Injury Prevention, 2024 PDF

Injury prevention Tai-Yin Wu Department of Public Health Institute of Epidemiology and Preventive Medicine 1  Outline Epidemiology and definition of injury Haddon matrix Injury prevention – Tr...

Injury prevention Tai-Yin Wu Department of Public Health Institute of Epidemiology and Preventive Medicine 1  Outline Epidemiology and definition of injury Haddon matrix Injury prevention – Traffic injury – Leisure injury – Adolescent’s adventurous activities 2 3 4 5 6 7  Top mortality causes by age group 15-24 years old (1,121 total mortalities) accidents Mortality (%) self harm(suicide) 0.5 1.2 12.9 1.3 malignant tumors 0.8 1.3 heart disease(not including 1.4 HTN) brain vessel diseases 2.9 47.2 congenital diseases 8.9 musculoskeletal system and connective tissue disease pneumonia murder 21.3 kidney diseases others 8 Injury related mortality by county Death Rate Ranking County/City Number of Deaths Death Rate 1 Chiayi County 272 54.3 2 Taitung County 114 52.8 3 Hualien County 170 52.3 4 Pingtung County 382 46.8 5 Nantou County 226 45.9 6 Yunlin County 307 45.2 7 Miaoli County 224 41.2 8 Yilan County 167 36.8 9 Changhua County 464 36.5 10 Penghu County 38 36.0 11 Hsinchu County 195 34.4 12 Tainan City 645 34.3 13 Kaohsiung City 831 30.0 14 Taichung City 792 28.1 15 Chiayi City 69 25.9 16 Taoyuan City 558 24.7 17 Hsinchu City 107 23.8 18 Lienchiang County 3 22.8 19 Keelung City 82 22.3 20 Kinmen County 26 18.5 21 New Taipei City 728 18.1 9 22 Taipei City 367 14.0 Total 6,767 28.7 Injury related fatality 10  Concepts about injury Injuries vs. accidents Preventable vs. fate – Intentional – Unintentional Unintentional accidents are referred to as “injury” Short period of time Sudden onset Unpredictable results: body injury, financial loss (National Safety Council) 11 Causes: Natural factors, human factors  Concepts about injury Traditional Contemporary Accident WHO recommended Unpredictable to use “injury” instead Unpreventable of accident since 1978 Unavoidable Predictable Random: same Preventable incidence for Potentially avoidable everyone Are accidents really “accidents”? 12  The World Medical Association declaration Injury is the main cause of disability for children & adolescents Injury prevention should be viewed as a major public health issue WHO: There is huge difference in the incidence of injury world wide Middle to low income countries contributed to 90% injury related mortalities globally 13  WHO report Within a country, injury rates vary across different social classes The living and working conditions of the impoverished population are more dangerous than those of the wealthy Buildings in poor communities are often older and in need of repair, and the rate of homicides is higher The poor also have fewer opportunities to access high-quality emergency medical and rehabilitation services The root causes of injuries deserve special 14 attention 15  Injury Characteristics：Energy transfer in a short period of time with undetermined results Haddon matrix and principle of prevention: – 3 X 3 matrix: (host, vector, environment) X (before, accident, after) – Ex：Traffic accident, occupational injury, domestic injury – Principles: The closer to the origin, the better the protection (II) Haddon’s matrix: another example of “best doctor” Before During After Host Agent Environment 16 3D structure: Runyan CW, 1998 phase X factor X decision criteria 17 The 3rd axis of Haddon’s matrix Third axis: factors to aid decision making – Effectiveness – Cost – Freedom – Equity – Stigmatization – Preference – Feasibility – Other judgment factors Not every item in the 3rd axis is always needed When conducting research analysis, select the items needed for analysis based on the actual situation 18  Unified framework The third axis should base on public health approach（PHA） – Surveillance – Risk factor identification – Intervention evaluation – Program implementation Injury can be described in a scientific way (CDC, USA, 1990) – Runyan CW : Using the Haddon matrix: introducing the third dimension, Injury Prevention. 4(4):302-7, 1998 – Lett R., Kobusingye O., Sethi D.: A unified framework for injury control: the public health approach and Haddon's Matrix combined. Injury Control & Safety Promotion. 9(3):199-205, 2002. 19  Outline Epidemiology and definition of injury Haddon matrix Injury prevention – Traffic injury – Leisure injury – Adolescent’s adventurous activities 20  Injury prevention Primary prevention – Helmet, safety belt, car seat – Avoid alcohol/drug use while driving – Road design – Car design 21  Injury prevention Secondary prevention – Police road survey of traffic violation – Reporting system Tertiary prevention – Emergency service system – Rehabilitation and long-term care Significance – Mortality & morbidity: important reason for deaths and disability – Years of potential life lost (YPLL): 22 Leading cause Principles of prevention Eliminate energy accumulation Reduce energy accumulation Prevent the release of accumulated energy – Change the speed and space of energy release – Use time-space distance to separate hazards from those vulnerable to injury – Install barriers, modify contact surfaces, strengthen the human body, quickly detect and perform emergency aid Apart from legislation and community intervention, counseling and health education have limited effects (Grade: I Statement). Child safety seats, seat belts, and banning drunk driving still require legislation and community 23 intervention!  Traffic accident The main cause of injury Effective measures (USPSTF) Safety belt for both front and back seats（A statement） Children’s safety seat（A statement） –