Time off work and/or loss of earnings reported in over half of cases
Explore mandatory lead use in certain public spaces to boost public safety, urge researchers

Mental trauma, including specific phobias and post traumatic stress disorder (PTSD), succeeds 1 in 7 dog related injuries, while over half of cases result in the need for time off work and/or loss of earnings, suggests a study of personal injury claims data for England and Wales, published online in the journal Injury Prevention.

As most of these claims involved unrestrained dogs in non-residential locations, mandating lead use on highways and in public spaces should now be explored to boost public safety, urge the researchers.

The latest estimates for 2024 indicate that there are 13.6 million dogs in the UK. Hospital admissions for dog related injuries have risen from 4.76/100,000 people in 1998 to 18.7 in 2023 in England. In Wales, they rose from 16.3/100,000 people in 2014 to 23.7 in 2022, note the researchers.

The information on these injuries isn’t as comprehensive as it needs to be, suggest the researchers. Currently, hospital records don’t differentiate between dog bites and dog strikes (any dog-related injury not caused by a bite); not everyone who needs hospital treatment will be admitted to hospital; and there’s little or no information on the longer term effects.

While civil claims data are more informative, these claims are only pursued when there are sufficient assets to cover damages and legal costs, point out the researchers.

Most solicitors’ firms, however, collect initial contextual and impact data before making a judgement as to whether the case can be taken on. If these initial data were routinely collated and analysed, this would remove the inherent socioeconomic bias of analysing court records, they explain.

To find out if this might be a viable option, and how informative these data would be, the researchers analysed anonymised civil claims enquiry data from 1 January 2017 to 31 March 2024, provided by a specialist law firm operating throughout England and Wales.

The enquiry data contained information about the injured person, including their age and sex; date, location/land use, and context of the incident; breed and level of restraint of the dog; and consequences including physical injuries, mental trauma, medical treatment, time off work and loss of earnings.

Data were categorised into incidents involving dog bites and those involving strikes or other types of behaviour.

Analysis of the data showed that 816 dog-related incidents, comprising 842 individual claims, were recorded between January 2017 and March 2024.

Most (94%) incidents occurred in England and primarily involved dog bites (just over 91%); 7% were dog strikes.

Half of dog bite victims were male (53%), while dog strike victims were mainly female (70%). Women were more than twice as likely to be involved in a non-bite incident as men. Most of the injured didn’t know the dog involved (80%).

The three most common locations for dog bites were in front of a private residential property (just over 34%), on a highway or pavement (18%), and inside a private residential property (11%).

Almost half of non-bite incidents occurred in public spaces (49%), the most frequent of which were outdoor recreational areas, such as parks and nature reserves (34%), highways or pavements (23%), and ‘forestry, open land and water’ (11.5%).

Delivery workers made up over 1 in 4  (28%) of those bitten, most often during a delivery to a private residential property, when an unrestrained dog came out of the front door (12%). Other situations involved walking, exercising, playing in public without a dog (11.5%); and walking with one’s own dog (11%).

The most common circumstances for non-bite incidents were either with a dog when out walking, exercising, or playing in public (34%) or without (27%); and when a dog escaped from a private property (10%).

In both types of incident, most of the dogs weren’t restrained at the time: 79% of biting dogs; and 86% of non-bite incidents. Most dogs involved in a bite (69%) or non-bite (77.5%) incident were reported to be with their owner.

Almost all (98%) of bite, and 78% of non-bite, incidents ended up with a physical injury. Fractures comprised nearly 4% of injuries, while tissue loss or amputations made up 3%. Non-bite incidents were primarily described as fractures (73%), muscle/tendon/ligament damage (9%), and soft tissue damage (9%). The head was injured in 1 in 7 bite cases.

Most of those injured reported psychological consequences: (90%) of those who were bitten; and 76% of those who were the victims of other types of injuries.

In all, 15% (1 in 7) of all those injured were formally diagnosed with a mental illness as a result of the incident, while 6.5% were diagnosed with a specific phobia and 4% with PTSD. Other mental health consequences included anxiety, disturbed sleep, and avoidance.

Most of the physical injuries sustained resulted in a hospital visit. A quarter of those bitten, and nearly a third of those who weren’t bitten, required surgery.

Of the claimants still working when injured, 59.5% of those bitten and 56% of those who weren’t bitten took time off work, up to a maximum of 5 years. Over half of those bitten (54%) and 41.5% of those who weren’t reported loss of earnings as a result of their injuries.

There is no centralised registry of these cases across all law firms. And the researchers acknowledge that their study was based on data from one law firm and therefore may not be fully representative.

But they suggest: “These data implicate unrestrained dogs in non-residential locations as a major inciting factor for dog-related injuries, and injury prevention strategies need to explore how lead use can be effectively legislated.”

They add: “Most claimants reported that dogs were with their owners and off lead. Almost half of bite and more than 80% of non-bite incidents occurred in non-residential locations and the majority involved unrestrained dogs… These findings raise concerns over owner control.”

Current national legislation on lead control doesn’t affect public highways or urban green spaces, where most injuries occur, they argue.

