Michal Grivna

Factors affecting anatomical region of injury, severity, and mortality for road trauma in a high-income developing country: Lessons for prevention

OBJECTIVES To study the factors affecting anatomical region of injury, severity, and mortality among road users in United Arab Emirates so as to improve preventive measures. METHODS Data of the Trauma Registry of Al Ain city were collected prospectively over 3 years (2003-2006) at the main trauma hospital. For traffic injuries, the following were assessed: gender, nationality, road user type, anatomical region(s) of injury, systolic blood pressure on admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and mortality. Analysis included frequencies, cross-tabulations, and logistic regression. RESULTS There were 1070 patients, 89% male, 25% UAE nationals, and with a mean age of 31 years. Expatriates, mainly from non-Arabic speaking, low-income countries, accounted for 88% of injured pedestrians, whilst nationals were overrepresented among vehicle occupants (29%), and motorcyclists 37%. Injuries of the extremities and head were frequent among pedestrians, motorcyclists, and bicyclists, whilst head and spine injuries were most common among front and rear vehicle occupants and drivers. The median ISS was five for pedestrians and four for all other road user types, including rear vehicle occupants. The mean hospitalisation was 9.7 days; 13% of patients were admitted to ICU with mean stay of 6.5 days. Overall mortality was 4%; pedestrians accounted for 61% of deaths. Predictors of mortality were GCS (p<0.001), ISS (p<0.01) and systolic blood pressure on admission (p<0.03). CONCLUSIONS Head injury was a major factor affecting mortality, followed by injury severity and hypotension. To reduce injury incidence and severity, legislation and education are needed to ensure use of seat belts by all vehicle occupants including rear passengers, high-visibility devices by other road users, helmets by motorcyclists and bicyclists, protective clothing and boots for motorcyclists, and traffic engineering for pedestrians.

Occupational injury in the United Arab Emirates: epidemiology and prevention.

BACKGROUND The United Arab Emirates (UAE) is developing rapidly, with many foreign construction, farm and industrial workers. AIMS To assess the epidemiology of occupational injury hospitalizations using a trauma registry. METHODS Surgical admissions from March 2003 to April 2005 were recorded in the registry at the main trauma hospital in Al Ain city (population 348,000). Prevention-related variables were analysed using SPSS and severity was quantified by injury severity scores (ISS). RESULTS There were 614 occupational injury hospitalizations, an incidence of approximately 136/100,000 workers/year. Males accounted for 98% of injuries, the 25-44 age group for 69% and non-nationals for 96%. External causes included falls 51%, falling objects 15%, powered machines 11%, animal-related 7% and burns 6%. Median ISS was 4 for all six main external causes. Extremities were most frequently injured, followed by chest, head and neck, abdomen and face. Mean hospitalization duration was 9.4 days, with 36% hospitalized for >1 week. CONCLUSIONS The main external causes were proportionately much more frequent than in industrialized countries. Effective countermeasures are needed to reduce the incidence and severity of occupational injury among vulnerable migrant workers in the UAE.

Prevalence and Issues in Non-Use of Safety Belts and Child Restraints in a High-Income Developing Country: Lessons for the Future

Objective. In United Arab Emirates (UAE), a high-income developing country, safety belt (SB) legislation was implemented in 1998, covering only front-seated adults on highways outside cities. We assessed wearing of SBs after 5 years, together with use of safety restraints by rear passengers and children, perceptions about SBs, and use of tinted glass. Methods. A cross-sectional survey in 2003–2004 in Al Ain, population 400,000 and the main desert city of UAE, used random sampling of petrol stations; about 80% of UAEs population is non-citizens. Five of 30 stations were selected, including 3 different speed zones; vehicles with children were over-sampled. Drivers were interviewed by questionnaire. Use of safety restraints and presence of tinted glass were verified by observation. Confounding and correlation were assessed by stratification and logistic regression. Results. The sample included 500 vehicles, containing 959 adults and 876 children; 382 vehicles had children. SBs were used by 29% of drivers, 14% of front-seat and 2% of rear-seat adult passengers. 23% of children were in front; only 4% in front and 1% in the rear were restrained. SBs were worn by only 11% of UAE-citizen drivers and 10% of off-duty police and military. Odds ratio for non-use by citizens was 3.55 (95% CI 1.96–6.42). Use was greater among older drivers (p < 0.0005, X 2 trend). Reasons for non-use of SBs included discomfort 42%, forgetfulness 25%, uselessness 17%, carelessness 13%, and dangerous 3%. Among citizens, 15% believed SBs are dangerous. Tinted glass was present in 68% of vehicles. Conclusions. SB legislation failed to protect the population, with low use of restraints by citizens, military, and police, and virtually none among children and rear passengers. Lessons include the necessity of drafting laws that provide comprehensive and effective protection, study of cultural constraints to compliance with injury prevention measures, and locally effective interventions to prepare citizens and enforcers for the expected new behaviour. Highly tinted glass is widespread and poses a barrier to enforcement.

