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Ksinan AJ, Dalecká A, Kukla L, Pikhart H, Bobák M. Early-Life Temperamental Differences as Longitudinal Predictors of Unintentional Injuries. J Pediatr Psychol 2024; 49:35-44. [PMID: 37847645 PMCID: PMC10799721 DOI: 10.1093/jpepsy/jsad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Unintentional injuries are the leading cause of hospitalization and death among children. Compared to environmental factors, less attention in injury preventive efforts has been paid to how individual characteristics relate to the risk of injury. Using a large prospective cohort, the current study assessed the longitudinal impact of early-life temperament on the cumulative number of injuries until mid-adolescence. METHODS The data came from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). Temperament was evaluated by mothers when children were 3 years old (N = 3,545). The main outcome was the pediatrician-reported sum of child's injuries from age 3 to 15 (seven timepoints). Latent profile analysis (LPA) was used to determine classes based on temperamental dimensions and then extended to a mixture model with a distal count outcome. The covariates included maternal conflict and attachment, sex, family structure, and maternal education. RESULTS The LPA determined the existence of three classes: shy children (8.1% of the sample; lowest activity/highest shyness), outgoing children (50.8%; highest activity/lowest shyness), and average: children (41.1%; middle values). Results from a mixture model showed that the outgoing temperament was associated with the highest longitudinal risk for injuries, as both average children (IRR = 0.89 [0.80, 0.99]), and the shy children (IRR = 0.80 [0.68, 0.95]) had lower risk. CONCLUSIONS Early childhood temperamental differences can have long-term effects on injury risk. Highly active children showed the highest risk for future injuries, suggesting that these characteristics make them more likely to be involved in novel and potentially dangerous situations.
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Affiliation(s)
- Albert J Ksinan
- RECETOX, Faculty of Science, Masaryk University, Czech Republic
| | - Andrea Dalecká
- RECETOX, Faculty of Science, Masaryk University, Czech Republic
| | - Lubomír Kukla
- RECETOX, Faculty of Science, Masaryk University, Czech Republic
| | - Hynek Pikhart
- RECETOX, Faculty of Science, Masaryk University, Czech Republic
- Department of Epidemiology & Public Health, University College London, Institute of Epidemiology and Health Care, UK
| | - Martin Bobák
- RECETOX, Faculty of Science, Masaryk University, Czech Republic
- Department of Epidemiology & Public Health, University College London, Institute of Epidemiology and Health Care, UK
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Raspopovic KM, Bankovic D, Petrovic A, Opancina V, Nikolic S, Vojinovic RH. Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:129. [PMID: 38256390 PMCID: PMC10820898 DOI: 10.3390/medicina60010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/31/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.
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Affiliation(s)
- Katarina M. Raspopovic
- Institute for Children’s Diseases, Clinical Center of Montenegro, 81000 Podgorica, Montenegro;
| | - Dragic Bankovic
- Faculty of Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Aleksandra Petrovic
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Valentina Opancina
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Simon Nikolic
- Faculty of Medicine, University of Kosovska Mitrovica, 11000 Belgrade, Serbia;
| | - Radisa H. Vojinovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
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3
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Zhu Z, Kong W, Lu Y, Shi Y, Gan L, Tang H, Wang H, Sun Y. Epidemiological and clinical features of paediatric inpatients for scars: A retrospective study. Burns 2023; 49:1719-1728. [PMID: 36918334 DOI: 10.1016/j.burns.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To describe the epidemiological and clinical features of paediatric scar inpatients and then to facilitate therapeutic schedule for children with scars. METHODS In this cross-sectional study, data of patients admitted for scar treatment in 1064 tertiary hospitals from 2013 to 2018 were extracted through the Hospital Quality Monitoring System (HQMS) database. Demographic and clinical features of children with scars were analysed statistically and highlighted compared with those of adults and the elderly scar cases. RESULTS In this study, 53,741 paediatric scar cases, accounting for 30.29% of all hospitalized for scar, were analysed. Compared to adults and the elderly, children with scars were mainly males (62.27% vs 50.98% vs 49.85%, P < 0.001) and were vulnerable to scalds (37.10%) and operative intervention (34.11%). Although the scalp/face/neck was the most common affected location, the proportion of scars involving upper limbs (27.88% vs 21.69% vs 7.28%, P < 0.001), lower limbs (15.14% vs 10.28% vs 6.56%, P < 0.001) and perineum (4.59% vs 3.13% vs 2.65%, P < 0.001) was higher in children than that in other two groups. Scar contracture was the most common complications in children (45.27%). Nearly 66% of paediatric scar cases received surgical treatment during hospitalization, among whom release of lesion was the most frequent operation (56.35%). The proportion of keloids was relatively lower in child cases than in other two groups (6.20% vs 14.48% vs 18.15%, P < 0.001). Additionally, the median LOS in child cases was 9 (5-15) days, slightly exceeding that in adult/elderly cases. CONCLUSIONS Scars were common inducing factors of hospitalization and contributed greatly to the disease burden of children. More attention should be paid to those who are males, burn survivors, or skin-injured at extremities and perineum to improve therapeutic strategies and prognoses for paediatric scar patients.