The Highway Code advises that dogs should be ‘kept on a short lead when walking on the pavement, road or path shared with cyclists or horse riders’, but this is only guidance, not law. And while local authorities can introduce Public Space Protection Orders (PSPOs), it’s unclear how often these are applied or how much of a deterrent they are, they highlight.

“We recommend that national legislation is updated so that all dogs should be on a fixed- length short lead (less than 2 metres) on public highways and in urban green spaces (unless a local authority provides provisions for off-lead areas, or make areas exempt).

“This exemption provision is to ensure that the important balance between public safety and dog welfare can be achieved. This should be partnered with a nationally coordinated public communication campaign,” they conclude.

09/01/2025

Notes for editors
Research: Using civil claim enquiry data to understand the context and impact of dog- related injuries in England and Wales between 2017 and 2024 Doi: 10.1136/ip-2025-045863
Journal: Injury Prevention

External funding: Biotechnology and Biological Sciences Research Council; Economic and Social Research Council

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Data analysis
Subjects: People

The post Mental trauma succeeds 1 in 7 dog related injuries, claims data suggest first appeared on BMJ Group.

Women more than twice as likely as men to be affected, responses show
Various barriers prevented most respondents from reporting the incident

Six out of 10 music fans say they have been sexually harassed or assaulted at a live gig in the US, suggest the results of a survey, published online in the journal Injury Prevention.

Women are more than twice as likely as men to have been affected, the responses indicate, but various barriers prevented most respondents from reporting the incident at the time.

Data from Australia, the UK, Sweden, Finland and Nigeria indicate that inappropriate sexual behaviour is prevalent at live music events. But few studies have focused on the USA or included a broad range of venues, such as festivals and large arenas, theatres, and clubs, note the researchers.

To explore this further, adults were invited to participate in GrooveSafe’s Fan Experience Survey in 2024 if they had been to at least one live music gig in the previous year.

Respondents were asked how often they went to live music gigs, and which of 7 types of inappropriate sexual behaviour they had experienced while at the event, ranging from unwanted comments/jokes to non-consensual sex. They were also asked who they were with, and at what type of venue, when the incident occurred.

Respondents who reported experiencing at least one incident of inappropriate sexual behaviour were also asked to indicate if they felt they could report their most recent experience to staff or security working at the music venue.

If they hadn’t felt able to report the incident, they were asked which barriers they had faced, including not knowing to whom to report it; feeling uncomfortable doing so because of being drunk or high; finding it hard to find help; assuming that they wouldn’t be believed; and the status or fame of the perpetrator.

In all, 1091 people filled in the survey. Just over half (51%) were women and over two thirds (66%) were aged between 30 and 49 and said they went to live music events often or very often (67%).

Six out of 10 (61%) respondents said they had experienced inappropriate sexual behaviour at a live music event at some point during their lifetime. A greater proportion of women (82%) than men (39%) said they had experienced sexual harassment and/or sexual assault, and 20% of the women indicated that it had happened often.

And significantly more women than men reported experiencing inappropriate sexual behaviour in large arenas and when attending live music gigs with friends and significant others.

Most respondents (88%) didn’t report the incident to the music venue concerned. Among the 574 respondents who gave their reasons, around half (48%) didn’t feel they could report it and 42% felt they could, but chose not to.

The most common barrier to reporting the incident expressed by both 1 in 4 men and women was the feeling that nothing would be done about it anyway.

The researchers acknowledge various limitations to their findings. These include the possibility that those who had experienced sexual harassment/assault in the past would have been more likely to complete the survey.

And some types of inappropriate sexual behaviour weren’t offered as options in the questionnaire: upskirting, inappropriate photography, and flashing, for example.

Limited surveillance and regulations and difficulties in obtaining assistance from venue staff facilitate inappropriate sexual behaviour, say the researchers.

“The high prevalence of [inappropriate sexual behaviour] incidents reported in this study is disturbing as [these] incidents can have both short and long-term consequences to health and quality of life and unfavourable social, cultural, and economic impacts,” they write.

And they conclude: “Music venues should develop or expand on existing [inappropriate sexual behaviour] prevention, training, and response efforts. Future research might examine existing policies and procedures related to [its] prevention, communication, reporting and response.”

22/09/2025

Notes for editors
Research: Prevalence and reporting of sexual harassment and sexual assault at live music events in the USA Doi: 10.1136/ip-2025-045809
Journal: Injury Prevention

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; survey data
Subjects: People

The post 6 in 10 US music fans say they have been sexually harassed/assaulted at a live gig, survey suggests first appeared on BMJ Group.

Women and over 65s seem to be most at risk due to being pulled along on the dog leash

The annual cost of hand and wrist injuries among dog walkers in the UK is estimated to top £23 million, with women and the over 65s most at risk as a result of being pulled along on the dog leash, finds a review of the available evidence, published online in the journal Injury Prevention.

Cases of dog walking injuries have been rising in recent years in tandem with an increase in dog ownership and dog walking to improve fitness, explain the researchers.  In the UK alone, there are around 8.5 million dogs–one for every seven to eight people.

