The role of public policy in reducing moped and scooter injuries in South Carolina

INTRODUCTION

Mopeds and electric scooters have grown in popularity in recent years. A South Carolina (SC) law was passed on November 19, 2018, aimed to regulate mopeds and scooters. This study aims to evaluate whether this SC law was associated with a decrease in the moped injury rate in a Level 1 Trauma Center.

METHODS

A retrospective review of trauma registry data was used to identify a cohort of patients 14 years and older who came to a Level 1 trauma center for a moped/scooter accident between January 2014 - December 2022. The proportion of moped injuries before and after the passing of the law was calculated. The chi-square test and Wilcoxon Rank Sum test were used to compare differences in proportions for categorical factors and continuous factors, respectively.

RESULTS

A total of 350 moped injury cases were identified. There was a significant decrease in the moped injury rate after the passing of the 2018 SC law (0.9 % vs 1.8 %, p<0.001). Additionally, those treated post-law implementation were significantly older (47.4 vs 43.2 years, p = 0.013) and more likely to be male (95.5 % vs 87.9 %, p = 0.025) than those treated pre-law. Patients treated post-law were significantly more likely to be uninsured (45.1 % vs 42.7 %, p = 0.009) and less likely to have commercial (16.2 % vs 20.1 %, p = 0.009), or government (29.7 % vs 35.6 %, p = 0.009) health insurance compared to those treated pre-law. There was no significant difference between the two groups in Glascow Coma Scale, Injury severity score, Trauma Injury Severity Score, or rate of fatalities.

CONCLUSION

After the implementation of a SC law, we found that the local proportion of injuries due to moped and scooter accidents was significantly lower than pre-law proportions. These findings suggest that public policies aimed at increasing regulations for mopeds may decrease the rate of injury, but not severity, from moped use.

Comparisons of musculoskeletal injuries among three different modalities of Taekwondo (Kyorugi, Poomsae, and Shibum): a one-year follow-up prospective epidemiologic study

The purpose of the study was to report the injury rates and characteristics (body location, type, mechanism, and severity) of musculoskeletal injuries in Kyorugi, Poomsae, and Shibum. A total of 137 Korean collegiate Taekwondo players - Kyorugi (n = 44), Poomsae (n = 46), and Shibum (n = 47) - were prospectively studied in 2019. Injury rates per 1,000 athlete-exposures (AEs) and time-exposures (TEs) during training and competition were calculated. Additionally, body location, type, mechanism, and severity of injury were analysed. The highest injury rate was recorded in Poomsae (172.0/1,000 AEs and 79.5/1,000 TEs) followed by Kyorugi (47.1/1,000 AEs and 25.9/1,000 TEs) and Shibum (57.5/1,000 AEs and 17.0/1,000 TEs). The frequently injured body location was the thigh (Kyorugi = 17%; Poomsae = 25%; Shibum = 18%). The common injury types were muscle cramps/spasms in Kyorugi (33%) and Poomsae (59%), and sprain in Shibum (41%). The common injury mechanisms were gradual onset in Kyorugi (40%) and Shibum (49%), and non-contact trauma in Poomsae (91%). Regarding the severity, the number of days from the injury onset to recovery > 1 week were higher in the order of Kyorugi (78%), Shibum (54%), and Poomsae (28%). Our data provide preliminary evidence that different injury prevention strategies should be applied to each modality of Taekwondo.