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Affiliation(s)
- Zhe Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China; Clinic of the 91681 troop of PLA, Zhejiang, China
| | - Weishi Kong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yahuan Lu
- Department of Respiratory Medicine, Shanghai 411 Hospital, Shanghai, China
| | - Ying Shi
- China Standard Medical Information Research Centre, Shenzhen, China
| | - Lanxia Gan
- China Standard Medical Information Research Centre, Shenzhen, China
| | - Hongtai Tang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Haibo Wang
- Clinical Trial Unit, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Centre for Data Science in Health and Medicine, Peking University, Beijing, China.
| | - Yu Sun
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, Shanghai, China.
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Rosenblum S, Nardi-Moses T, Goez H, Demeter N. Children Who Experience Unintentional Injuries: Their Functional Profiles. Occup Ther Int 2022; 2022:6731339. [PMID: 36419546 PMCID: PMC9649315 DOI: 10.1155/2022/6731339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/15/2022] [Indexed: 11/14/2023] Open
Abstract
Unintentional injuries are accidents that pose a major health problem among school children. This study compared the functional behavior and executive function characteristics of school-aged children who experienced unintentional injuries with those of controls who had not been injured. We investigated the background characteristics of injured children, injury characteristics, and parents' perceptions of the children's functional behaviors and executive function abilities. The study included 53 children aged 6 years to 18 years. Of them, 32 had experienced unintentional injuries. The 21 children who had not experienced unintentional injuries served as a control group matched for age and living environment. Parents of both groups completed (1) a demographic questionnaire addressing their children's background, daily functional behavior characteristics, and injury characteristics and (2) the Behavior Rating Inventory of Executive Function (BRIEF). Sixty percent of the children in the research (injured) group had been prediagnosed with learning disabilities or attention deficit hyperactivity disorders, compared with no child in the control (uninjured) group. Most injuries were limb fractures (60%) and sustained outside the home (50%). Parents of children who had been injured expressed significantly more concerns about their children's daily behavior than did parents of the control group and reported their children as usually, but not always, independent and responsible. Compared with the children in the uninjured group, the children in the injured group had significantly lower executive function abilities in the BRIEF's eight subscales, total behavioral regulation and metacognitive indices, and global executive function scores (p < .001). Children with certain diagnoses, functional behavior features, and deficient executive function abilities may be at risk for unintentional injuries. Raising occupational therapists' awareness of these aspects may contribute to identifying, treating, and preventing accidental injuries among at-risk children.
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Affiliation(s)
- Sara Rosenblum
- Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
| | | | - Helly Goez
- Division of Rehabilitation Medicine and Developmental Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Canada
| | - Naor Demeter
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 3498838, Israel
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Zhang L, Liu J, Tang Y, Wang L. The impact of children's temperament on recurrent unintentional injuries: the role of paternal parenting styles as a mediator. PeerJ 2022; 10:e14128. [PMID: 36248711 PMCID: PMC9559059 DOI: 10.7717/peerj.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Background Unintentional injuries (UIs) pose a threat to the health of children all over the world and are a major global health problem. The recurrence of UIs are influenced by the host itself or environmental factors. Children's temperament and paternal parenting styles (PPS) are important potential factors for poor health outcomes, including recurrent unintentional injuries (recurrent UIs). Therefore, exploring the relationship among these variables may help reduce the likelihood of recurrent UIs in children. Purpose To elucidate the mediating effect of PPS in the relationship of children's temperament characteristics and recurrent UIs among children. Methods By multistage random cluster sampling method, a total of 2,850 pupils in grades four and five from 10 different schools were included. The survey included the characteristics of UIs in the past year, parenting styles, and children's temperament. Structural equation modeling (SEM) was used to examine the possible mediating effect of PPS between children's temperament and recurrent UIs. Results In this study, the incidence rate of recurrent UIs was 3.8%. In temperament, children with recurrent UIs had higher mean scores than the non-recurrent UIs group (t = -3.40, -3.52, -3.45, respectively; p < 0.001) in the activity, predictability, persistence. Meanwhile, the scores of negative PPS (punishing, over-interference, rejection, and overprotection) were higher in the recurrent UIs group than in the non-recurrent UIs group (t = -5.78, -5.05, -5.56, and -3.29; p < 0.001, < 0.001, < 0.001, < 0.001, respectively). Using a stepwise binary logistic regression model, grade (OR = 0.23, 95% CI [0.12-0.41], p < 0.001), activity (OR = 1.61, 95% CI [1.14-2.26], p = 0.007) and over-interference (OR = 2.28, 95% CI [1.37-3.80], p = 0.002) had a significant independent relationship with recurrent UIs. The SEM results indicated that children's temperament was significantly related to negative PPS (β = 0.26, p < 0.001) and recurrent UIs (β = 0.11, p = 0.029). The results of the bootstrap test confirmed the significance of the mediating effect of PPS (β = 0.06, p < 0.001) between children's temperament and recurrent UIs. Conclusions These results suggest that negative PPS plays an important role in mediating children's temperament and recurrent UIs. It is essential to consider PPS when creating tailored intervention programs to reduce children's recurrent UIs.
