezes; p<0,05). A proteína total salivar seguiu o mesmo padrão com aumento observado após o BST (+34%; p<0,05). As concentrações de imunoglobulina-A salivar (IgA-s) não mostraram diferença significativa após o BST. Os níveis de GSH e TBARs na saliva não mostraram diferença significativa, enquanto que a concentração de ácido úrico diminuiu após o BST (-26%; p<0,05). Interessantemente, a superóxido dismutase (SOD) salivar aumentou (3,6 vezes; p<0,05), enquanto que os níveis de catalase (CAT) na saliva não alteraram significativamente. Não houve correlação de nenhum dos parâmetros analisados com o desempenho no TSt, entretanto atletas localizados no percentil superior (P90) de cortisol na saliva (11,2 ng/ mL à 32,7 ng/ mL) apresentaram tempos mais longos para a resolução do ToH. A eletroforese 2D mostrou que 215 spots só apareceram no momento Pré-BST, 63 spots aumentaram e 108 diminuíram a sua expressão após o BST. Concluindo, a saliva é sensível às modificações induzidas pelo BST. A manutenção dos níveis salivares de TBARs após o BST parece ocorrer em função da diminuição dos níveis de ácido úrico, componente este que possui uma expressiva ação antioxidante. Neste sentido, o aumento de SOD pós-exercício parece agir como uma segunda linha de defesa antioxidante contra a produção de ROS induzidas pelo BST. Além disso, os resultados dos testes de função executiva indicam que níveis elevados de cortisol salivar possuem um efeito deletério no tempo de resolução da ToH, que se refere à memória de trabalho, o planejamento e solução de problemas. No entanto o TSt, que envolve a atenção seletiva e a velocidade de processamento de informações parecem não ser afetados pelos níveis de cortisol em repouso. E finalmente, a eletroforese 2D mostrou que o BST induziu a expressão diferencial de proteínas, visto que não surgiram proteínas novas após o teste, e dezenas de proteínas foram up-reguladas e down-reguladas após o BST. Estes dados sugerem que após uma análise proteômica, estas proteínas possam ser candidatas a marcadores de desempenho físico e/ou cognitivo em futuros estudos.

Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis.

BACKGROUND: Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. METHODS: A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0-16 points). RESULTS: The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I(2)=63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). CONCLUSIONS: Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.

Is a single item stress measure independently associated with subsequent severe injury: a prospective cohort study of 16,385 forest industry employees

Background: A previous review showed that high stress increases the risk of occupational injury by three- to five-fold. However, most of the prior studies have relied on short follow-ups. In this prospective cohort study we examined the effect of stress on recorded hospitalised injuries in an 8-year follow-up.
Methods: A total of 16,385 employees of a Finnish forest company responded to the questionnaire. Perceived stress was measured with a validated single-item measure, and analysed in relation recorded hospitalised injuries from 1986 to 2008. We used Cox proportional hazard regression models to examine the prospective associations between work stress, injuries and confounding factors.
Results: Highly stressed participants were approximately 40% more likely to be hospitalised due to injury over the follow-up period than participants with low stress. This association remained significant after adjustment for age, gender, marital status, occupational status, educational level, and physical work environment.
Conclusions: High stress is associated with an increased risk of severe injury.