Despite the many cognitive and physical health benefits of dog ownership, it is not without its risks of injury, they add. But few studies have reported on hand and wrist injuries sustained while dog walking, despite the fact that all types of hand and wrist injuries make up between 10% to 30% of all emergency department visits.

To plug this knowledge gap, the researchers scoured research databases, looking for relevant studies, with a view to quantifying the risk profile and estimating the types and costs of hand/wrist injury among dog walkers in the UK.

Out of an initial haul of 102 studies, five were included in the evidence review. All were published between 2012 and 2024 and included a total of 491,373 patients, nearly three quarters of whom (364,904) were female. Some 65,623 (nearly 13.5%) were younger than 18, and 152,247 (31%) were older than 65.

In all, 491,400 injuries had been sustained while dog walking. Of these, 110,722 (22.5%) were specific fractures or soft tissue injuries to the hand and wrist. Finger fractures were the most common injury (34,051; 31%), followed by wrist fractures (27,904; 25%), finger soft tissue injuries (26,959; just over 24%), and wrist soft tissue injuries (18,920; 17%).

The dog’s direct or indirect role in the injury was reported in four of the included studies (458,749 patients). Being pulled by a leash with/without a fall, was the most common cause of a direct injury, accounting for over two thirds of incidents (314,189; 68.5%).

Tripping over the leash/dog and falling (20%); and getting tangled up in the leash with (11%) or without (1%) a fall made up the rest.

One study reported an additional 14 indirect injuries, which wouldn’t have happened had the dog not been present: 11 of these occurred while walking the dog but weren’t caused by the dog pulling the handler on the leash.

Dog walking didn’t emerge as any more risky than any other activity for sustaining a hand or wrist injury. But women and older adults were disproportionately affected by dog walking injuries.

This is not entirely surprising, say the researchers, given that older women are more likely to have osteoporosis and so be more susceptible to fractures, while older people generally are more likely to have balance and gait issues and to have impaired eyesight, they suggest.

Based on data from the included studies, and assuming that the UK population comprises 45 million adults, the potential annual costs of surgery and casts for broken wrists alone, as a result of dog walking, could exceed £23 million annually in the NHS in England, estimate the researchers.

And this doesn’t include the wider economic toll of these patients not being able to work, and the potentially increased care demands required, they add.

The researchers acknowledge various limitations to their findings. Four of the five included studies were carried out in the USA. And three used the same data source. Trends in dog ownership, dog breeds, leash type and walking environments weren’t analysed in the included studies either.

But they note: “Although this review does not show dog-walking to be an outstanding risk factor for causing hand and wrist injuries within the adult population compared with all other causes, it does highlight a significant number of such injuries to be attributable to dog ownership, particularly in the elderly and female population.”

And they suggest: “Teaching safer leash-holding practices, such as holding the leash in the palm as opposed to finger or wrist wrapping, or leash choice, such as avoiding retractable devices that can lead to sudden increases in tensile force at the end of their working range, may be recommended.” Dog obedience training may also be helpful, they add.

25/06/2025

Notes for editors
Systematic review: Dog walking-related injuries of the hand and wrist: a systematic review Doi: 10.1136/ip-2025-045629
Journal: Injury Prevention

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Systematic review
Subjects: People

The post UK annual cost of dog walkers’ hand/wrist injuries estimated to top £23 million first appeared on BMJ Group.

Time to bolster restrictions and use better evidence to inform policy, say researchers

Thousands of young children worldwide are still swallowing magnets despite an increase in regulations, finds a review of the available evidence, published online in the journal Injury Prevention.

With US children among those seemingly most at risk, it’s time to bolster restrictions and use better evidence to inform policy, say the researchers.

The swallowing of small high powered magnets is a significant issue worldwide, especially among children under the age of 4, note the researchers, because they are commonly found in household items, such as toys, remotes, and small household appliances, they add.

While swallowing one of these magnets isn’t usually problematic, swallowing several or in combination with a metallic object can cause serious harm, often requiring surgery or other invasive procedures, they point out.

In a bid to build the evidence base and better inform policy, the researchers sought to compare global reports of children’s magnet swallowing and current regulatory policies for countries throughout the world.

They trawled through international research databases looking for relevant studies published between 2002 and 2024 on the frequency and medical outcomes of magnet swallowing among children from birth up to the age of 18.

From an initial haul of 2998 articles, 96 eligible studies were included in the review. Information on case volume, demographics of the affected children, and the interventions required was extracted from each study.

A comprehensive online search was also made of policies related to magnet production, sales, and use in each country, drawing on information from government websites, news articles, or other descriptions of policies that could be translated into English or Spanish.

Most of the published studies originated from Asia and the Middle East (44 studies), North America, including Mexico (28), and Europe (11), plus a handful from Chile, Australia, Egypt and Tunisia, representative of only 23% of the world’s countries.

The number of incidents reported in any one study ranged from 1 to 23,756. Overall, the US reported the highest number of cases (23,756), possibly as a consequence of the breadth of its reporting systems, suggest the researchers. A total of 47 single case reports came from 23 different countries.