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Jović D, Skela-Savič B, Petrović-Tepić S, Knežević D, Tepić A, Burgić-Radmanović M, Dobrovoljski D, Egeljić-Mihailović N. Unintentional injuries of children and adolescents treated in emergency medical services: A cross-sectional study. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-40755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background/Aim: Unintentional injuries among children and adolescents have become a common issue in public healthcare. The study objective was to analyse the characteristics and identify predictors associated with unintentional injuries in children and adolescents treated in emergency medical services (EMS) in the Republic of Srpska, Bosnia and Herzegovina. Methods: A cross-section study with retrospective analysis of WebMedic e-database from 14 EMS, in the period between January 2018 and December 2020 was conducted. Research included patients with unintentional injuries, aged ≤ 19 years, of both sexes. For comparison between groups, Chi-squared and multivariate logistic regression were used in risk factor analysis. Results: A total of 1,856 cases were identified, most injuries resulted from falls (46.7 %) and traffic injuries (26.9 %). Boys were significantly more affected by injuries than girls (p < 0.001). Falls were the major cause for reporting to EMS among age groups of children (0-9 years) and adolescents (10-14 years), whereas injuries in traffic were dominant in adolescents aged 15 to 19. The most common injuries were head injuries (35.7 %). Risk factors of unintentional injuries were age (p < 0.001), sex (p = 0.046), weekday (p = 0.016), winter (p = 0.014), body region (head, abdomen, lower and upper limbs (p < 0.001), thorax (p = 0.009)). Conclusions: There were significant differences in characteristics of unintentional injuries according to age and sex. Chances for occurrence of unintentional injuries among children increased with their age, especially for boys. These differences might indicate areas where preventive measures should be undertaken.
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Ma X, Zhang Q, Jiang R, Lu J, Wang H, Xia Q, Zheng J, Deng W, Chang F, Li X. Parents' attitudes as mediators between knowledge and behaviours in unintentional injuries at home of children aged 0-3 in Shanghai, Eastern China: a cross-sectional study. BMJ Open 2021; 11:e054228. [PMID: 34949628 PMCID: PMC8712987 DOI: 10.1136/bmjopen-2021-054228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Parental behaviours are important in preventing unintentional injury at home among young children. Previous research showed an inconsistent relationship between knowledge and behaviours, indicating that the mechanisms may vary for different behaviours. This study aimed to examine the mediating roles of different attitudes in the mechanism of knowledge acting on different behaviours. DESIGN Cross-sectional study. SETTING Eastern China. PARTICIPANTS Participants were recruited using stratified community-based sampling. A total of 488 parents of children aged 0-3 years participated in the study and 476 (97.5%) valid questionnaires were recovered. PRIMARY OUTCOME MEASURES Parents' knowledge, attitudes (including injury attribution, preventability and responsibility) and behaviours (including supervision behaviours, risky behaviours and providing a safe home environment). RESULTS The results of mediation analysis showed that the mediator variables were different for different behaviours and that all associations were positive. Parents' knowledge (β 0.19, 95% CI 0.13 to 0.24) and attitude of injury attribution (β 0.37, 95% CI 0.21 to 0.46) were directly associated with risky behaviours. Attitude of preventability was directly associated with parents' supervision behaviour (β 0.27, 95% CI 0.14 to 0.40). Parents' attitude of preventability mediated the positive association between knowledge, attitudes of injury attribution and responsibility, and supervision behaviours, as well as providing a safe home environment. In addition, the occurrence of child injuries at home was directly associated with home environment (β -0.41, 95% CI -0.82 to -0.01). CONCLUSIONS The current findings confirm that attitudes play varying mediating roles between knowledge and different behaviours. An important recommendation is that parents' attitudes, especially towards preventability and responsibility, need to be considered when health providers develop health education programmes targeted at improving parental supervision behaviours and providing a safe home environment.
