1. Violence & Injury Prevention (VIP) Nurah M Alamro, MD. MPH. Lecturer – Community Medicine College of Medicine King Saud University nmalamro@ksu.edu.sa

2. Definitions Injury “Acute exposure to physical agents such as mechanical energy, heat, electricity, chemicals, and ionising radiation interacting with the body in amounts or at rates that exceed the threshold of human tolerance. In some cases, injuries result from the sudden lack of essential agents such as oxygen or heat.” (Source: Gibson, 1961; Haddon, 1963) 10/11/20152N.ALAMRO - COMM 311

3. Definitions Violence “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.” (Source: WHO, 1996) 10/11/20153N.ALAMRO - COMM 311

4. The Global Injury Problem 5 million deaths worldwide = 9% of all deaths (2000) 12% of global burden of disease Road traffic “incidents” are the leading cause of injury deaths worldwide 90% of injury deaths occur in low- and middle- income countries Highest number of deaths in S.E. Asia & Western Pacific regions 10/11/20154N.ALAMRO - COMM 311

5. Principles! “accident” VS. "injury event” Unintentional VS. intentional injury Injury prevention and control 10/11/20155N.ALAMRO - COMM 311

6. The Epidemiological Model VectorAgent Host Environment 10/11/20156N.ALAMRO - COMM 311

7. The Haddon Matrix Factors Phase Human Vehicles and Equipment Environment Pre- Crash Crash Prevention  Information  Attitudes  Impairment  Enforcement  Road worthiness  Lighting  Braking  Handling  Speed management  Road design  Speed limits  Pedestrian facilities Crash Injury prevention during the crash  Use of restraints  Impairment  Occupant restraints  Other safety devices  Crash protective roadside objects Post- crash Life-sustaining  First aid skill  Access to medics  Ease of access  Fire risk  Rescue facilities  Congestion 10/11/20157N.ALAMRO - COMM 311

8. The Ecological Model IndividualCommunity Relationship Society Complex Linkages Source: Krug E et al., eds., 2002. 10/11/20158N.ALAMRO - COMM 311

9. VIP Temporal primary secondary tertiary Targeted universal selective indicated Approach passive active 10/11/20159N.ALAMRO - COMM 311

10. VIP strategies Engineering Environmental modification Enforcement Education /empower ment Evaluation 10/11/201510N.ALAMRO - COMM 311

11. VIP Public Health Approach Defining Characteristics  Population-based  Multidisciplinary  Evidence-based  Collective action  Prevention 10/11/201511N.ALAMRO - COMM 311

12. (1) Surveillance What is the problem? (2) Risk factor identification What are the causes? (4) Implementation How is it done? (3) Develop and evaluate interventions What works? The Public Health Approach 10/11/201512N.ALAMRO - COMM 311

13. Public Health Approach in Action DESEPAZ in Colombia (1) Surveillance High rate of violent crime (2) Risk factors Alcohol Handguns Attitudes/values (3) Interventions Education Legislation Community involvement Reduction in homicides Public demand for more prevention (4) Implementation Special budgets for police, judiciary etc. Television advertising Cultural/educational Programmes /Restrictions on alcohol and handguns 10/11/201513N.ALAMRO - COMM 311

14. Severity Setting Activity Mechanism Intent Nature Categorizing Injury 10/11/201514N.ALAMRO - COMM 311

15. Data Classification Systems International Classification of Disease (ICD) Occupational Injury and Illness Classification System (OIICS) Nordic Medico-Statistical Committee (NOMESCO) The International Classification of External Causes of Injury (ICECI) The Abbreviated Injury Severity Scale (AIS) 10/11/201515N.ALAMRO - COMM 311

16. Injury Pyramid Deaths Injuries resulting in hospitalization Injuries resulting in ambulatory and emergency treatment Injuries resulting in treatment in Primary care settings Injuries treated by paramedics only (school nurse, physiotherapist, first aid) Untreated injuries or injuries which were not reported 10/11/201516N.ALAMRO - COMM 311

17. Types of data and potential sources of information Mortality Death certificates Reports from mortuaries Morbidity and Health-related Hospitals Medical records Self Reported Surveys Media 10/11/201517N.ALAMRO - COMM 311

18. Community-based Demographic records Local government records Law enforcement Police records Prison records Economic-social Institutional or agency records Special studies Source: adapted from Krug et al., eds., 2002 10/11/201518N.ALAMRO - COMM 311

19. Health Statistics and Informatics Leading Causes of Mortality and Burden of Disease world, 2004 % 1.Ischaemic heart disease 12.2 2.Cerebrovascular disease 9.7 3.Lower respiratory infections 7.1 4.COPD 5.1 5.Diarrhoeal diseases 3.7 6.HIV/AIDS 3.5 7.Tuberculosis 2.5 8.Trachea, bronchus, lung cancers 2.3 9.Road traffic accidents 2.2 10.Prematurity, low birth weight 2.0 % 1.Lower respiratory infections 6.2 2.Diarrhoeal diseases 4.8 3.Depression4.3 4.Ischaemic heart disease 4.1 5.HIV/AIDS3.8 6.Cerebrovascular disease 3.1 7.Prematurity, low birth weight 2.9 8.Birth asphyxia, birth trauma 2.7 9.Road traffic accidents 2.7 10.Neonatal infections and other 2.7 MortalityDALYs

20. Health Statistics and Informatics Adult mortality rates by major cause group and region, 2004

21. Source: WHO, 2004 10/11/201521N.ALAMRO - COMM 311

22. Health Statistics and Informatics Ten leading causes of burden of disease, world, 2004 and 2030

23. Quiz In epidemiological model of road traffic incident, the host is: Car Driver Energy transferred Wet road Defining VIP according to target group include except: Universal Selective Indicated Passive

24. Injury can be categorised according: Severity Intent Setting All of the above The apex of the injury pyramid represents: Relatively small number of non-fatal injury cases Relatively small number of fatal injury cases More numerous injuries of lesser severity More numerous injuries of greater severity

25. According to WHO, RTA as a leading cause of burden of disease in 2030 will rank: 1 st 3 rd 20 th 9 th

26. “PreventionVaccine DiseaseInjury” “Prevention is the Vaccine for the Disease of Injury” 10/11/201526N.ALAMRO - COMM 311