Sequential studies in several countries documented an increase in incidence over time, including China and the US. Boys comprised between 20% to 86% of magnet swallowing cases, while the overall average age ranged between 2 and 8.

There were more cases in towns/cities than in rural communities, and most children found the magnets or objects containing them at home, daycare, and nursery in toys, and in school and office supplies.

A significant proportion of the children required admission to hospital, surgery, and/or other medical interventions. Magnets were found in all parts of the gut, and documented injuries included obstruction,twisted intestine (volvulus), perforation, fistulas, and abscesses.

A rise in the number of cases over time was reported in several countries. This could indicate a true increase, or improvements in reporting accuracy, say the researchers. Magnet marketing, cost, and availability may all explain the increases, as might changes in industry and government regulations, they add.

But whatever the reason, it’s clear children swallowing magnets remains a problem worldwide, they emphasise.

Only 10 policies were found online: 2 from Canada and the US; 3 from the European Union, UK, and France; 1 each from the UAE, Taiwan, Japan, Australia and New Zealand.

These policies ranged in their intent and wording, with some banning small magnets altogether (UAE, New Zealand, and the UK). Others limited the strength of magnets, required stricter labelling, or some combination of the two. Bans were associated with fewer cases.

The US, for example, introduced regulations in 2014 which were overturned in 2016, after which the number of new cases rose by 444%. New safety standards were adopted in 2022, but these don’t apply to toys marketed for under 14s, the demographic most at risk, say the researchers.

“Many countries still lack national policies aimed at limiting access to small, ingestible magnets, even countries with published incidence of morbidity and mortality from paediatric magnet ingestions,” note the researchers.

They acknowledge that they were often not comparing like with like and that granular data were often not available. Cases that don’t require medical intervention are likely underreported, so potentially underestimating the true number of cases.

But the researchers nevertheless conclude: “These data demonstrate that paediatric magnet ingestion is an international problem that must be addressed. Every geographic area has different availability of products and types of restrictions in place, yet the problem remains the same: If magnets are accessible to children, some children will inevitably ingest them, leading to a wide range of severe consequences.

“These data also provide some insight about potential solutions. Removal of magnets from the market is linked to a decreased incidence of injuries related to magnet ingestions and thus, such policies should be proposed, promoted, and enforced.”

21/05/2025

Research: Paediatric magnet ingestion persists worldwide despite increasing regulatory policies Doi: 10.1136/ip-2024-045545
Journal: Injury Prevention

External funding: None declared

Externally peer reviewed? Yes
Evidence type: Systematic review
Subjects: Children

The post Thousands of young children worldwide still swallowing magnets despite increased regs first appeared on BMJ Group.

Findings highlight the importance of barriers to prevent suicides by jumping

Early evidence indicates that the installation of safety nets on the Golden Gate Bridge in San Francisco has been successful in reducing the number of suicides at the bridge.

The results, published online in the journal Injury Prevention, show a 73% decline in suicides in the 12 months since the nets were completed relative to the number before net installation began.

The researchers say their findings “highlight the value of installing nets on this bridge and the importance of barriers as a strategy to prevent suicides by jumping.”

The Golden Gate Bridge is a San Francisco landmark, but it is also well-known as a location for jumping suicide. The installation of safety nets to prevent suicide by jumping from the bridge was completed in January 2024, but was controversial, and no studies have yet examined their effectiveness.

To evaluate whether the safety nets were working as intended, researchers studied the change in suicide rates at the bridge during three periods: before (January 2000 to July 2018), during (August 2018 to December 2023) and after their installation (January 2024 to December 2024).

Because staff and volunteers at the bridge are trained to intervene when someone is displaying signs of a suicidal crisis, they also examined whether the three periods were linked to changes in the number of times a third party intervened to prevent suicide.

During the entire study period, there were 681 confirmed suicides and 2,901 interventions by a third party.

There were 2.48 suicides per month before installation of the safety nets, 1.83 during installation and 0.67 after installation. During installation, suicides declined by 26% and after installation by 73%.

There were 8.22 interventions by a third party per month before installation of the safety nets, 14.42 during installation and 11 after installation. During installation, the number of interventions by a third party increased by 75% and after installation by 34%.

It’s unclear why the number of third party interventions declined from the period of installation to the period once the nets were complete, but one possibility is that removing this suicide method resulted in fewer people visiting the site with the intention to jump, and therefore there were fewer opportunities for a third party to intervene, explain the authors.

They also acknowledge several study limitations including only having a year of post-installation data, the possibility that some suicides were misclassified as accidental drownings, and being unable to evaluate potential displacement effects (eg, suicide at a nearby jumping site) or substitution to other suicide methods.

However, they say to the best of their knowledge, this is the first study on the effectiveness of the newly installed safety nets at the Golden Gate Bridge and provides early but clear evidence that the safety nets are associated with an immediate and substantial reduction in suicides at the site.

“There are many high-risk places around the world where people die by jumping from heights,” they add. “Our study provides further evidence to policymakers that barriers are highly effective means of reducing suicide at bridges.”

