Ragnar Andersson

Socio‐demographic risk factors for home‐type injuries in Swedish infants and toddlers

In this paper we use data from Swedish national registers to study socio‐demographic patterns of hospital admissions as a result of injuries sustained at home (poisoning, falls, scalding and ingestion/intrusion of foreign objects) in children 0–3 y. The study population comprised 546 336 children born in Sweden during the period 1987–91. The different injury mechanisms peaked at different ages: ingestion of foreign objects at 10–12 mo, scald injuries at 13–15 mo, non‐drug poisoning at 16–18 mo and drug poisoning at 24–30 mo. In a multivariate analysis it was demonstrated that children of young mothers (<24 y) were more likely to have been admitted to hospital because of fall injuries and poisonings, while children with more than two siblings had a slightly increased risk for all injuries. Children of mothers born in a non‐western country were more likely to have been admitted to hospital because of scald injuries; odds ratio (OR) 1.7 (95% CI: 1.4–2.1), while they were less likely to have been admitted because of fall injuries; OR 0.8 (0.7–0.8) and non‐drug poisoning; OR 0.5 (0.4–0.6). Children in families who received social welfare benefits were more likely to have been admitted to hospital because of fall injuries; OR 1.3 (1.2–1.4), drug poisoning; OR 1.8 (1.7–2.0), non‐drug poisoning; OR 1.4 (1.3–15) and scald injuries; OR 1.1 (1.1–1.5), while injuries with ingestion/intrusion of foreign objects tended to vary little with socio‐economic indicators.

Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition

Objectives—To examine the relationship between the magnitude, and the relative importance of unintentional child injury mortality with socioeconomic development, and to conceptualise the dynamic changes in injury mortality within the framework of epidemiological transition. Design—Ecological cross sectional study using data on 51 countries. Main outcome measures—The relationship between total mortality rates, unintentional injury mortality rates, and percentage in children 1–14 years of age with gross national product (GNP) per capita. Results—Unintentional injury mortality rates in children were negatively correlated with GNP per capita. However, by categorising the data, we found some areas of non-correlation: in children 5–14 years in low income versus lower middle income countries, and in all age and gender groups in lower high income versus higher high income countries. A high percentage of total deaths due to injuries was clearest in the lower middle income countries in all age and gender groups. Conclusions—The changes in child injury mortality in relation to socioeconomic development could be conceptualised as three stages: a stage of high magnitude; a stage of high priority; and a stage of improvement. Most middle income countries are in the high priority stage where both injury mortality rates and injury percentage of total deaths are high.

Sense of coherence and lack of control in relation to outcome after orthopaedic injuries

This study aimed to investigate whether sense of coherence (SOC) and lack of control are related to outcome after moderate orthopaedic injuries. One hundred and eleven patients with orthopaedic injuries were included. The patients were followed up 1 year after the injury (physical examination, Disability Raring Index (DRI), Visual Analogue Scale, Becks Depression Inventory and SF-36). At a minimum of 2 years after the injury, the patients filled out a questionnaire, which included three SOC questions and one question about sense of lack of control. The results showed that a low sense of coherence, sense of having less control over ones life, and signs of depression were associated with an increased risk of having a less good clinical and functional outcome 1 year after the injury (odds ratios varied between 2 and 11). We conclude that these factors seem to be predictive of the outcome and should be taken into consideration when designing rehabilitation programs for injured patients.

Hidden accident rates and patterns in the Swedish mining industry due to involvement of contractor workers

Abstract Subcontracting or contracting out work is a practice that has been utilized in the Swedish mining industry. According to official statistics on occupational injuries, mining accident rates have declined in recent years. However, mining accidents involving contractor workers are not recorded in the statistics for the mining industry, but rather in the statistics for those branches of industry within which their own employer (or “mother company”) are classified. Using data from the Swedish National Information System on Occupational Injuries, this cross-sectional study covers a five-year period in which 2397 accidents have been examined. The objective was to investigate the occurrence and pattern of occupational accidents among contractor workers, using mining company employees as a comparison group. The obtained results suggest that the official statistics do not reflect the real risk situation in the branch due to an involvement of contractor workers. Although there is a lack of valid exposure data concerning contractors, the results indicate that this category of worker seems to incur more frequent and more severe injuries. These workers also seem to perform different tasks and work under other conditions than mining company employees at the time of injury.

The effects of political and economic transitions on health and safety in Estonia: an Estonian-Swedish comparative study.

A general and dramatic deterioration of health in Estonia during the transition period 1990-1994 was analysed using Sweden as a comparative example. Though there were diverging trends between Estonia and Sweden in the leading cause of death, cardiovascular diseases, the gap in mortality from injury had increased most rapidly. While the injury mortality rate slightly decreased in Sweden from 1990 to 1994, it almost doubled in Estonia. In 1994, the total injury death rate for men was about 6 times higher in Estonia than in Sweden. The death rates for some types of injuries, such as alcohol intoxication and homicide, were many tenfolds higher in Estonia than in Sweden. Injury contributed the most to the widening health gap between the countries, especially in males. The mechanisms of this sudden health deterioration remain to be fully explained. It could be hypothesised that behind the traditional behavioural risk factors, the influence of socio-political factors related to economic and political reconstruction is present. A widespread risk-taking and unhealthy behaviour among Estonians can likely be partly explained as a way of coping with the distress created by the new demands of transition society. An important challenge on the way to improvement is creating the political will among policy-makers to confront the tremendous problems of controlling the factors in society that affect the populations health in Estonia.