Spinal injury rates and specific causation in motor vehicle collisions

Motor vehicle collisions (MVCs) are a leading cause of acute spinal injuries. Chronic spinal pathologies are common in the population. Thus, determining the incidence of different types of spinal injuries due to MVCs and understanding biomechanical mechanism of these injuries is important for distinguishing acute injuries from chronic degenerative disease. This paper describes methods for determining causation of spinal pathologies from MVCs based on rates of injury and analysis of the biomechanics require to produce these injuries. Rates of spinal injuries in MVCs were determined using two distinct methodologies and interpreted using a focused review of salient biomechanical literature. One methodology used incidence data from the Nationwide Emergency Department Sample and exposure data from the Crash Report Sample System supplemented with a telephone survey to estimate total national exposure to MVC. The other used incidence and exposure data from the Crash Investigation Sampling System. Linking the clinical and biomechanical findings yielded several conclusions. First, spinal injuries caused by an MVC are relatively rare (511 injured occupants per 10,000 exposed to an MVC), which is consistent with the biomechanical forces required to generate injury. Second, spinal injury rates increase as impact severity increases, and fractures are more common in higher-severity exposures. Third, the rate of sprain/strain in the cervical spine is greater than in the lumbar spine. Fourth, spinal disc injuries are extremely rare in MVCs (0.01 occupants per 10,000 exposed) and typically occur with concomitant trauma, which is consistent with the biomechanical findings 1) that disc herniations are fatigue injuries caused by cyclic loading, 2) the disc is almost never the first structure to be injured in impact loading unless it is highly flexed and compressed, and 3) that most crashes involve predominantly tensile loading in the spine, which does not cause isolated disc herniations. These biomechanical findings illustrate that determining causation when an MVC occupant presents with disc pathology must be based on the specifics of that presentation and the crash circumstances and, more broadly, that any causation determination must be informed by competent biomechanical analysis.

Muskuloskeletal injuries in mountain running races: A 5 seasons study

INTRODUCTION

Mountain running races have grown in popularity in the recent years. Nonetheless, there are few studies on injuries and injury rates. Moreover, these studies have focused on long-distance events such as ultramarathons (>42 km). Therefore, the aim of the present study was to examine the severity, type, and body location of musculoskeletal injuries during 20-42 km mountain running races. In addition, the injury rates in this type of races were examined.

METHODS

Data on injuries were collected during 36 mountain running races over 5 consecutive seasons from 2015 to 2019. The participants reported all musculoskeletal injuries on a standardized injury report form. The results were presented as the number of injuries per 1000 h exposure and per 1000 participants.

RESULTS

Twenty eight injuries were reported. Most injuries occurred in the ankle (32%) followed by the knee (14%) and foot/toe (11%). The number of injuries represented an overall injury rate of 1.6 injuries per 1000 h running and 5.9 injuries per 1000 runners. The case fatality rate was 0.

CONCLUSIONS

The incidence of musculoskeletal injuries during 20-42 km mountain running races is low. In addition, the majority of injuries experienced by runners are minor in nature and located in lower extremities, mainly the ankles.

Epidemiology of hip and groin injuries in Swedish male first football league

PURPOSE

This study aimed to investigate the incidence, pattern, and burden of hip/groin injuries in Swedish professional male football players over five consecutive seasons.

METHODS

Injury history from 16 football teams in the Swedish male first football league was evaluated during five consecutive seasons. The team's medical staff recorded team exposure and time-loss injuries prospectively between 2012 and 2016.

RESULTS

In total, 467 time-loss injuries located in the hip/groin area were recorded among 1,687 professional male football players, with an overall incidence and burden of 0.82/1,000 h and 15.6/1,000 h, respectively. There appeared to be an increased risk of hip/groin injuries during the last two seasons (2015-2016); however, the difference was not statistically significant (n.s). Recurrent injury rate was relatively low (14%), and overuse injuries accounted for the majority of injuries and absence days. Muscle injuries were the main injury type, while kicking and sprinting/running were the primary causes of injury. Goalkeepers had the lowest percentage of injuries and absence days.

CONCLUSION

Hip/groin injuries are a substantial problem in football, but does not seem to be an increasing phenomenon in the Swedish male first football league. Index and overuse injuries accounted for the majority of injuries and absence days. Thus, the focus should be on preventing hip/groin injuries to lower the injury rate. These new findings should be taken into consideration when designing and implementing preventive training interventions.

LEVEL OF EVIDENCE

II.