19/03/2025

Notes for editors
Short report: Change in suicides during and after the installation of barriers at the Golden Gate Bridge doi 10.1136/ip-2024-045604
Journal: Injury Prevention

External funding: National Health and Medical Research Council

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; modelling study
Subjects: People

The post Installing safety nets on Golden Gate Bridge linked to 73% decline in suicides first appeared on BMJ Group.

Odds of alcohol/substance use much higher among 10-17 year olds than older age groups

The numbers of e-scooter and e-bike injuries have tripled in the US since 2019, fuelled by alcohol and substance use, finds a nationwide analysis of emergency department visits, published online in the journal Injury Prevention.

And the odds of alcohol and substance use were much higher among 10-17 year old riders with these injuries than they were among older age groups, the findings show.

E-scooters and e-bikes, collectively known as micromobility devices, have become increasingly popular, thanks to their zero emissions, amid higher fuel prices and better biking infrastructure, note the researchers.

Emerging evidence points to increasing numbers of injuries associated with their use, and the researchers wanted to explore trends in these figures and the contributory factors, with the aim of informing effective prevention strategies and enhancing safety measures.

They mined emergency department data from 100 hospitals out of more than 5000 nationwide contributing to the National Electronic Injury Surveillance System (NEISS).

They looked in particular at yearly visits, patient demographics, injury details, and alcohol/substance use associations from 2019 to 2022.

During this period, micromobility devices prompted 4020 emergency department visits out of a total of 1,331,871, of which 3700 were due to e-scooters and 320 due to e-bikes.

This corresponds to nationwide weighted estimates of 279,990 e-scooter injuries, and 16,600 e-bike injuries nationwide.

The smaller wheel size of e-scooters might account for the difference in injury numbers because it contributes to a higher likelihood of losing balance and sustaining injuries, suggest the researchers.

The number of emergency department visits tripled, rising from a weighted estimate of 22,835 in 2019 to 65,892 in 2022. Men sustained most of these injuries, with 80% of them involving 18-39 year olds and those of White ethnicity.

Nearly 18% of e-scooter emergency department visits and 12.5% of e-bike visits ended up with an admission to hospital. And approximately 0.4% of those injured by e-scooters died.

Most e-scooter injuries occurred on the street (72%) compared with nearly a third of e-bike injuries (nearly 31%).

Alcohol use was implicated in 327 of all the e-scooter and e-bike injuries; substance use was implicated in 116; and both alcohol and substance use were implicated in 39.

Specifically, alcohol use was reported in nearly 9% of e-scooter injuries and in 2.5% of e-bike injuries. Substance use was implicated in 3% of e-scooter injuries and just under 1% of e-bike injuries.

Men and boys were more than 2.5 times as likely to have used alcohol and more than twice as likely to have used substances as women and girls.

Alcohol was 7.5 times more likely to be implicated in the injuries sustained by 10-17 year olds, and substance use 4 times more likely in this age group than among 18–39-year olds.

But the over 40s had 35% lower odds of alcohol-related, and 40% lower odds of substance-related, emergency department visits than 18–39 year olds.

“Younger individuals are more likely to be intoxicated, and this impairs their mental and physical health, leading them to engage in risky activities while riding these micromobility devices that can result in injuries,” point out the researchers.

The legs and the head were the areas of the body most likely to be affected in e-scooter injuries associated with alcohol and substance misuse (29% and 19%, respectively), followed by injuries to the chest (10%), face (10%), shoulder (7%) and abdomen (6%).

The areas of the body most likely to be affected in e-bike injuries associated with alcohol and substance misuse were the legs (34%), head (18%), shoulders (12%) and face (7%).

This is an observational study, and relies on weighted estimates. The researchers also acknowledge that the data analysis was limited by its retrospective nature and lack of detailed information on the units of alcohol and substance use consumed, or helmet use.

The NEISS database doesn’t include the mechanism of injury, nor does it provide more details on injury type, limiting the ability to draw specific conclusions on the exact cause.

Nevertheless, they conclude: “Our findings emphasise the critical and pressing issue of alcohol and substance use in relation to e-scooter and e-bike injuries.

“As these forms of transportation gain popularity, institutions, governments, healthcare practitioners and the general public must work together to develop effective risk mitigation strategies.

“By addressing this issue early, we can reduce the frequency and severity of e-scooter-related injuries and improve overall public safety.”

10/12/2024

Notes for editors
Research: Alcohol-related injuries from e-scooter and e-bike use in the US (2019–2022): a retrospective study Doi: 10.1136/ip-2024-045461
Journal: Injury Prevention

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post US e-scooter/e-bike injuries have tripled since 2019, fuelled by alcohol/substance use first appeared on BMJ Group.

More than 12,000 lives lost to these incidents between 2001 and 2021
Poverty, rurality, non-White ethnicity and firearms ownership all linked to higher rates

There’s more than a 10-fold difference in the rates of unintentional gun deaths across US states, with such incidents claiming more than 12,000 lives between 2001 and 2021, finds research published online in the journal Injury Prevention.

