What are the priorities for prevention and control of non-communicable diseases and injuries in sub-Saharan Africa and South East Asia?

Last year’s UN high level meeting sought to galvanise the international community into scaling up its response to the escalating global burden of non-communicable diseases. With resources tight, D Chisholm and colleagues examine which interventions should be given priority for action and investment

Health in Brazil 5 Violence and injuries in Brazil: the effect, progress made, and challenges ahead

Although there are signs of decline, homicides and traffic-related injuries and deaths in Brazil account for almost two-thirds of all deaths from external causes. In 2007, the homicide rate was 26.8 per 100 000 people and traffic-related mortality was 23.5 per 100 000. Domestic violence might not lead to as many deaths, but its share of violence-related morbidity is large. These are important public health problems that lead to enormous individual and collective costs. Young, black, and poor men are the main victims and perpetrators of community violence, whereas poor black women and children are the main victims of domestic violence. Regional differentials are also substantial. Besides the sociocultural determinants, much of the violence in Brazil has been associated with the misuse of alcohol and illicit drugs, and the wide availability of firearms. The high traffic-related morbidity and mortality in Brazil have been linked to the chosen model for the transport system that has given priority to roads and private-car use without offering adequate infrastructure. The system is often poorly equipped to deal with violations of traffic rules. In response to the major problems of violence and injuries, Brazil has greatly advanced in terms of legislation and action plans. The main challenge is to assess these advances to identify, extend, integrate, and continue the successful ones.

Corporate liability for workplace deaths and injuries-reflecting on Victoria's laws in the light of the Esso Longford explosion

The purpose of this article is to consider some different legal models for the liability of corporations for the deaths and serious injuries of their employees, with particular emphasis on the law in Victoria.

Two recent developments in Victoria prompt this consideration. First, on 30 July 2001, the Victorian Supreme Court handed down its sentencing decision in the case arising from the explosion on 25 September 1998 at the Longford gas plant operated by Esso Australia Pty Ltd. The decision marked the end of the formal public consideration of a devastating event in Victorian industrial history, which began with the Royal Commission set up on 20 October 1998 to investigate the causes of an explosion in which two workers died and eight others were injured. Second, in early 2002, the Victorian Government failed in its attempt to introduce new criminal offences for corporate employers whose employees are killed or seriously injured at work. In spite of their failure to be passed by the Legislative Council in Victoria, these proposals warrant consideration. They represent a growing trend by policy makers in attempting to address more effectively the question of the liability for deaths and serious injuries of workers to employers who operate through the corporate form.

Adiposity and its metabolic consequences contribute to Achilles tendinopathy

Pain in the Achilles tendon commonly affects active individuals but is also seen in sedentary people. This thesis shows that the accumulation of excess body fat, abnormal blood lipids and glucose metabolism were associated with Achilles tendinopathy. Targeting these lifestyle factors may improve treatment outcomes for tendon injury.

Training patterns and negative health outcomes in triathlon : longitudinal observations across a full competitive season

AIM: Despite heavy training requirements, triathlon is a sport that is rapidly increasing in popularity. Yet, there is limited research detailing the relationship between training, the incidence of injuries and illness, psychological stress, overtraining and athlete burnout amongst triathletes. Six hypotheses relating inter-individual differences to training factors were generated to evaluate change in self-reported measures of these negative health outcomes over a training year.

METHODS: Thirty, well-trained, triathletes (males n=20: age=27.1±9.1 years and females n=10: age=27.4±6.6 years) from a local triathlon club participated in this study. The study commenced during pre-season training, and involved weekly monitoring of each athlete until the end of the competitive season 45 weeks later. Linear Mixed Modelling was used for the analysis.

RESULTS: Signs and symptoms of injury and illness (SAS) were significantly associated with increases in training factors (P≤0.05); however, greatest impact on SAS was produced by psychological stressors (P≤0.001). Common symptoms of overtraining were significantly affected by increases in exposure to both training and psychological stressors (P≤0.05). Mood disturbance was not significantly affected by training factors (P>0.05) but rather increases in psychological stressors (P≤0.001). Finally, each of the three athlete burnout subscales were significantly affected by both psychological (P≤0.001) stressors as well as varying combinations of training factors (P≤0.05).

CONCLUSIONS: Exposure to stressors (either training or psychological) had significant effects on all negative health outcomes assessed.