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Affiliation(s)
- Xueqi Ma
- School of Public Health, Fudan University, Shanghai, China
- China Research Center on Disability, Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia, USA
| | - Ruo Jiang
- School of Public Health, Fudan University, Shanghai, China
- China Research Center on Disability, Fudan University, Shanghai, China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai, China
- China Research Center on Disability, Fudan University, Shanghai, China
| | - Huiping Wang
- Preventive Health Department, Community Health Centre of Jiading Town, Shanghai, China
| | - Qinghua Xia
- Chronic Disease Prevention and Control Department, Changning District Center for Disease Control and Prevention, Shanghai, China
| | - Jicui Zheng
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Deng
- School of Public Health, Fudan University, Shanghai, China
| | - Fengshui Chang
- School of Public Health, Fudan University, Shanghai, China
- China Research Center on Disability, Fudan University, Shanghai, China
| | - Xiaohong Li
- School of Public Health, Fudan University, Shanghai, China
- China Research Center on Disability, Fudan University, Shanghai, China
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Le PA, Hoang VM, Tran TTH, Khuong QL, Takeuchi M, Nguyen TL, Pham TQN, Le VT, Tran QB, Park K. Violence and non-fatal injuries among Vietnamese in-school adolescents: national prevalence estimates and associated factors. Int J Inj Contr Saf Promot 2021; 29:197-206. [PMID: 34547990 DOI: 10.1080/17457300.2021.1979046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
School violence and injury are major public health problems worldwide. The data of this study were from the Viet Nam Global School-based Student Health Survey (GSHS) - a nationally representative survey conducted in 2019, with a sample size of 7690 students aged 13-17 years old. We found the prevalence of violence and non-fatal injury to be 14.5% and 21.4%, respectively. Factors related to higher odds of violence and non-fatal injuries in both sexes included smoking cigarettes, drinking alcohol, having mental health problems (loneliness, worrying and suicidal thinking), and truancy. In contrast, parental monitoring was associated with lower odds of violence, and parental respect was a protective factor of both violence and non-fatal injuries. Students who experienced violence had a higher likelihood of having non-fatal injuries in both sexes. Future policies should consider individual factors and parent-child bonding, to mitigate the burden of violence and injury among in-school adolescents in Viet Nam.
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Affiliation(s)
- Phuong-Anh Le
- World Health Organization, Country Office for Viet Nam, Ha Noi, Viet Nam
| | - Van Minh Hoang
- Center for Population Health Science, Ha Noi University of Public Health, Ha Noi, Viet Nam
| | - Thi Tuyet Hanh Tran
- Department of Environmental Health, Ha Noi University of Public Health, Ha Noi, Viet Nam
| | - Quynh Long Khuong
- Center for Population Health Science, Ha Noi University of Public Health, Ha Noi, Viet Nam
| | - Momoe Takeuchi
- World Health Organization, Country Office for Viet Nam, Ha Noi, Viet Nam
| | - Tuan Lam Nguyen
- World Health Organization, Country Office for Viet Nam, Ha Noi, Viet Nam
| | - Thi Quynh Nga Pham
- World Health Organization, Country Office for Viet Nam, Ha Noi, Viet Nam
| | - Van Tuan Le
- Department of Student Affairs, Ministry of Education and Training, Ha Noi, Viet Nam
| | - Quoc Bao Tran
- General Department of Preventive Medicine, Ministry of Health, Ha Noi, Viet Nam
| | - Kidong Park
- World Health Organization, Country Office for Viet Nam, Ha Noi, Viet Nam
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Reddy B V, Pundhir A, Gupta A. Unintentional injury and its determinants among adolescents. J Public Health Res 2021; 10. [PMID: 34313092 PMCID: PMC8696390 DOI: 10.4081/jphr.2021.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Globally, unintentional injury has been a documented public health problem among adolescents having debilitating consequences and accountable for economic burden. The study was undertaken to estimate the prevalence of unintentional injury, identify the determinants and consequences among adolescents. Design and Methods: This cross-sectional study recruited 222 adolescents using systematic random sampling from a site covered under UHTC Srinagar Garhwal, Uttarkhand. Binary and multivariate logistic regression was used to compute crude and adjusted odds ratio (95% CI) for establishing an association between risk factors and unintentional injury. Descriptive measures (causes, consequences, etc.) describing injuries were presented in tabular, graphical form in proportions. Results: 73.1% of the adolescents suffered from unintentional injury. The risk factors associated (statistically insignificant) with unintentional injury was males (AOR=1.019, 95% CI=0.524-1.979), living in nuclear family (AOR=1.540, 95% C =0.766-3.093), smoked tobacco (AO=2.797, 95% CI=0.227-34.4377), visually impaired (AOR=1.629 95% CI=0.548-6.458) and living in house with overcrowding (AOR =1.66, 95% CI=0.818-3.395). Five percent of those affected with unintentional injury had disability.% of those affected with unintentional injury had disability. Conclusions: Health education addressing causes, risk factors, consequences of unintentional injury among adolescents, parents, school, and district health authorities should be mandated for the formulation of policy to prevent unintentional injuries. Significance for public health Adolescence is often a period of life that connects adolescence to maturity and is marked by significant physical, psychological, and social changes. The country's changing disease profile is profoundly embedded in the country's recent social, fiscal, and environmental developments. The cost of adolescent accidental injury to the country is rising as a result of damage and death. As a result, avoiding accidental accidents is crucial. More evidence on the overall costs and benefits of injury prevention is also required. This will assist governments in prioritising investments, and it is a subject on which leading scholars and organisations will collaborate. Injury prevention can be low-cost, with a high return on investment in terms of preventable years of life loss and disability-adjusted life years for young children.