Poverty, rural residency, non-White ethnicity and firearms ownership are all associated with higher rates, the findings show.

Firearms kill over 130 Americans every day. Most of these deaths are intentional, but of the 48,830 firearm related deaths in 2021, 549 were unintentional, note the researchers. But it’s not clear if rates differ within and between states.

To explore this further, the researchers looked at data on unintentional firearms deaths recorded in the Centers for Disease Control WISQARS database for the period between 2001 and 2021—a time period chosen to gather meaningful estimates from less populated states.

And they drew on national data sources for rurality, non-White ethnicity, poverty, gun ownership, and population by state to assess which of these factors might be associated with a heightened risk of an unintentional gun death.

Analysis of all the data showed that there’s more than a 10-fold difference in the rates of unintentional gun deaths across US states, with such incidents claiming more than 12,000 lives between 2001 and 2021.

The highest rates clustered in Southeastern states, followed by states in the Northern Plains and Mountain West. The highest unadjusted rates were in Mississippi (0.68/100,000 of the population), Louisiana (0.64), and Alabama (0.60).

The lowest rates were in the Northeast, followed by scattered states in the West and Midwest, such as Washington, Utah, and Michigan. The lowest unadjusted rates were in Massachusetts (0.03/100,000 of the population), New York (0.06), Maryland (0.06) and Connecticut (0.06).

Rhode Island (0.05) also had a low rate, although the estimate was unstable due to the low number of deaths in the state.

Factors significantly associated with a heightened risk of an unintentional firearms death were the percentage of families living below the poverty line in each state, the percentage of the population living in rural areas, and the percentage of gun owners.

Further in-depth analysis revealed strong predictors of an unintentional firearm death: the percentage of people identifying as non-White; the percentage of families living below the poverty line; and the estimated firearms ownership in each state.

The researchers note various limitations to their findings, including that no precise measurement of firearm ownership exists, and that other factors omitted from their analysis might be strongly associated with a heightened risk of unintentional firearms deaths.

“Attempts to alleviate the complex nature of poverty in America are challenging, complex and unlikely to happen quickly. Attempts to reduce firearms ownership are equally unlikely, and arguably inappropriate as firearms represent an integral part of culture and life for many Americans, including especially Americans living in rural areas,” write the researchers.

“Prevention of unintentional firearms mortality is essential nationwide, but should be targeted especially to vulnerable populations, including those living in states identified by this research to have crude rates that far exceed national averages and are 10 times higher than crude rates in the least vulnerable states,” they conclude.

“Prevention must be multifaceted,” they add, “and should include efforts along at least three pathways: education and training; policy;and engineering of safer firearms and firearms storage.”

26/07/2024

Notes for editors 
Short report: Unintentional firearms mortality disparities across states—USA, 2001–2021  Doi 10.1136/ip-2024-045268
Journal: Injury Prevention

Funding: Centers for Disease Control and Prevention (CDC)

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post More than 10-fold difference in rates of unintentional gun deaths across US states first appeared on BMJ Group.

That’s around 80% of the country’s estimated 81 million gun owners
Perceived need now prompting women and those of minority ethnicity to own a gun

Some 65 million Americans now own firearms for protection—around 80% of the country’s estimated 81 million gun owners—suggest the results of a nationally representative survey carried out in 2023, and published online in the journal Injury Prevention.

This perceived need is changing the profile of gun owners, the findings indicate, with increasing numbers of women and those of minority ethnic backgrounds citing protection as the primary reason for owning a firearm.

In 2021, firearms caused the highest absolute number of deaths on record in the USA, taking nearly 49,000 lives. This death toll coincided with a surge in firearm purchases during the COVID-19 pandemic, adding 7.5 million owners to the existing total.

The reasons for gun ownership in the USA have steadily evolved from tools of necessity to tools of self defence, facilitated in part by the liberalisation of firearms policies, such as concealed carry and stand your ground (SYG) legislation, note the researchers.

In 2017–2021, between 60% and 70% of firearm owners cited protection as the primary reason for ownership, compared with 48% in 2013 and only 26% in 1999.

The researchers therefore wanted to update information about the motivations for firearm ownership, explore any changes in the profile of gun owners, and assess the impact of SYG laws.

They drew on data from the National Firearm Attitudes and Behaviors Study, which aimed to examine the prevalence, contextual factors, beliefs and perceptions surrounding firearm behaviours among a nationally representative sample of  20,284 US adults in May and June 2023.

Of the 8172 who completed the survey, 2477 respondents reported owning a firearm. They were asked their primary reason for owning a gun. Motivations other than protection, such as hunting and target shooting, were collapsed into one ‘other’ category due to low numbers citing this reason.

And they were also asked if they had carried a firearm outside the home in the past 12 months, excluding for hunting, target shooting, or for work.

States in which gun owners lived were categorised by SYG law status. At the time of the survey, 30 states with SYG laws were identified, of which 8 had already applied the legislation.

Among those who said they owned a gun, 79% cited protection as the most important reason for doing so, and 58% reported carrying a firearm outside their home in the past 12 months.

