Journal of Injury and Violence Research
Volume:3 Issue: 1, Jan 2011

Since the tragic events experienced on September 11, 2001, and other recent events such as the hurricane devastation in the southeastern parts of the country and the emergent H1N1season, the need for a competent public health workforce has become vitally important for securing and protecting the greater population. The primary objective of the study was to assess the training needs of the U.S. Mexico border states public health workforce. The Arizona Center for Public Health Preparedness of the Mel & Enid Zuckerman College of Public Health at The University of Arizona implemented a border-wide needs assessment. The online survey was designed to assess and prioritize core public health competencies as well as bioterrorism, infectious disease, and border/binational training needs. Approximately 80% of the respondents were employed by agencies that serve both rural and urban communities. Respondents listed 23 different functional roles that best describe their positions. Approximately 35% of the respondents were primarily employed by state health departments, twenty-seven percent (30%) of the survey participants reported working at the local level, and 19% indicated they worked in other government settings (e.g. community health centers and other non-governmental organizations). Of the 163 survey participants, a minority reported that they felt they were well prepared in the Core Bioterrorism competencies. The sections on Border Competency, Surveillance/Epidemiology, Communications/Media Relations and Cultural Responsiveness, did not generate a rating of 70% or greater on the importance level of survey participants. The study provided the opportunity to examine the issues of public health emergency preparedness within the framework of the border as a region addressing both unique needs and context. The most salient findings highlight the need to enhance the border competency skills of individuals whose roles include a special focus on emergency preparedness and response along the US-Mexico border

Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years). A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention priorities could include home, road and school safety; especially dissemination and uptake of proven interventions. Burns should be focus of domestic injury prevention among under-fives. Commercial passenger motorcycles require better regulation and control.

Because individual practitioner's commitment to routine screening for IPV is the greatest predictor that women will be screened and referred for services, it is vital that screeners are dedicated, knowledgeable, and confident in their ability to recognize and assist victims of violence. Self-efficacy has been consistently linked in the literature with successful outcomes. Intimate partner violence (IPV) constitutes a major public health problem. In the absence of Federal or State regulation, individual hospitals and systems are left to develop their own policies and procedures. This paper describes the policies and procedures developed by an American domestic violence counseling and resource center. Design: Post test surveys were used. Settings: Hospitals, medical offices, and medical schools surrounding an urban area in Pennsylvania participated. Participants: 320 nurses and medical students participated in training provided by a domestic violence center. Post test surveys measured self-efficacy, the perceived usefulness of screening the accessibility of victim services, understanding of obstacles faced by victims, and knowledge-level regarding local IPV services. Participants also self-reported their gender, age, race, and position with the hospital system. Nurses and medical interns exhibit a wide range of self-efficacy regarding their ability to screen victims of intimate partner violence. Intimate partner violence (IPV) training yielded participants who were better informed about IPV services and the obstacles faced by victims. In the absence of uniform screening guidelines, hospitals, systems, and individual practitioners must be vigilant in screening procedures. Partnerships with women's centers may provide valuable resources and training that may ultimately improve patient care.

Adversity early in life has been suggested as a protective factor for elderly suicides. However, studies examining this relationship in general population suicide rates are scarce. The relationship between general population suicide rates and four proxy measures of adversity earlier in life was examined using data from the World Health Organization and the United Nations data banks. General population suicide rates were negatively correlated with the percentage of children under the age of 5 years who were underweight, the percentage of children under the age of 5 years who were under height, the percentage of infants with low birth weight babies, and the percentage of the general population that was undernourished. The only independent predictor general population suicide rates in both sexes, on multiple regression analysis, was the Gini coefficient (a measure of income inequality). Income inequality may lead to low birth weight, undernourishment, underweight and under height because income inequality results in poor access to healthcare and nutrition. These adversities may increase child mortality rates and reduce life expectancy. Those surviving into adulthood in countries with greater adversity early in life may be at reduced risk of suicide because of selective survival of those at reduced risk of suicide due to constitutional or genetic factors and development of greater tolerance to hardship in adulthood.