Strengthening public health medicine training for medical students: Development and evaluation of a lifestyle curriculum

Background: Lifestyle factors are major determinants for health and safety. Although many graduates lack interviewing and observational skills for prevention and student lifestyle often deteriorates during training, few medical schools teach comprehensive assessment of lifestyle, particularly in the context of the home environment. Aims: A lifestyle curriculum was developed to teach basic causality and provide practical experience in assessing nutrition, exercise, safety, tobacco addiction, and food hygiene, together with generic skills in history taking, on-site observation, researching and presenting. Methods: Lifestyle has been integrated into the first-year curriculum, evaluated, and improved at the United Arab Emirates University since 2001. After an introduction to determinants of health, students conduct a home interview and observational survey for family residential and traffic safety, smoking, and food hygiene. For nutrition and exercise, students assess personal lifestyle. Generic skills are developed in the context of lifestyle. Evaluations were by faculty and students, including assessed impact on knowledge, skills, and personal lifestyle. The lifestyle curriculum was compared with other countries by detailed search. Results: Detailed evaluation found strong agreement/agreement among students that knowledge had improved on: counselling of patients and families 97%, promoting healthy lifestyles 100%; interviewing 88%; history taking 84%; using research for medical practice 89%; and importance of prevention 96%. Eighty six percent were stimulated to think in new ways about health. Improved personal diet was reported by 60% (p < 0.0004) and exercise by 55% (p < 0.0004), while 36% of non-users started wearing a safety belt in front (p < 0.0004) and 20% in the rear (p = 0.008). Literature review found comprehensive lifestyle curricula to be rare. Conclusions: A lifestyle curriculum developed prevention-oriented history-taking and observation skills for health maintenance, addressing health priorities, improving medical student lifestyle, and strengthening generic skills. Since lifestyle is a major determinant of health, medical schools should consider development of an appropriate curriculum to address their local and national health priorities.

Severe childhood burns in the Czech Republic: risk factors and prevention

OBJECTIVE To assess risk factors for paediatric burn injuries in the Czech Republic and to suggest preventive measures. METHODS This study included all children aged 0-16 years hospitalized during 1993-2000 at the Prague Burn Centre and data from the Czech Ministry of Health on national paediatric burn hospitalizations during 1996-2006. Personal, equipment and environmental risk factors were identified from hospital records. FINDINGS The incidence of burn admissions among 0-14 year-olds increased from 85 to 96 per 100,000 between 1996 and 2006, mainly due to a 13% increase among 1-4 year-olds. Between 1993-2000 and 2006, the proportion of burn victims in the country hospitalized at the Prague Burn Centre increased from 9% to 21%. Detailed data were available on 1064 children (64% boys). Around 31% of all burn hospitalizations were in 1 year-olds. Some 79% of burns occurred at home: 70% in the kitchen, 14% in the living room or bedroom and 11% in the bathroom. Of the 18% occurring outdoors, 80% involved boys. Scalds from hot liquids accounted for 70% of all burns. The mean hospital stay was 22 days for boys and 18 days for girls. CONCLUSION Most burns involved scalds from hot liquids at home: beverages in kitchens and water in bathrooms. There is a need for passive preventive measures, such as redesigned domestic cooking and eating areas, safer electrical kettles and temperature control devices for bathrooms. Educational programmes should be developed for parents and caregivers. A national plan for child burn prevention with specific targets would be helpful.

An analysis of the health status of the United Arab Emirates: the ‘Big 4’ public health issues

Background : The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. Methods : A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. Results : The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. Conclusion : The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. To access the supplementary material to this article please see Supplementary files under Article Tools online.BACKGROUND The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. METHODS A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. RESULTS The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. CONCLUSION The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. To access the supplementary material to this article please see Supplementary files under Article Tools online.