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Affiliation(s)
- Venkatashiva Reddy B
- Department of Community Medicine, NRI Academy of Medical Sciences, Chinna Kakani, Guntur, Andhra Pradesh.
| | - Ashish Pundhir
- Department of Community Medicine, Rama Medical College, Kanpur, Uttar Pradesh.
| | - Arti Gupta
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh.
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Aboagye RG, Seidu AA, Bosoka SA, Hagan JE, Ahinkorah BO. Prevalence and Correlates of Unintentional Injuries among In-School Adolescents in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136800. [PMID: 34202752 PMCID: PMC8297100 DOI: 10.3390/ijerph18136800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/27/2022]
Abstract
Injuries among adolescents pose significant public health problems. Unintentional injuries are the leading cause of adolescents’ mortality and disability with the largest burden in low-and middle-income countries. Yet, there is paucity of data in Ghana on adolescent injuries. The present study aimed to determine the prevalence and correlates of unintentional injuries among in-school adolescents in Ghana using data from the Global School-Based Health Survey. Cross-sectional data on 2058 adolescents in junior and senior high schools who randomly participated in the 2012 Global School-Based Health Survey were analyzed. Descriptive statistics were performed to determine the prevalence of unintentional injuriesacross the background characteristics of in-school adolescents. Binary logistic regression was employed to determine the factors associated with unintentional injuries. The results were presented as crude and adjusted odds ratios at a 95% confidence interval. The prevalence of one or more serious injuries in the past 12 months was 57.0%. The most commonly reported type and cause of injuries were “I had a cut or stab wound” (15.2%) and “I fell” (13.1%), respectively. In the adjusted regression, in-school adolescents aged 14–16 (aOR = 1.60, CI = 1.12–2.28) were more likely to report one or more serious injuries compared to their counterparts aged 13 or younger. In-school adolescents who participated in physical education (aOR = 1.27, CI = 1.03–1.58) had higher odds of reporting one or more serious injuries. The odds of being injured was higher among adolescents who were truant at school compared to those who were not truant (aOR = 1.42, CI = 1.14–1.77) In-school adolescents who were bullied were more likely to report being injured one or multiple times compared to their counterparts who were not bullied (aOR = 2.16, CI = 1.75–2.65). In addition, the odds of being injured once or multiple times were higher among adolescents who were physically attacked (aOR = 2.21, CI = 1.78–2.75), those that engaged in physical fighting (aOR = 1.94, CI = 1.54–2.45), and those who reported high psychological distress (aOR = 2.00, CI = 1.52–2.63) compared to their counterparts who were not. Conversely, adolescents in senior high schools were 39% less likely to be injured once or multiple times compared to those in junior high schools (aOR = 0.61, CI = 0.47–0.79). A relatively high prevalence of unintentional injuries was found among in-school adolescents in the study. The numerous factors identified in this study could be integrated into health promotion and injury prevention activities to help reduce the occurrence of injuries among in-school adolescents. Moreover, students who are susceptible to unintended injuries such as older adolescents, victims of bullying, those who participate in physical education, those who are often involved in fights, truants, and those who have psychological distress should be sensitized to take measures that will reduce their level of susceptibility. First aid treatment services should also be made available in schools to treat victims of unintended injuries.