A developmental model of epidemiological transition for elderly suicide rates with four sequential stages has been developed to simultaneously explain cross-national variations in elderly suicide rates, trends over time for elderly suicide rates and age-associated trends in suicides rates reported in the literature. This model was supported by demonstration of a curvilinear (inverted U-shaped curve) relationship between elderly suicide rates and socio-economic status fitting the quadratic equation Y = A + BX - CX2 (where Y is the suicide rate, X is the socio-economic status and A,B, and C are constants) in both sexes. However, this relationship was derived from a cross-sectional study and, therefore, only an association can be inferred. One way to substantiate this further would be to examine the above curvilinear relationship between suicide rates and socio-economic status in a series of younger age-bands because a large part of the epidemiological transition hypothesis was contingent upon the impact of socio-economic status, through a series of mechanisms, on life expectancy. It was hypothesized that the curvilinear (inverted U-shaped curve) relationship between suicide rates and socio-economic status would be absent in younger age-bands and may be present in the younger age-bands closer to the older age-bands (i.e. 45-54 years and 55-64 years). The curvilinear relationship between suicide rates in five age-bands 15-24 years to 55-64 years in both sexes and gross national domestic product (GDP), a measure of socio-economic status, fitting the above quadratic equation was examined with curve estimation regression model using data from the World Health Organization. In males in the age-bands 35-44 years, 45-54 years and 55-64 years there was a statistically significant curvilinear (inverted U-shaped curve) relationship with GDP and fitted the quadratic equation Y = A + BX - CX2; this relationship was absent in males in the age-bands 15-24 years and 25-34 years. In females in the age-bands 45-54 years and 55-64 years there was a statistically significant curvilinear with GDP (inverted U-shaped curve) and fitted the quadratic equation Y = A + BX - CX2; this relationship was absent in females in the age-bands 15-24 years, 25-34 years and 35-44 years. Although caution should be exercised in accepting the model of the epidemiological transition hypothesis for elderly suicide rates because it had been generated from cross-sectional data using an ecological design, the findings of the current study of suicide rates in younger age-bands provide support for this hypothesis

The current study compared working and non-working groups of women in relation to intimate partner violence. The paper aims to explore the relationship between women’s economic empowerment, their exposures to IPV and their help seeking behavior using a nationally representative sample in India. This was a cross sectional study of 124,385 ever married women of reproductive age from all 29 member states in India. Chi-square tests were used to examine differences in proportions of dependent variables (exposure to IPV) and independent variables. Multivariate logistic regressions were used to assess the independent contribution of the variables of economic empowerment in predicting exposure to IPV. Out of 124,385 women, 69432 (56%) were eligible for this study. Among those that were eligible 35% were working. In general, prevalence of IPV (ever) among women in India were: emotional violence 14%, less severe physical violence 31%, severe physical violence 10% and sexual violence 8%.For working women, the IPV prevalence was: emotional violence 18%, less severe physical violence 37%, severe physical violence 14% and sexual violence 10%; whilst for non-working women the rate was 12, 27, 8 & 8 percents, respectively. Working women seek more help from different sources. Economic empowerment is not the sole protective factor. Economic empowerment, together with higher education and modified cultural norms against women, may protect women from IPV.

The aim of the Budapest Monitoring System of Self-Poisoning Pregnant Women was to evaluate the potential congenital abnormality inducing effect of extremely large doses of drugs among pregnant women who attempted suicide. This system was appropriate to describe the characteristics of these pregnant women as a secondary finding from this model. All self-poisoned patients were cared for at a toxicological inpatient clinic in Budapest, between 1960 and 1993. Of a total of 1,044 pregnant women identified from the three different periods of the project, only 19 (1.8%) died. Women who survived were visited at home to reveal birth outcomes, and their exposed children were examined medically to identify congenital abnormalities and tested to estimate their cognitive-behavioral status. The previous or subsequent children of these pregnant women were used as controls with a similar examination protocol. In general, self-poisoned pregnant women were young (peak age was between 18 and 20 years), 62% had their first pregnancy, 55% were unmarried, they had lower socioeconomic status, 46% were smokers and 22.5% drinkers, but depression/panic disorder occurred only among 17 pregnant women. Suicide attempts with drugs were most frequent in the fourth post-conceptional week and second month of pregnancy. In general they used smaller doses of drugs for suicide than non-pregnant age-matched women. Of 1,044 self-poisoned pregnant women, 926 had known pregnancy outcomes and 411 (44.4%) delivered live-born babies. The self-poisoning model appears to have several benefits (e.g., dose-response estimation of drugs) in comparison with other methods when evaluating teratogenic/fetotoxic effect of drugs. It is suggested that an international monitoring system of self-poisoned pregnant women should be established to provide a larger data base.

The main objective for introducing this case study is to create a platform from which the importance of road traffic related injuries and traumas can be emphasized and discussed within and across various fields of investigation. The long term goal is to entice public campaign around unmet needs for higher road safety measures to reduce primary, secondary, and tertiary risks of injuries and traumas. CASE: a 28-year-old pregnant woman with a 16-week gestational age fetus was involved in a road car crash resulting in multiple traumas. Evaluation and treatment was initiated in the local Urgent Care Unit and continued in the emergency department and operation room. Patient underwent the following procedures: laparotomy, diverting colostomy, terminating pregnancy, right calcaneal traction and long leg splint, as well as multiple irrigation-debridements. Finally, the wound was left open and the patient was admitted to Intensive Care Unit. We hope that the introduction of this case for a "Ground Round" discussion will stir up a comprehensive discussion regarding the injury and trauma related preventive measures as well as treatment approaches in cases involving pregnant women in car accidents, and will bring about a holistic overview of this issue by the experts in various fields.