Injury Causation PhD course jan- febr 2008 Leif Svanström

Injury Causation ”A kind of” summary of previous teaching in the Course Research/Evaluation of Safety promotion & Injury Prevention Leif Svanström

Injury Causation Which are the causes to intervene on? Research/Evaluation of Safety promotion & Injury Prevention Leif Svanström

Relation between Homo sapiens, environmental and societal levels

Disease, injury, material or psychological damage in relation to Homo Sapiens/environmental/societal systems

Causes of Injuries – Factors related to injuries from A. Physical Environment B. Social Environment C. Habits of Life D.”Individual” Risk Factors

A. Physical Environment (Areas) 1.Transport 2.Housing 3.Production, Commercial, Service 4.Public (School, Public facilities, Institutions) 5.Sports 6.Entertainment, Culture and Park 7.Nature 8.Sea, Lake & River

1.Transport Area Rules of thumb: 10-15% of All Injuries Children: 60% of deceased, years of age: 80% -High Energy Content Involved

O-VISION on traffic What did You learn?

Prevention Demands Co-operation Between Societal Sectors – Intersectoral work Contribution from Voluntary Organizations – peoples participation -Decentralized Work (A Safe Community)

Three Main Areas of Prevention Separate Un-protected Road Users Alcohol: 0 – tolerance Decrease Average Speed

2. Housing Area 30-40% of all injuries Home Accidents: Happens in all Types of Homes and Every Kind of Dwelling as Apartment, Villa, Outhouse, Garden & Yard. incl. Accidents on Farms, but un-related to Farming or Lumbering. Children % Elderly Dominate: -Children in Different Stages of Development -Fall Injuries -75% of Injuries in the Elderly in Homes

3.Production, Commercial, Service Areas % of All Injuries Mortal Injuries -Decrease of Mortal Injuries -Related to Transport Vehicles -Falls -Falling Objects -Machines

The Most Dangerous Branches: -Foreign and Coastal Shipping -Slaughter -Iron and Steel -Stowing -Metal Recycling (Non-Iron) out of Scrap -Butchery -Ship-Yard -Concrete Industry Farming & Lumbering, Construction Industry, Transport are Branches with High Mortality Risk.

Environmental Exposure and Injuries -Organic Solvents -Noise -Lighting -Climate -Heavy Physical Load Transport Injuries within the Work Sector must be Noticed!

4. Public Area (School, Public facilities, Institutions) About 10% of All Injuries -School is more Dangerous to Children than Work to Grown-ups -7-9 Years: 1/3 of All Injuries;10-15 Years: ½ of All Injuries (Grown-ups: 1/3 are Work-related) -Physical Education is 3 Times More Risky than Other Lessons. Basketball, Handball and Gymnastics and In-Door Soccer are most Common.

5. Sports Area 15-20% of All Injuries - increasing -Relatively Few Mortal Injuries In Sweden: -Folksam Insurance Company: 4% Leads to Invalidity -Per 1,000 Insured: -Ice-Hockey Handball Basketball 9.9 -Bandy 7.8

6.Entertainment, Culture and Park Areas 2-4% of All Injuries The Area has been Investigated to a Very Limited Extent

7. Nature 3-6% of All Injuries Mountain Accidents are Registered. Snow-Mobile Related Injuries has been Studied.

8. Sea, Lake & River 1-3% of All Injuries -Has decreased the last 100 Years -Mostly Due to less Exposure -The Number of Accidents are Halved the Same Time as the Number of Boats has been Doubled -6 out of 10 Deceased were Under Influence of Alcohol -½ were doing Sports-Fishing -Bigger Boats show fewer Mortal Injuries

B. Social Environment Examples: -Different Schools -Pupils Mix -Ethnicity -School Bussing -Long School Hours -Alternative Pedagogic Programs -Psycho-Social Load -Urbanization -Unemployment -Work Organization, Stress, Monotony, Stimulation, Demand/ Control, Decision Making, Shift Work

C. Habits of Life 1. Tobacco 2. Alcohol -All Injuries: 1/3 Males, 1/6 Females -High: Single Accidents in Traffic, Drownings, Falls, Snow-Mobiles -1/5 of All Emergencies at Hospitals -More when Injury Diagnosis 3. Diet 4. Physical Activity -Regular Warming up -Experience

D. "Individual"Risk Factors(1) 1. Age and Gender -Children, esp. Boys are Over-Represented -Older Women are Over-Represented -Younger Men and Motor Vehicles -Women and Falls -All Road Users Accidents are Dominated by Males, Motor Bike and Moped Related Accidents Strikes Males to 90 % -Males over 40 Years of Age dominates Boat Accidents

D. "Individual"Risk Factors(2) 2. Genetics -Accident Proneness - Does it Exist? 3. Bodily Constitution 4. Previous Diseases or Injuries