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Affiliation(s)
- Richard Gyan Aboagye
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe PMB 31, Ghana;
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast PMB TF0494, Ghana;
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Department of Estate Management, Takoradi Technical University, Takoradi P.O. Box 256, Ghana
| | - Samuel Adolf Bosoka
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe PMB 31, Ghana;
| | - John Elvis Hagan
- Physical Education and Recreation, Department of Health, University of Cape Coast, Cape Coast PMB TF0494, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 100131, 33501 Bielefeld, Germany
- Correspondence:
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia;
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11
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Yin X, Li D, Zhu K, Liang X, Peng S, Tan A, Du Y. Comparison of Intentional and Unintentional Injuries Among Chinese Children and Adolescents. J Epidemiol 2020; 30:529-536. [PMID: 31708510 PMCID: PMC7661334 DOI: 10.2188/jea.je20190152] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The patterns and risk factors of intentional injuries compared to unintentional injuries among Chinese children and adolescents have not been examined in depth. This work comprehensively describes patterns of intentional injuries in China, for which little information has been previously published. METHODS All cases involving individuals 0-17 years old registered at emergency rooms and outpatient clinics were examined using data submitted to the National Injury Surveillance System from 2006 through 2017. A logistic regression model was performed to explore the risk factors related to intentional injuries compared to unintentional injuries. RESULTS A total of 81,459 (95.1%) unintentional injuries, 4,218 (4.9%) intentional injuries (4,013 violent attacks and 205 self-mutilation/suicide) cases were identified. Blunt injuries accounted for 59.4% of violent attacks, while cuts and poisoning accounted for 37.1% and 23.4% of injuries involving self-mutilation/suicide, respectively. For unintentional injuries, falls (50.4%) ranked first. Additional risk factors for intentional injuries included being male (odds ratio [OR] 1.6), coming from rural areas (OR 1.9), being staff or workers (OR 2.2), and being a student (OR 1.8). As the age of the patients increased, so did the risk of intentional injuries (OR 5.0 in the 15-17 age group). Intentional injuries were more likely to occur at 00:00-03:00 am (OR 2.0). CONCLUSIONS Intentional injuries affected more males, rural and older children, school students, and staff or workers. The mechanisms and occurrence times differed according to age group. Preventive measures should be taken to reduce the dropout of rural students, strengthen the school's violence prevention plan, and reduce self-harm.
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Affiliation(s)
- Xiling Yin
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology.,Zhuhai Center of Disease Control and Prevention
| | - Deyun Li
- Zhuhai Center of Disease Control and Prevention
| | - Kejing Zhu
- Zhuhai Center of Disease Control and Prevention
| | | | - Songxu Peng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology
| | - Aijun Tan
- Zhuhai Center of Disease Control and Prevention
| | - Yukai Du
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology
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12
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Wickramasinghe S, Gunawardena NS, Punyadasa D, Gunawardena S, Wickramasinghe C, Lokubalasooriya A, Peiris R, Senanayake S. Serious non-fatal unintentional injuries among in-school adolescents in Sri Lanka: results from the 2016 Sri Lankan global school-based health survey. BMC Public Health 2020; 20:1697. [PMID: 33183265 PMCID: PMC7664062 DOI: 10.1186/s12889-020-09839-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/04/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Unintentional injuries among adolescents is a major public health problem the world over. A great majority of the annual deaths among adolescents is due to unintentional injuries; it is also the leading cause of death among adolescents in the world. The aim of this study was to estimate the incidence of injuries and their associated factors among school going adolescents aged 13-17 years using data from the most recent Global School-Based Health Survey (GSHS) conducted in Sri Lanka. METHODS A cross-sectional survey was conducted using a self-administered questionnaire, among 3262 adolescents attending government schools. The sample was selected through a two-staged cluster sampling technique. In the first stage, 40 schools were selected using probabilities proportional to school enrollment size, from all schools in the country that have classes in grades 8-12. Then, from the selected schools, classes were selected using systematic equal probability sampling with a random start. The weighted prevalence was calculated, and logistic regression analysis was conducted in order to determine the correlates. RESULTS During the 12 months before the survey, 35.8% (95% CI-30.7 - 41.1) of the students reported being seriously injured one or more times. The injuries were more common among males, but were equally common among the two different age groups (13-15 age group vs 16-17 age group). The most common type of injury was cut or stab wounds (5.5%), followed by broken bones/dislocated joints (5.3%). Multivariable analysis revealed that only a few factors were associated with injury, such as being of the male sex, being bullied, being physically attacked, and/or being in a physical fight. CONCLUSION This study demonstrated that the prevalence of serious unintentional injuries among school going adolescents is a major public health problem in Sri Lanka. This timely and comprehensive survey would help policy makers and researchers identify the unmet needs related to adolescent injuries. Furthermore, evidence generated form the study should be given due consideration when designing school-based interventions to prevent adolescent injuries.