Injuries associated with Japanese high-school men's volleyball: a two-year survey and analysis

[Purpose] There are many factors associated with sports injuries in volleyball that remain unclear; therefore, many of these injuries are still not being effectively prevented. This study aimed to help effectively prevent injuries among and provide conditioning guidance to participants of a high-school men's volleyball team. [Participants and Methods] The participants were 36 males of a high-school men's volleyball team, and the circumstances of injury occurrence, injury type, injury site, exposure time, and injury rate per 1,000 player-hours were evaluated among these participants. [Results] Over the 2 year period, 68 injuries occurred, and the injury rate was 1.51/1,000 player-hours. Specifically, the injuries comprised 40 cases of trauma (58.8%) and 28 cases of disorders (41.2%). Additionally, injuries occurring during training tended to be disorders, and injuries occurring during matches tended to be traumas. The most common site of injury was the ankle joint. [Conclusion] The results suggest that it is important for players to have appropriate knowledge about the injuries, acquire accurate form, and undergo various types of site-specific training in order to prevent injury. In the future, the causes and circumstances of occurrence of injury must be verified in a larger number of participants.

INJURY INCIDENCE IN COMPETITIVE CROSS-COUNTRY SKIERS: A PROSPECTIVE COHORT STUDY

BACKGROUND/PURPOSE

Endurance sports, including cross-country skiing, require long hours of repetitive training potentially increasing the chance of injury, yet injury incidence and risk factors for adult cross-country skiers remain relatively unexplored. Data for elite adult north American competitive cross-country skiers is unexplored. A 12 month prospective surveillance study was undertaken to calculate the injury incidence and exposure of cross-country skiers. Injuries by anatomic location and mechanism of injury were calculated. Further, the relationships between new injury and the participant's demographics and physical assessment parameters were examined. The aims of this study were to determine the injury incidence and any risk factors for injury in elite adult north American cross-country skiers.

METHODS

Elite cross-country skiers (35 men, 36 women) self-reported demographics, injury history, and injury and training surveillance monthly over 12 months. t-tests compared the mean number of injuries per individual, per 1,000 training/exposure hours between anatomic regions, type of injuries, and seasons. Spearman's correlation analyses tested the relationship between new injury and Movement Competency Screen (MCS) score, past injury, total training time, and running training time. To determine if new injury could be predicted from any demographic data, intake physical measures, or, monthly injury, training and racing data, a regression model was developed.

RESULTS

Overall, 58% of participants (18 men, 23 women) completed the study, and reported 3.81 injuries per 1,000 training/exposure hours. Over 12-months, lower extremity injury incidence (2.13) was higher than upper extremity (0.46) and trunk injury incidence (0.22) (p < 0.05). Non-traumatic/overuse injury incidence (2.76) was higher than acute injury incidence (1.05) (p < .05). Non-ski-season injury incidence (5.25) was not statistically higher than ski-season injury incidence (2.27) (p = 0.07). New injuries were positively correlated with previous injury (p < 0.05), but not with any other variables (p > 0.05).

CONCLUSION

In this year-long monthly survey of injuries and training load in elite adult north American cross-country skiers, new injuries were positively correlated with previous injury. Lower extremity, and non-traumatic/overuse injuries had the highest incidence rates. There was no significant correlation between new injuries and physical assessment parameters or training load.

LEVEL OF EVIDENCE

Level 3, Prospective Longitudinal Cohort Study.

Adductor squeeze test and groin injuries in elite football players: A prospective study

OBJECTIVE

To examining the relationship between hip adductor strength and groin injury incidence during the competitive season of professional football teams.

DESIGN

Prospective Cohort study.

SETTING

Controlled laboratory environment.

PARTICIPANTS

Seventy-one players volunteered to participate.

MAIN OUTCOME MEASURES

In the pre-season, maximal hip adductor strength was measured by means of the isometric adductor squeeze test. Hip adductor strength, normalized by body mass, was compared between players who suffered a groin injury (n = 18) vs uninjured players (n = 53). Risk ratios (RR) were used to evaluate the likelihood of players to suffer this type of injury.

