Virginia Hazel Routley

China belting up or down? Seat belt wearing trends in Nanjing and Zhoushan

National seat belt wearing legislation became effective in China May 2004 and associated provincial and city regulations followed. Despite rapid motorisation seat belt studies in China have been scarce. Patterns and trends in urban seat belt wearing were observed for all driver, front and rear seating positions over the years 2005-2007 in two eastern cities Nanjing (Jiangsu Province) and Zhoushan (Zhejiang Province). There were 35,256 vehicles observed in Nanjing, 20,939 in Zhoushan and 95,933 occupants overall. Males dominated all seating positions, especially drivers. Seat belt wearing overall was significantly higher for drivers (49.9% Nanjing, 47.4% Zhoushan) than for front seat passengers (9.1% Nanjing, 1.0% Zhoushan) and virtually nonexistent for rear passengers (0.5% Nanjing, 0.2% Zhoushan). Generally levels declined significantly from year to year (drivers Nanjing 66.7%, 47.7%, 38.6%; Zhoushan 57.4%, 57.9%, 30.6%; front passengers Nanjing 19.2%, 6.6%, 3.2%). Zhoushan wearing did not initially decline, 2006 observations coinciding with anticipation of provincial regulations (July 2006). Observations revealed an absence of child restraints. Pretend wearing/belt tampering was observed almost exclusively in taxi drivers (14.2% of Nanjing taxi drivers, 11.3% of Zhoushans). Awareness of and attitudes to urban seat belt laws should be investigated, appropriate countermeasures developed and enforcement reassessed.

Rollerblading injuries in young people

Objective: To study injuries In young people associated with the use of rollerblades, draw comparisons with skateboarding and rollerskating injuries, and suggest strategies for injury prevention.

Pattern of seat belt wearing in Nanjing, China.

Objective: To describe the patterns of seat belt wearing in Nanjing, China for drivers, front seat passengers, and rear occupants of motor vehicles. Design: Roadside observational study. Setting: Four sites in central and northern Nanjing during daylight hours over 1 week in April 2005. Subjects: Drivers and passengers of 17 147 cars, taxis, goods vans, and pickups, which traveled in the inside traffic lane. Main outcome measures: Percentage seat belt wearing for each of seating position, age/sex, time of day, vehicle type, day of week. Results: The rate of seat belt wearing was significantly higher in drivers (67.3%, 95% CI 66.6 to 68.0) than front seat passengers (18.9%, 95% CI, 18.0 to 19.8). It was negligible for second front seat passengers (2.6%, 95% CI 0.3 to 4.9) and rear seat passengers (0.5%, 95% CI 0.3 to 0.7). Belt tampering, such that protection would be reduced in the event of a crash, was observed for 18.5% of taxi drivers. Drivers were most likely to wear seat belts in cars and vans and at a city roundabout; front seat passengers were most likely to wear seat belts in non-taxi vehicles, during the evening rush hour, if the driver was wearing a belt, and on the local north road. Drivers were least likely to wear a belt in the early morning, in pickups and taxis, on Tuesday (or the following week), and on the local north road; front seat passengers were least likely to wear a belt in taxis and if the driver was not wearing a belt. Conclusions: Rates of seat belt wearing by passengers were low despite national legislation and provincial regulations coming into effect several months before the survey. Combined education and enforcement are necessary accompaniments to legislation.

Towards a reassessment of the role of divorce in suicide outcomes: Evidence from five pacific rim populations

The connection between divorce and suicide risk in Asia is unclear. To understand the contribution of cultural transitions to suicide among the divorced, we compare age- and sex-specific suicide rates among divorced men and women from five Pacific Rim populations: Hong Kong, Taiwan, Japan, South Korea and the state of Victoria in Australia. On a cultural spectrum, we consider Hong Kong and Taiwan to lie between the more individualistic Australian culture and the more collectivistic Japanese and Korean cultures. Coefficients of aggravation (COA) are also compared. Suicide rates were found to be higher among the divorced than among other marital status groups in all five populations, but this difference was small in Victoria. The effect of divorce was significantly greater for men than for women only in Japan and South Korea. In the other populations, divorced men and women were at equal risk. Age trends in suicide rates for the divorced groups differed across populations. The COAs for the divorced group aged 40 or younger in the East Asian populations were higher than the COAs for older divorced groups, though this was not the case in the Victorian population. Suicide patterns among the divorced in the East Asian populations can be understood in terms of the legacy of Confucian traditions. Gender differences in Japan and South Korea may reflect either gender inequality (male dominance in formal interactions and emotional dependence in domestic life within a deteriorating Confucian family support system) or unique socio-cultural factors among married women. Divorced East Asian groups aged 40 or younger may be at a higher risk of suicide due to individual-level cultural ambivalence combined with a desire for systemic-level emotional interdependence. Social welfare regimes in the four East Asian populations need to fill the vacancy left by retreating traditional family systems. Research implications are discussed.