Given that over 81 million Americans are estimated to own firearms, this equates to around 65 million people owning firearms for protection, calculate the researchers.

Ownership for protection was not notably higher among firearm owners living in SYG states, but firearm owners in these states were more likely to carry a gun outside of the home: 50% vs 35% in states without SYG legislation.

Ownership for protection was characterised by more frequent carriage, despite owning fewer firearms, and more first-time firearm owners.

Gender and race/ethnicity emerged as factors strongly associated with ownership for protection. Women, Black and Hispanic people were more likely to own firearms for protection than for other reasons.

And Black and Asian women (99% prevalence) almost exclusively owned a gun for protection and while fewer men cited protection as their primary motivation for owning a gun, owning for protection was more common among Black men (88.5%) than it was among White men (70%).

Other characteristics, including political affiliation, weren’t significantly associated with desire to own a gun for protection. Neither was knowing someone who had been shot or killed by a firearm. But the feeling that there was no one they could trust or rely on was more common among those who cited protection as the primary reason for gun ownership.

This study didn’t set out to address causality or determine the reasons why respondents own firearms for protection, caution the researchers, who also point to certain limitations to their findings.

Among them, the sampling and response biases inherent in surveys and the relatively small number of respondents, which although weighted to generate a representative sample at the regional and national level, may not capture the full spectrum of firearm owners and related characteristics.

Social pressures may also have affected people’s willingness to be honest about their behaviours and motivations, suggest the researchers. For example, only 5% of firearm owners reported carrying their firearm for protection, despite most of them (79%) citing protection as the reason for ownership.

“Given that over 81 million Americans are estimated to own firearms, this nationally representative survey finds that around 65 million people own firearms for protection (79% of firearm owners).

These 2023 estimates are higher than previous years, indicating a continuing trend where firearm ownership is now predominantly motivated by protection, and appealing to demographics beyond the ‘traditional’ firearm owner, including women and minority races, regardless of political affiliation,” write the researchers.

“SYG laws specifically affect the legal right to use deadly force for self-defence in public places, and therefore, increased firearm carriage might be a mechanism by which states with SYG laws have contributed to higher rates of firearm violence,” they suggest.

“The simultaneous relaxing of concealed carry laws and strengthening self-defence laws may be reinforcing firearm behaviours for protection, particularly carriage in public places,” they add.

“Rising rates of firearm ownership among non-traditional firearm-owning groups, particularly members of historically marginalised populations, may reflect a growing desire to protect against external threats, such as hate crimes,” they suggest.

26/07/2024

Notes for editors
Short report: Firearm ownership for protection in the USA, 2023: results from a nationally representative survey Doi 10.1136/ip-2024-045244
Journal: Injury Prevention

Funding: National Institutes of Health/National Institute of Child Health and Human Development

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; survey data
Subjects: People

The post 65 million Americans now own firearms for protection, suggests survey first appeared on BMJ Group.

Flips, jumps, turns on flat ground; quarter pipe and ramp moves pose highest risk at all ages

To curb the risk of falls, it may be worth grading skateboard parks like ski runs according to the popularity of the metal and concrete features they contain and the level of expertise required, conclude researchers in the journal Injury Prevention.

Their analysis of the moves performed by more than 500 young skateboarders reveals that flips, jumps, and turns on flat ground and quarterpipe (a curved concave ramp) and ramp tricks seem to pose the greatest risk, and are universally popular.

A grind box, where the T-shaped turn parts under the skateboard deck, known as trucks, slide along the edge or surface of a long relatively narrow box, was also a high risk feature, but more often used by older skateboarders, the analysis shows.

In recent years, the number of skateparks has increased as the popularity of the sport has grown among young people, note the researchers. While falls are a recognised hazard of the activity, not much is known about the design features of skateparks or the types of tricks performed there that might increase injury risk. 

To try and plug this knowledge gap, the researchers set out to identify the preferred features and tricks, and to gauge the frequency and severity of falls, among 526 predominantly male (98%) skateboarders at one large skatepark in Canada.

The skateboarders were divided into a younger group of 11–15 year olds (166) and an older group of 16-20 year olds (360) and were unobtrusively video recorded while performing their tricks.

Fall severity was scored whenever a trick was attempted, ranging from 1, indicating successful completion, to 5 and 6, indicating that the skateboarder fell onto part of, or their entire, body.

The proportion of children using each feature was computed for each age group, as was the proportion of falls on each feature. Popular features were defined by at least 10 children in one of the age groups using them. 

Among young skateboarders, most (74%) used the flat ground, followed by the quarterpipe (46%) and the ramp (47%). Few attempted the grind box, stairs, or railing. 

Older skateboarders spent the most time on the flat ground (71%), the quarterpipe (46%), the ramp (51%), and the grind box (35%). Few used the railing or the stairs. 

The highest fall frequency was on the grind box (85% of younger skateboarders; 67% of older ones), followed by the flat ground (65% and 61%, respectively). Lower fall frequency (about 35%) was comparable across both age groups for the quarterpipe and the ramp.