Differences in cause-specific patterns of unintentional injury mortality among 15-44-year-olds in income-based country groups

OBJECTIVES The aim of the present study was to investigate the cause-specific patterns of unintentional injury mortality among 15-44-year-olds in various income-based country groups, and to analyze which specific causes contribute the most to the unintentional injury mortality in each country group. MATERIALS AND METHODS Cross-sectional data on the five most common causes of unintentional injury mortality by age-sex specific subgroups were compiled for 57 countries from the World Health Statistics Annuals for the year 1993 (1991-1994 if information for 1993 was unavailable). Data were categorized into four income-based country groups according to their gross national product (GNP) per capita for the year 1993. The differences between means and rate ratios of low, lower-middle, and upper-middle income countries were calculated by comparing them with those of the high-income countries. Regression analysis was performed to determine the trends in the direction of income for each specific cause of unintentional injury mortality by age-sex. RESULTS For any of the specific causes of unintentional injury mortality there was an inverse relationship between mortality rates and GNP per capita except for motor vehicle traffic (MVT) among the 15-24-year-old age group. MVT accidents were the most common cause and contributed 26-77% of all unintentional injury mortality. The second most common cause was poisoning in all country groups except low-income countries where drowning dominated for males and mixed causes for females. Upper-middle income countries represented the highest MVT mortality in all age-sex subgroups except among 15-24-year-old females for which high-income countries displayed the highest rate. For other causes, lower-middle income represented the highest rates with a few exceptions. In the 15-24-year age group, the rate ratio of motor vehicle traffic mortality was higher in high-income countries compared to low-income countries, while in the 35-44-year age group, all other country groups showed a higher rate ratio than high-income countries. Drowning for males and burns for females in the low and middle-income countries were significantly higher than in high-income countries.

Differences in injury mortality between the Nordic countries - with special reference to differences in coding practices

The aims of the study are to analyse the incidence and patterns in injury mortality in the Nordic countries, and to assess the extent to which any differences found can be explained in terms of either variation in statistical validity or the existence of genuine differences. The study considers the entire injury panorama, and is performed between certain categories of injuries. Analysis is applied to all ages, and also to certain specific age categories. Finland appears as the Nordic country with the highest injury mortality. While examining potential source of errors, nothing was found to merit an adjustment of Finlands rate. All potential correction would bring the rates of the other Nordic countries closer to that of Finland. Poisoning was found to be a diagnosis that varies in application between the Nordic countries. Falling is the diagnosis with the greatest problems of sensitivity, and cannot be recommended for comparative purposes.

Technological development and occupational accidents as a conditional relationship: A study of over eighty years in the Swedish Mining industry

Abstract The paper analyzes the relationship between technological development and occupational accidents in the Swedish mining industry from 1911 to 1990. Technological development is divided into three technological stages: handicraft, mechanization, and automation. Some contextual factors related to industrial relations and legislation are also investigated regarding the direction and magnitude of this relationship. It was observed that two types of variables can explain variations in accident rates: 1. (a) variables that affect the likelihood of accidents occurring, such as mechanization, reduction in working hours spent underground, and unemployment 2. (b) variables that affect or are affected by the propensity to declare accidents, as determined, for instance, by Swedens Work Insurance Act of 1955 or the Work Insurance Act of 1929. This study shows that the relationship between technological development and occupational accidents can be regarded as conditional, since changes in technology are not sufficient in themselves fully to explain variations in accident frequencies.

Etiological differences between accidental and non-accidental occupational overexertion injuries

Abstract Andersson, R., Kemmlert, K. and Kilbom, A, 1990. Etiological differences between accidental and non-accidental occupational overexertion injuries. Journal of Occupational Accidents , 12: 177–186. Unintentional injuries and accidents are often considered equal or corresponding terms. However, definitions are different in various countries. In Swedish official statistics overexertion injuries, which are the dominating types of occupational injuries at present, are subdivided into accidents and diseases. The former are appearing suddenly and the latter appear gradually. In this study the relevance of this distinction is evaluated from an etiological and preventive point of view. It is shown that differences exist between the two groups in several important respects. Differences in sex, age, injured part of body, industry, load situation, etc., give support to the conclusion that overexertion accidents and diseases originate from different causal conditions. It was also found that the descriptions of the origin and countermeasures in the basic injury reports were poorer as regards accidents. These findings should be taken into consideration when preventive programmes are designed.

The impact of advances in production technology on industrial injuries: A review of the literature

The paper reviews scientific studies of the past two decades dealing with the effects of advances in production technology on industrial injuries. The main features of these studies and the evidence gathered with regard to injury frequency, severity and characteristics are described. The accident co-determinants pointed to by the studies are highlighted. Methodological and theoretical shortcomings are discussed, and a research agenda comprising five questions is proposed. The fairest conclusion at this stage is that technological change may have positive effects with regard to injury occurrence and also promote personal well-being. But the conditions and moderating factors enabling favorable outcomes are not yet fully understood.