Drowning in a high-income developing country in the Middle East: Newspapers as an essential resource for injury surveillance

Despite frequent media accounts of drownings in the United Arab Emirates, little was known about the epidemiology and prevention of such incidents. The research objective was to assess newspapers as a national source on incidence, activities, and risk factors for drowning in this high-income media-rich developing country where official sources do not include sufficient variables for injury prevention. The three main national English and six Arabic newspapers were assessed for electronic retrieval of incidents, which proved impractical; however, the largest English-language paper maintained a clipping file on drowning. Newspaper data, including incidence, activity, and purpose, together with personal, equipment, and environmental risk factors, were compared with Ministry of Health reports for 1998-2002. Incidence from clippings was 0.50drownings/100,000population/year and from Ministry reports, 0.27. Activity such as swimming or boating and purpose of activity such as recreational or occupational were unreported by the Ministry. Activity was reported in 100% of newspaper clippings. Swimming (49%) was the most common activity. The purpose of 17% of cases was classified as occupational. Gender was 100% complete in both sources. In newspaper reports, age was classifiable as child or adult, while the Ministry used age groups. National citizenship was 100% reported by Ministry; 91% of newspaper reports included nationality, providing details for expatriates. Swimming ability was unreported by Ministry, and by newspaper 52%, of whom 73% were non-swimmers. While the newspaper provided information on body of water, mainly ocean and pools, this was unreported by Ministry. Month was unspecified by Ministry, 100% by newspaper. Neither reported safety equipment. The newspaper proved the most useful resource for drowning prevention since there were more incidents and most included key variables; however, Ministry reports provided supplementary information. Newspapers with electronic searching on health terms, including injuries, would be a national asset for surveillance.

Bicycle-related injuries requiring hospitalization in the United Arab Emirates

OBJECTIVES To study the anatomical distribution, severity, and outcome of bicycle-related injuries requiring hospitalization in Al-Ain city, United Arab Emirates in order to improve preventive measures. METHODS All patients with bicycle-related injuries who were admitted to Al-Ain Hospital or who died after arrival were studied. Data were prospectively collected over a period of six years (October 2001-October 2007). Demography of patients, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), hospital stay, and mortality were analysed. RESULTS There were 130 patients (126 males). Mean (SD) age was 27.1 (14.5) years. 17.7% were United Arab Emirates (UAE) nationals. None of the patients was wearing a helmet. The percentage of UAE nationals of less than 15 years old was significantly higher (65.2%) than non-UAE nationals (14.3%) (p<0.0001, Fishers Exact Test). The most common mechanism of injury for UAE nationals was falling from a bicycle (73.7%) whilst for non-UAE nationals was hitting a moving vehicle (66.7%). 96 (73.9%) patients had head and face injuries whilst 91 patients (70%) had extremity injuries. On arrival to the hospital, the median (range) ISS was 4 (1-41) and the median (range) GCS was 15 (3-15). The median (range) of total hospital stay was 4 (1-95) days. 17 patients (13.1%) were admitted to the Intensive Care Unit. Two patients died because of head injury (overall mortality was 1.5%). CONCLUSIONS The majority of hospitalized injured cyclists in our study were low income adults using cycling as a cheap transportation method. Compulsory helmet use by bicycle riders and subsidising helmet cost should be adopted so as to reduce morbidity and mortality of bicycle-related injuries.

The legal framework and initiatives for promoting safety in the United Arab Emirates

Injury is a leading cause of morbidity and mortality in the United Arab Emirates (UAE). The UAE is a rapidly developing country with fast economic growth, demographical and environmental changes that are associated with new hazards emerging at a similar pace. The UAE as a federal entity has federal and local systems responsible for safety policy, regulations and enforcement. To set priorities for safety promotion and injury prevention, it is necessary to have data on the most frequent external causes of injury and the main individual, equipment and environmental risk factors that contribute to injury. However good quality data for injury prevention are scarce. The aim of this paper is to describe the scale of injury as a public health problem in the UAE, and the development of safety policies, regulations and promotion efforts with special emphasis on traffic, occupational and child safety.

Breast cancer screening awareness, knowledge, and practice among arab women in the United Arab Emirates: a cross-sectional survey.

Background Breast cancer screening can reduce morbidity and mortality and improve the survival rate for this malignancy. Low participation in screening programs has been attributable to many factors including lack of knowledge. The aim of this study was to assess breast cancer screening knowledge, attitudes and practices among women of screening age (≥40 years old) in the city of Al Ain, United Arab Emirates (UAE). Methods A cross-sectional survey was conducted in 2013 using the Breast Cancer Awareness Measure (CAM). Four out of twelve cultural and religious community centers in Al Ain city were randomly selected. Two hundred and forty seven women were interviewed. Chi Square test and regression analysis were used to analyze the data. Results Despite the increase in the uptake of screening modalities in our study group, a lack of knowledge about breast cancer screening is still evident. Almost half (44.8%) of women who never had a Clinical Breast Exam (CBE) and 44.1% of women who never had a mammography expressed a lack of knowledge about the existence of these screening techniques. Nearly one third of the participants interpreted the presence of a breast lump incorrectly and, moreover, expressed fewer worries about the nature of the lump than would normally be expected. Conclusions The National screening program needs to be improved and directed towards more efficient and targeted utilization of resources. Healthcare professionals play a major role in alerting women to the importance of periodic screening.