Younger skateboarders experienced the highest risk on the flat ground, followed by the ramp, and the quarter pipe. Older skateboarders also experienced the highest risk on the flat ground, followed by the grind box and the ramp. Fall risk is high on flat ground because it’s used to try out tricks, explain the researchers.

As to the type of preferred tricks, younger skateboarders most often performed turns (61% of them), with jumps, slides, and flips performed less often. They seldom tried other types of tricks. 

Older skateboarders mostly did jumps (61% of them) and other types of tricks (53%). Other popular tricks included slides (47%), turns (42%), and stalls (30%).

The highest fall frequency for younger skateboarders was during flips, with 94% of them falling when they tried these, followed by slides (67% fell), and jumps (42%). The highest fall frequency for older skateboarders was also for flips (81% fell) and slides (72%).

There are no universal safety standards for skatepark design, note the researchers, who suggest that features might be grouped together strategically to encourage younger skateboarders in one area and older skateboarders in another. 

“Segregating ages by design might reduce imitation of risky tricks performed by older skateboarders that are viewed by younger skateboarders but are beyond their skillset,” they suggest.

“It may prove useful to moderate risk of falling if features are differentially coded across the skatepark to suggest difficulty levels, much like what is done on ski hills,” they add.

Finding ways to encourage skateboarders to use protective gear might also be helpful, given that most of those who featured in the analysis weren’t wearing helmets, for example.

The researchers acknowledge that there were few female skateboarders in their study, and that they graded fall severity on the potential to cause injury.

“It would be useful to talk directly with skateboarders who have experienced a medically attended injury and assess how these affect their decisions with regard to features they will use and/or tricks they plan to attempt on returning to the skatepark,” they conclude.

13/12/2023 

Notes for editors
Research: Adolescents at the skatepark: identifying design features and youth behaviours that pose risk for falls doi 10.1136/ip-2023-045017
Journal: Injury Prevention

Funding: Canadian Institutes of Health Research

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Young people

The post Grade difficulty of skatepark features like ski runs to curb fall risk, say researchers first appeared on BMJ Group.

Risks even higher for those on scooters rather than in cars, findings indicate

Pregnant women involved in road traffic collisions—even those with minor injuries—are at heightened risk of potentially serious birth complications, including dislodgement of the placenta (placental abruption), very heavy bleeding, and the need for a caesarean section, finds a Taiwanese study published online in the journal Injury Prevention.

And the risks are even higher for those on scooters rather than in cars, the findings indicate.

Road traffic collisions are the leading cause of traumatic injury during pregnancy, with previously published research suggesting they account for up to 70% of such injuries. But most of the evidence base to date on the associated outcomes draws on hospital records and collisions involving cars. 

To try and provide a broader perspective, the researchers drew on information supplied to the National Birth Notification (BN) Database in Taiwan, medical insurance claims, and death registry data between 2007 and 2016.

Some 20,844 births were recorded among 20,739 women involved in a road traffic collision while pregnant during this period. They were each matched with 4 randomly selected women, of the same age and at the same stage of pregnancy, but who hadn’t been involved in a road traffic collision (83,274 in total).

Information was collected on potentially influential factors, including area of residence, household income, nationality, lifestyle, and risky behaviours, such as alcohol and drug taking during the pregnancy.

The women who had been involved in road traffic collisions were more likely to live in rural areas, to be financially disadvantaged, and to have engaged in risky behaviours during their pregnancy.

Compared with their peers, these women were 31% more likely to experience prolonged contractions, 51% more likely to experience placental abruption, 19% to bleed very heavily before birth, and 5% more likely to need a caesarean section delivery. 

Pregnant women who had sought emergency care or who had been admitted to hospital within 3 days of the incident were 77% and nearly 6 times more likely, respectively, to experience placental abruption. 

These women were also at significantly increased risk of heavy bleeding before birth, C-section delivery, and delivering underweight babies.

Injury severity was also an important factor: women who had been severely injured in the collision were 4 times as likely to experience placental abruption, 61% more likely to need a C-section, and 80% more likely to deliver prematurely than those who hadn’t been injured.

But pregnant women with minor injuries were still at significantly increased risk of birth complications, including placental abruption (70% more likely), induced labour (54% more likely), and prolonged contractions (34% more likely).

Pregnant women riding scooters at the time of the incident also had significantly higher risks of birth complications, ranging from 6% (C-sections) to 83% (placental abruption) than those in cars.

“These findings reinforce the fact that healthcare workers should be aware of these effects and consider providing pregnant women with educational materials about road traffic safety and choice of vehicle while travelling during pregnancy,” write the researchers.

“Given the associations observed, a better understanding is needed in future research of the circumstance following crashes during pregnancy in order to develop effective management,” they add.

Notes for editors
Research: Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population based retrospective study Doi 10.1136/ip-2022-044810
Journal: Injury Prevention

Funding: Ministry of Science and Technology

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Case-control study
Subjects: Pregnant women

The post Pregnant women in traffic collisions at heightened risk of birth complications first appeared on BMJ Group.