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13
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Bardón Cancho EJ, Arribas Sánchez C, Rivas García A, Lorente Romero J, Vázquez López P, Marañón Pardillo R. Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Wang Z, Chen H, Yu T, Liu S, Hu M. Status of injuries as a public health burden among children and adolescents in China: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17671. [PMID: 31702619 PMCID: PMC6855559 DOI: 10.1097/md.0000000000017671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Injuries among children and adolescents remain a major public health problem in China. In the present study, we undertook a systematic review and meta-analysis of the published literature of epidemiological studies investigating injuries among children and adolescents in China and aimed to describe the status of injury among children and adolescents (aged 0-19 years) in China nationwide. A random-effects meta-analysis model was used to calculate the pooled prevalence of injury with 95% confidence intervals (CIs) across studies. The potential heterogeneity moderators were identified by subgroup and sensitivity analysis. A total of 775,615 children and adolescents were included in this study. Overall, the pooled injury prevalence among children and adolescents aged 0 to 19 years was 23.0% (95% CI 20.0%-27.0%) in studies using 1996 version of injury definition, and 13.0% (95% CI 10.0%-17.0%) in studies using 2004 version of injury definition. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. CONCLUSION Our study shows a moderately high injury prevalence among children and adolescents aged 0 to 19 years in China, more prevention policies and programs should be urgently developed to decrease the occurrence of child and adolescent injury.
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Affiliation(s)
- Ziyu Wang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha
| | - Hui Chen
- Department of Medicine, Betta Pharmaceuticals Co., Ltd., Hangzhou
| | - Taolin Yu
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha
| | - Siyun Liu
- Department of Medical Records, Chongqing General Hospital, Chongqing, China
| | - Ming Hu
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha
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15
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Bardón Cancho EJ, Arribas Sánchez C, Rivas García A, Lorente Romero J, Vázquez López P, Marañón Pardillo R. [Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain]. An Pediatr (Barc) 2019; 92:132-140. [PMID: 31266733 DOI: 10.1016/j.anpedi.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Thirty-eight million patients with injuries are treated in Emergency Departments every year, 90% of them being in the form of unintentional injuries (UIs). There are currently no global records of its management in Spain, or the risk factors that may be associated with them. The objective of this study is to describe the management of UIs in Spanish paediatric emergency departments, and to analyse factors related to the presence of serious injuries. MATERIAL AND METHODS A sub-study of a prospective multicentre observational study conducted over 12months in 11hospitals of the Spanish Paediatric Emergency Research Group (RiSEUP-SPERG), including children from 0 to 16years of age consulting for UIs. Epidemiological data, circumstances of the injury, and data on emergency care and discharge destination were recorded on the 13th day of each month. RESULTS A total of 10,175 episodes were recorded, of which 1,941 were UIs (19.1%), including 1,673, of which 257 (15.4%) were severe. The most frequent complementary test was simple radiography (60.0%), and the most frequent procedure was limb immobilisation (38.6%). A significant relationship was found between presenting with a severe UI and age >5 years (OR2.24; 95%CI: 1.61-3.16), history of fracture (OR2.05; 95%CI: 1.22-3.43), or sports activity as a mechanism of injury (OR1.76; 95%CI: 1.29-2.38), among others. CONCLUSION In Spain, most UIs are not serious. X-rays and immobilisation of extremities are the most frequently performed tests and procedures. Severe UIs were associated with individual factors, such as age >5years or history of fracture, and with sports activity as a mechanism associated with severity. It is vital to implement measures to improve the prevention of these injuries and to support the training of caregivers through educational programmes.