RESULTS

Most of the reported groin injuries occurred during competitive matches (5.5 per 1000 match hours). Maximal isometric hip adductor strength was lower in the groin-injured group compared with their uninjured counterparts (429.8 ± 100 vs 564 ± 58.7 N, d = -1.58 and 5.40 ± 1.27 vs 7.71 ± 0.89 N/kg, d = -1.88, respectively). Results revealed that values of maximal isometric adductor strength lower than 465.33 N increased the probability to suffer a groin injury by 72%. Furthermore, values of force relative to body mass lower than 6.971 N/kg increased the probability to suffer a groin injury by 83%.

CONCLUSION

The assessment of Hip adductor strength, in addition to other measurements, might help practitioners to determine the probability of suffering an overuse groin injuries in elite football players.

Genetic biomarkers in non-contact muscle injuries in elite soccer players

PURPOSE

Damage to skeletal muscle necessitates regeneration to maintain proper muscle form and function. Interindividual differences in injury severity, recovery time, and injury rate could be explained by the presence of single nucleotide polymorphisms (SNPs) in genes involved in the reparation and regeneration of connective tissue . We wished to identify new genetic biomarkers that could help to prevent or minimize the risk of non-contact muscle injuries and are associated with a predisposition to developing muscle injuries.

METHODS

Using allelic discrimination techniques, we analysed 12 SNPs in selected genes from the genomic DNA of 74 elite soccer players.

RESULTS

SNPs in the hepatocyte growth factor (HGF) gene showed evidence of a statistically significant association with injury incidence, severity, and recovery time. SNPs in the SOX15 gene showed evidence of a statistically significant association with injury incidence. SNPs in the GEFT and LIF genes showed evidence of a statistically significant association with recovery time.

CONCLUSIONS

Genetic profile could explain why some elite soccer players are predisposed to suffer more injuries than others and why they need more time to recover from a particular injury. SNPs in HGF genes have an important role as biomarkers of biological processes fragility within muscle injuries related to injury rate, severity, and long recovery time.

Occupational accidents in the Danish merchant fleet and the nationality of seafarers

Background

The aim of the study was to examine occupational accidents reported from non-passenger merchant ships registered in the Danish International Ship Register in 2010-2012, with a focus on analysing nationality differences in the risk of getting injured in an accident.

Methods

Data about notified occupational accidents were collected from notifications sent to the Danish Maritime Authority and from records of contact with Danish Radio Medical. Events were matched by personal identification and accident data to create a unified database. Stratified cumulative time spent on board by seafarers was used to calculate accident rates. Incidence rates of different nationalities were compared by Poisson regression.

Results

Western European seafarers had an overall accident rate of 17.5 per 100000 person-days, which proved to be significantly higher than that of Eastern European, South East Asian and Indian seaman (adjusted incidence rate ratio 0.53, 0.51 and 0.74, respectively), although differences decreased over the investigated period. Smaller but in most cases still significant discrepancies were observed for serious injuries. The back injury rate of Western European employees was found especially high, while eye injuries seem to be more frequent among South East Asian workers.

Conclusions

The study identified substantial differences between nationalities in the rate of various accidents reported from merchant ships sailing under the Danish flag. The differences may be attributed to various factors such as safety behaviour. Investigation of special injury types and characterisation of effective elements of safety culture can contribute to the improvement of workplace safety in the maritime sector.

A prospective look at the burden of sharps injuries and splashes among trauma health care workers in developing countries: true picture or tip of iceberg

OBJECTIVES

Health care workers (HCWs) face constant risk of exposure to cuts and splashes as occupational hazard. Hence, a prospective observational study was conducted to observe the exposure of HCWs to various sharp injuries and splashes during health care and to work up a baseline injury rate among HCWs for future comparison in trauma care set ups.

METHODS

A 2 year and 5 month study was conducted among the voluntarily reported exposed HCWs of the APEX trauma centre. Such reported cases were actively followed for 6 months after testing for viral markers and counselled. The outcomes of such exposed HCWs and rate of seroconversion was noted. To form a future reference point, the injury rate in trauma care HCWs based on certain defined parameters along with the rate of under reporting were also analysed in this study.

