School-injury determinants and characteristics: developing an investigation instrument from a literature review

School environment and school injuries

Background: Although injuries at school are an important issue in public health, environmental factors in schools and school yards have seldom been the focus of school injury research. The goal of our investigation was to examine the effect of environmental factors on school injuries.

Methods: Nine comprehensive Finnish schools registered school injuries over a period of two school years. Injuries were classified as being associated with environmental factors, suspected environmental factors, and others. The consensus between two independent classifiers was 81%.

Results: A total of 722 injuries were classified. In 11.6% of these injuries, the physical environment factor was evident, and in 28.1% of the injuries, physical environment was suspected of being a contributory risk factor. Thus the physical environment of the school was a contributing factor in over a third (39.7%) of injuries occurring in the school, on the school yard or during the journey to, or from school. In this study, conducted in Finland, ice on the ground was mentioned most frequently as an environmental risk factor.

Conclusion: In Finland, the Nordic weather conditions are not taken into account in the school yard and playground plans as they ought to from the safety point of view. An initiative has been launched on a mandatory wintertime master plan for every school yard.

Unintentional injuries at school in China--patterns and risk factors

OBJECTIVE

To describe the rate and pattern of unintentional school injuries among primary and middle school students and to explore the major risk factors involved.

STUDY DESIGN

A cross-sectional survey of more than 10,000 students attending 6 primary and 4 middle schools selected randomly from all schools in Maanshan City of Anhui Province in eastern China was conducted to collect information on school injuries occurring in the 12-month period before the survey. Rate ratios for risk factors were estimated using the negative binomial regression analysis.

RESULTS

The annual person-based school injury rate was 5.22 (95% CI: 3.90-6.53) percent. The annual event-based injury rate was 5.40 (95% CI: 4.04-6.76) per 100 students. Most injuries in school were relatively mild and only 1.53% (9/590) of the episodes resulted in hospitalization. The most frequent injures were falls (73%), and the most commonly injured sites were the upper limbs (46%). Male sex, primary school grades, poor health status, poor ability to concentrate, bad risk-taking behavior and high study-related stress were important risk factors.

CONCLUSION

This study provided useful baseline information on school injuries in China and identified important risk factors that would be important in planning prevention strategies.

Do changes in the psychosocial school environment influence pupils' health development? Results from a three-year follow-up study

AIMS

This study analysed the effects of psychosocial factors at school on pupils' health and self-worth from a longitudinal perspective.

METHODS

A three-year prospective study was started in 1994, including 533 pupils (261 girls, 272 boys) from 25 different classes in grades 3 and 6. With age-adjusted questionnaires the changes in self-perceived health were compared with changes in psychosocial school environmental factors.

RESULTS

The girls in the older cohort reported a negative health development with decreased self-worth and increased somatic and psychological symptoms. Significant gender differences in ill health, but not in self-worth, developed, especially in the older cohort. A multiple regression analysis showed that a negative development of psychosocial factors at school, measured as control, demand, and classmate problems, was associated with poorer health and self-worth among the pupils. A trichotomization of the psychosocial variables at school indicated a possible causal relationship between psychosocial factors and ill health and self-worth.

CONCLUSIONS

The negative development in pupils' health and self-worth could partly be explained by the more unfavourable psychosocial environment that prevails at school at the senior level. The public health implications of our study can be summarized as the need for schools to improve pupils' social situation at school in relation to their work situation as well as to pay special attention to the school situation of girls at senior level.

Evaluation of the Utah student injury reporting system

The Utah Student Injury Reporting System (SIRS), implemented in 1984 to monitor injuries to students in grades K-12 in Utah schools, has served as a model for surveillance systems created by other states and some European countries. This paper evaluates the Utah experience in developing and administering the SIRS. The evaluation identifies usefulness of the system, discusses the sensitivity of the system in detecting school injuries, estimates the system's costs, and provides suggestions to other states and districts interested in building a cost-effective and efficient surveillance instrument.

Secondary school accident reporting in one education authority

BACKGROUND

Secondary schools appear to have very different accident rates when they are compared on the basis of accident report returns. The variation may be as a result of real differences in accident rates or different reporting procedures. This study investigates accident reporting from secondary schools and, in particular, the role of the school nurse.

METHODS

Accident form returns covering a 2-year period were collected for statistical analysis from 13 comprehensive schools in one local education authority in Wales. School sites were visited in the following school year to obtain information about accident records held on site and accident reporting procedures.