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Affiliation(s)
- Eduardo J Bardón Cancho
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Cristina Arribas Sánchez
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Arístides Rivas García
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jorge Lorente Romero
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Paula Vázquez López
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Rafael Marañón Pardillo
- Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, España
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16
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Han L, You D, Gao X, Duan S, Hu G, Wang H, Liu S, Zeng F. Unintentional injuries and violence among adolescents aged 12-15 years in 68 low-income and middle-income countries: a secondary analysis of data from the Global School-Based Student Health Survey. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:616-626. [PMID: 31278043 DOI: 10.1016/s2352-4642(19)30195-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Injuries and violence account for a substantial proportion of the global burden of disease in adolescents, especially among low-income and middle-income countries (LMICs). We aimed to compare the prevalence of unintentional injuries and violence among young adolescents in LMICs. METHODS We did a secondary analysis of data from the Global School-based Student Health Survey (GSHS) for adolescents aged 12-15 years from LMICs collected between 2009 and 2015. Survey data was collected using a standardised questionnaire. We used survey data to calculate the overall prevalence of serious injuries and violence (eg, physical attack, physical fighting) and bullying per country. We did a random-effects meta-analysis to calculate pooled overall and regional estimates. We also did subgroup analyses stratified by sex, age (12-13 years vs 14-15 years), and time period (2009-11 vs 2012-15). Logistic regression models adjusted for sex, weights, stratum, and primary sampling unit were used to analyse the differences in prevalence of serious injuries, violence, and bullying. FINDINGS We included data from 68 LMICs, including 164 633 young adolescents (77 707 [47·2%] boys; 86 926 [52·8%] girls). The overall prevalence of physical attack, physical fighting, and serious injuries during the past 12 months were 35·6% (95% CI 30·7-40·5), 36·4% (29·9-42·9), and 42·9% (39·0-46·9), respectively. Prevalence varied by WHO region and was higher among boys than girls for injuries (47·8% vs 37·5%, p=0·00094), physical attack (41·0% vs 29·4%, p=0·001), and physical fighting (45·5% vs 26·9%, p<0·0001). Fractures (22·6%, 95% CI 19·1-26·1) and cuts (21·8%, 16·8-26·8) were the most common types of serious injury, and falling was the main cause of these injuries (33·1%, 30·2-35·9). The overall prevalence of bullying at least once in the past 30 days was 34·4% (27·1-41·7), irrespective of age and sex. The most common types of bullying were physical (18·3%, 13·7-23·0), verbal-sexual (13·2%, 10·2-16·2), and racial-ethnic (11·6%, 9·2-14·0). INTERPRETATION The prevalence of unintentional injuries and violence remain high among young adolescents in LMICs. These countries should prioritise the development of anti-violence and anti-injury programmes to improve health in their young adolescent populations. FUNDING National Natural Science Foundation of China, National Key R&D Program of China, Natural Science Foundation of Zhejiang Province, Sanming Project of Medicine in Shenzhen, K.C. Wong Magna Fund in Ningbo University, and Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention.
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Affiliation(s)
- Liyuan Han
- Department of Epidemiology, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Dingyun You
- Department of Epidemiology, School of Public Health, Kunming Medical University, Kunming, China
| | - Xuping Gao
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Shiwei Duan
- Department of Epidemiology, Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fangfang Zeng
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China.
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López-Soto PJ, Morales-Cané I, Smolensky MH, Manfredini R, Dios-Guerra C, Rodríguez-Borrego MA, Carmona-Torres JM. Gender, socioeconomic, medical, and environmental factors related to domestic accidents of the elderly in Spain. Findings of a national survey. Women Health 2019; 59:985-996. [PMID: 30880631 DOI: 10.1080/03630242.2019.1587665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Domestic accidents pose serious threats to the independence of the elderly. We explored associations between domestic accidents and gender, socioeconomic, medical, and environmental factors using data from the European Health Survey 2014 for elderly Spanish female and male nationals. Records of 5960 participants (mean age ± SD: 75.9 ± 7.6 years), 59.8% of whom were women, were examined. Domestic accidents occurred in 460 (7.1%) seniors, predominately in women (78.5%). Age (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 1.00-1.03, p = .003], female gender (aOR 2.04 [95% CI 1.60-2.60, p < .001]), difficulty managing 12 stairs (reference: none) (some: aOR 2.03 [95% CI 1.53-2.68, p < .001]; much: aOR 2.88 [95% CI 2.15-3.87, p < .001]; inability: aOR 3.09 [95% CI 2.14-4.45, p < .001]), and depressive symptoms severity (reference: absent) (mild: aOR 1.44 [95% CI 1.10-1.89, p = .008]; moderate: aOR 1.91 [95% CI 1.35-2.71, p < .001];. Very severe: aOR 2.53 [95% CI 1.72-3.71, p < .001]; extremely severe: aOR 2.38 [95% CI 1.45-3.93, p = .001]) were independently associated with domestic accidents. Severity of depressive symptoms was the most prominent feature for women, while inability to manage 12 stairs was the most prominent for men. Our results suggest important gender differences in factors associated with domestic accidents that are relevant to intervention and preventive programs.
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Affiliation(s)
- Pablo J López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain
| | - Ignacio Morales-Cané
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin , Austin , TX , USA
| | - Roberto Manfredini
- Clinica Medica, Department of Medical Sciences, University of Ferrara , Ferrara , Italy
| | - Caridad Dios-Guerra
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain
| | - María Aurora Rodríguez-Borrego
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,Department of Nursing, University of Cordoba , Córdoba , Spain.,Department of Nursing, Reina Sofia University Hospital , Córdoba , Spain
| | - Juan Manuel Carmona-Torres
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC) , Córdoba , Spain.,School of Nursing and Physiotherapy, University of Castilla-La Mancha (UCLM) , Ciudad Real , Spain
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