RESULTS

In our study, doctors were found to have the highest exposure (129, 36.2%), followed by nurses (52, 14.6%) and hospital waste disposal staff (27, 7.6%). Of the source patients, a high number of them were HBV positive (11, 3.1%), followed by HIV positive patients (8, 2.2%). No seroconversion was seen in any of the exposed HCWs. Injuries by sharps (303, 85.1%) outnumber those due to splashes (53, 14.9%) which were much higher in those working in pressing situations. Underreporting was common, being maximally prevalent in hospital waste disposal staff (182, 51.1%).

CONCLUSIONS

High rates of exposure to sharp injuries and splashes among HCWs call for proper safety protocols. Proper methods to prevent it, encouraging voluntary reporting and an active surveillance team are the need of the hour.

Estimated rate of agricultural injury: the Korean Farmers' Occupational Disease and Injury Survey

Objectives

This study estimated the rate of agricultural injury using a nationwide survey and identified factors associated with these injuries.

Methods

The first Korean Farmers’ Occupational Disease and Injury Survey (KFODIS) was conducted by the Rural Development Administration in 2009. Data from 9,630 adults were collected through a household survey about agricultural injuries suffered in 2008. We estimated the injury rates among those whose injury required an absence of more than 4 days. Logistic regression was performed to identify the relationship between the prevalence of agricultural injuries and the general characteristics of the study population.

Results

We estimated that 3.2% (±0.00) of Korean farmers suffered agricultural injuries that required an absence of more than 4 days. The injury rates among orchard farmers (5.4 ± 0.00) were higher those of all non-orchard farmers. The odds ratio (OR) for agricultural injuries was significantly lower in females (OR: 0.45, 95% CI = 0.45–0.45) compared to males. However, the odds of injury among farmers aged 50–59 (OR: 1.53, 95% CI = 1.46–1.60), 60–69 (OR: 1.45, 95% CI = 1.39–1.51), and ≥70 (OR: 1.94, 95% CI = 1.86–2.02) were significantly higher compared to those younger than 50. In addition, the total number of years farmed, average number of months per year of farming, and average hours per day of farming were significantly associated with agricultural injuries.

Conclusions

Agricultural injury rates in this study were higher than rates reported by the existing compensation insurance data. Males and older farmers were at a greater risk of agriculture injuries; therefore, the prevention and management of agricultural injuries in this population is required.

An epidemiological study of the risk of cycling in the dark: the role of visual perception, conspicuity and alcohol use

To curtail the rising numbers of cyclists seriously injured in road crashes, more insights are needed into the factors that contribute to these crashes. For instance, darkness is known to be associated with higher injury rates, but little is known about the relative influence of factors such as poor conspicuity, impaired perception and alcohol use among cyclists. To examine these factors, the present study analyzed the epidemiological crash data for three meteorological light conditions: daylight, late evening darkness and early morning darkness; for two crash types: crashes with (M-crashes) and without motorized traffic (NM-crashes); and for different age groups. The relative injury rates (injury risk per distance travelled in darkness corrected for daylight injury risks for each age group) confirmed findings from earlier studies that cycling in late evening darkness is associated with higher injury rates than cycling in daylight conditions. This is the case for both crash types with only small differences between the age groups suggesting that poor conspicuity (M-crashes) and impaired perception (NM-crashes) may play a role. In comparison to late evening darkness, relative injury rates in early morning darkness are much higher. This is the case for both crash types with large differences among the age groups, suggesting that in addition to the absence of daylight also age related risk factors are at play. Support for this hypothesis was found from the analyses of hospital records, showing that the proportion of seriously injured cyclists who have been drinking is highest in early morning darkness and has strongly increased over the last decades. These insights provide input for the selection of countermeasures such as improved lighting (both street and bicycle lights) and interventions targeting alcohol use among cyclists.