RESULTS

The main factors determining the number of school accident reports submitted to the education authority relate to differences in recording and reporting procedures, such as the employment of a nurse and the policy of the head teacher/safety officer on submitting accident returns. Accident and emergency department referrals from similar schools may show significant differences in specific injuries and their causes.

CONCLUSIONS

The level of school accident activity cannot be gauged from reports submitted to the education authority. Lack of incentives for collecting good accident data, in conjunction with the degree of complacency in the current system, suggest that future accident rates and reporting activity are unlikely to change.

Pupil injury risks as a function of physical and psychosocial environmental problems experienced at school

OBJECTIVES

To investigate relations between physical and psychosocial environmental problems in schools, as perceived by school principals, and injuries among pupils.

METHOD

Proportionate injury ratios (PIRs) were computed for 77 public sector Swedish schools (33,248 pupils), and divided into four classes based on types of environmental problems reported. Sports related injuries, injuries during recesses, and violence related injuries were considered.

RESULTS

The schools reporting psychosocial problems (9.1% of schools and 7.3% of pupils) had more injuries than expected by chance than all types of injuries aggregated (PIR = 1.92; 95% confidence interval (CI) 1.64 to 2.27), and in the case of sports related injuries (PIR = 1.79; 95% CI 1.37 to 2.34) and injuries due to physical violence (PIR = 2.20; 95% CI 1.33 to 3.65). There were no significant excess risks of injuries for schools facing physical problems or a combination of physical and psychosocial problems.

CONCLUSIONS

Psychosocial problems may exacerbate the risk of intentional and unintentional injuries among pupils. The results offer a reminder that school environment must be planned as part of any assessment of youth safety.

Solving a linear model of nonfatal risk behavior and injuries in school children

A calculating method and computer program have been developed for solving an overdetermined system of linear equations. It was applied for calculation of group risk exposure of school children (10-15 years) to nonfatal injuries in sport recreation and playing (SRP). Interviewed non-injured school children were separated into non-overlapping groups of risky behavior. Data on interviewed non-injured and non-interviewed injured children were put into a linear system of equations consisting of a 4 x 3 matrix scheme. Each equation represents children of the same age and sex and consists of the percentage of interviewed children grouped into high medium or low risk behavior and of the percentage of injured children. Four methods of calculating the matrix system were evaluated and the best implemented as a new developed computer program. The resulting linear group risk factors enable the prediction of behavior outcome. Data on interviewed injured children were compared with the results obtained. The validation procedure is proposed by testing the sensitivity and robustness of the method.

Injuries to boys and girls in Swedish schools: different activities, different results?

The study examines gender-related injury frequency by the type of school activity. Data were taken from an injury register created during the school year 1996/97 with the help of 79 Swedish public-sector schools. Injury ratios (IRs) by gender, type of municipality, and type of school were computed for injuries during all types of activities, for sports-related injuries, and for injuries sustained during recess periods. IRs were higher among boys for recess activities, and among girls for sports activities. IRs showed major variation by type of school, and minor variation by type of municipality. Schools catering for pupils aged 7-12 years had the highest IRs for all groups of injuries, both on aggregate and by gender. Gender-related injury-event occurrence at school clearly varies with kind of activity, but less so with age of pupils. The extent to which this reflects individual differences rather than varying exposure is uncertain.

Multiple attribute entropy classification of school-age injuries

The data exploration task in epidemiology of school children injuries is aimed at defining specific risk groups that can be further analyzed for definition of prevention measures. These groups are selected by means of entropy classification of relevant data collected in the Koprivnica district, Croatia. The necessary pruning procedure for the entropy classification tree is proposed for: (a) entropy increase for uniformly populated classes, and (b) entropy decrease for the case of zeros in a class. The second reason for pruning is emphasized for multiple (> 3) attribute descriptions of injury events because the number of classes increases exponentially with the number of attributes. Four possible prevention groups have been found by entropy classification: (1) dislocation, sprain and strain injuries, mostly on legs of both age groups of boys (7-10 years, 11-14 years) in/around the house activities; (2) arm fractures of all boys in/around the house activities; (3) open wounds mostly of the head, in younger boys at school, and open wounds in younger boys in road traffic; and (4) contusions mostly on arms, of older girls at school and contusions in older boys in road traffic accidents. These groups comprise 57.2% of all considered cases.