Work and injuries in dancers: Survey of a professional dance company in Brazil

This study examined the daily life and most important physical injuries suffered and reported by the dancers of a professional (contemporary) dance company in S (a) over tilde $o Paulo, Brazil. Through an observational, cross,sectional, retrospective procedure using a questionnaire that collected qualitative and quantitative data, we were able to gather information on 30 dancers who collaborated with the survey. We determined that the injuries considered as most important by dancers were those that prevented dance activity during some months. These injuries occurred mainly during rehearsals (which is the activity occuppying, the most time on the schedule). Articular injuries were the most frequent and mainly involved the knee and ankle. They were related to classical technique, in which most of the company's artists started their dance careers. Medical care usually was sought within 1 day, and the prescribed treatment resolved the problem, but the injury cause was not identified in all cases.

Childhood trauma in substance use disorder and depression: An analysis by gender among a Brazilian clinical sample

Objective: In this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses. Methods: The study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the Childhood Trauma Questionnaire.. Results: A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. In all of the cases, the frequency was higher among women than men. Conclusion: Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment. © 2010 Elsevier Ltd. All rights reserved.

RISK FOR INJURIES AMONG MOTORCYCLISTS INVOLVED IN TRAFFIC INCIDENTS

The objective of this study was to identify, among motorcyclists involved in traffic incidents, the factors associated with risk of injuries. In 2004, in the city of Maringa-PR, it was determined that there were a total of 2,362 motorcyclists involved in traffic incidents, according to records from the local Military Police. Multivariate analysis was applied to identify the factors associated with the presence of injury. A significantly higher probability of injury was observed among motorcyclists involved in collisions (odds Ratio = 11.19) and falls (odds Ratio = 3.81); the estimated odds ratio for females was close to four, and those involved in incidents including up to two vehicles were 2.63 times more likely to have injuries. Women involved in motorcycle falls and collisions with up to two vehicles stood out as a high-risk group for injuries.

Effects of group stability on aggression, stress and injuries in breeding rabbits

On Swiss rabbit breeding farms, group-housed does are usually kept singly for 12 days around parturition to avoid pseudograviclity, double litters and deleterious fighting for nests. After this isolation phase there is usually an integration of new group members. Here we studied whether keeping the group composition stable would reduce agonistic interactions, stress levels and injuries when regrouping after the isolation phase. Does were kept in 12 pens containing 8 rabbits each. In two trials, with a total of 24 groups, the group composition before and after the 12 days isolation period remained the same (treatment: stable, S) in 12 groups. In the other 12 groups two or three does were replaced after the isolation phase by unfamiliar does (treatment: mixed, M). Does of S-groups had been housed together for one reproduction cycle. One day before and on days 2, 4 and 6 after regrouping, data on lesions, stress levels (faecal corticosterone metabolites, FCM) and agonistic interactions were collected and statistically analysed using mixed effects models. Lesion scores and the frequency of agonistic interactions were highest on day 2 after regrouping and thereafter decrease in both groups. There was a trend towards more lesions in M-groups compared to S-groups. After regrouping FCM levels were increased in M-groups, but not in S-groups. Furthermore, there was a significant interaction of treatment and experimental day on agonistic interactions. Thus, the frequency of biting and boxing increased more in M-groups than in S-groups. These findings indicate that group stability had an effect on agonistic interactions, stress and lesions. (C) 2012 Elsevier B.V. All rights reserved.

Molluscan memory of injury: evolutionary insights into chronic pain and neurological disorders.

Molluscan preparations have yielded seminal discoveries in neuroscience, but the experimental advantages of this group have not, until now, been complemented by adequate molecular or genomic information for comparisons to genetically defined model organisms in other phyla. The recent sequencing of the transcriptome and genome of Aplysia californica, however, will enable extensive comparative studies at the molecular level. Among other benefits, this will bring the power of individually identifiable and manipulable neurons to bear upon questions of cellular function for evolutionarily conserved genes associated with clinically important neural dysfunction. Because of the slower rate of gene evolution in this molluscan lineage, more homologs of genes associated with human disease are present in Aplysia than in leading model organisms from Arthropoda (Drosophila) or Nematoda (Caenorhabditis elegans). Research has hardly begun in molluscs on the cellular functions of gene products that in humans are associated with neurological diseases. On the other hand, much is known about molecular and cellular mechanisms of long-term neuronal plasticity. Persistent nociceptive sensitization of nociceptors in Aplysia displays many functional similarities to alterations in mammalian nociceptors associated with the clinical problem of chronic pain. Moreover, in Aplysia and mammals the same cell signaling pathways trigger persistent enhancement of excitability and synaptic transmission following noxious stimulation, and these highly conserved pathways are also used to induce memory traces in neural circuits of diverse species. This functional and molecular overlap in distantly related lineages and neuronal types supports the proposal that fundamental plasticity mechanisms important for memory, chronic pain, and other lasting alterations evolved from adaptive responses to peripheral injury in the earliest neurons. Molluscan preparations should become increasingly useful for comparative studies across phyla that can provide insight into cellular functions of clinically important genes.