Work-related suicide in Victoria, Australia: a broad perspective

While unintentional work-related injury is increasingly recognised as important and preventable, population studies of the full range of work related suicides have received less attention. The objective of this study is to investigate the epidemiology of work-related suicide in Victoria, July 2000–December 2007. The study draws on a database of all work-related deaths reported to the Victorian Coroner, inclusive of broadly defined work-relatedness. Inclusion criteria for work-related suicide were at least one of: suicide means was work related, work stressors were identified in police reports to the Coroners or the Coroners finding, the suicide method involved another persons work (e.g. rail suicide, heavy vehicle) or the suicide location was a workplace. Cases still open for investigation were excluded. Of 642 work-related suicides, 55% had an association with work stressors; 32% jumped or lay in front of a train or heavy vehicle; 7% involved a work location and 6% involved work agents. Work stressor cases identified included business difficulties, recent or previous work injury, unemployment/redundancy or conflict with supervisors/colleagues (including workplace bullying). Work-related suicide is a substantial problem, for which few detailed population wide studies are available. Further research is required to understand the contribution of work stressors and effective interventions.

Motor vehicle exhaust gas suicide in Victoria, Australia 1998-2002.

Motor vehicle exhaust gas suicide (MVEGS) is the second most frequent method of suicide in Victoria, Australia. It is a highly lethal method of suicide with 1.5 deaths for every hospital admission. Australian regulations require all vehicles manufactured since 1998 to have a maximum carbon monoxide exhaust emission level of 2.1 g/km, reduced from the previous level of 9.6 g/km. Information surrounding all Victorian MVEGS between 1998-2002 was analyzed to determine whether suicides occurred in vehicles with the lower emission levels. Between 1998-2002, 607 suicides by this means were recorded while just 393 hospital admissions were recorded for the same period. Mean carboxyhaemoglobin levels were significantly lower in fatalities using vehicles manufactured from 1998, however suicide still occurred in these vehicles (n = 25). The extent to which the new regulations contributed to the relatively low rate of suicide in vehicles less than 5 years old compared to their frequency in the fleet remains unknown. Based on international experience and the age of the Victorian vehicle fleet, it may take well over a decade until substantial decreases in MVEGS are observed in the absence of active preventive measures.

A descriptive analysis of work-related fatal injury in older workers in Australia 2000–2009

The objective of this study is to describe the extent, nature, age distribution and external causes of older-worker fatalities and to provide baseline data for future studies. The methods included retrospective descriptive cohort study using existing population-based mortality data. The study examined work-related fatalities aged 55 years and older, 2000–2009, in Australia following coronial investigation. Of the 336 fatalities identified, almost all (96.3%) were male. The industry with most deaths was agriculture, forestry and fishing (37.8%), followed by transport, postal and warehousing (19.3%) and construction (16.6%). The most frequent injury mechanism was transport-related (40.4%). With predicted workforce ageing, older-worker deaths will become a significant public health issue. Employers and authorities will need to understand older-workers characteristics and vulnerabilities to enable appropriate injury prevention strategy implementation.

Attitudes to seat belt wearing and related safety features in two cities in China

The study aimed to establish characteristics of vehicles, occupants, seat belt and vehicle safety features for the Chinese cities of Nanjing and Zhoushan in order to interpret previously observed low seat belt wearing rates, particularly of passengers. Convenience interview surveys, stratified by vehicle and occupant type, of 2280 motor vehicle users were conducted in 2006 and 2007. Most participants (74.4%) were male, particularly drivers. Over half the occupants surveyed were aged 30–39 years. Drivers had relatively new vehicles and less driving experience compared with more motorised countries. Seat belts in most front seating positions and in half of the rear seats were fitted and functional. Where fitted, reasons for ‘never wearing’ were mostly ‘feeling trapped and uncomfortable’; inconsistent wearers were influenced by ‘habit development, trip length, speed, comfort and enforcement’. Public awareness of the safety benefits of seat belts, strong enforcement and retrofitting are necessary to overcome these barriers as achieved by past and present best practice.

Focus on Seat Belt Use in China

Objective: To explain low seat belt use prevalence results of observation and interview surveys in Nanjing, Jiangsu Province, and Zhoushan, Zhejiang Province, and to extend knowledge on associated seat belt use determinants. Method: Ten focus groups comprising professional, owner, and taxi drivers; passengers; van drivers (Nanjing); or police (Zhoushan) were conducted to capture a range of experiences, attitudes, and opinions. Results: There was common agreement in all focus groups on the need to use seat belts on highways in the front seat but not to use in the rear seat regardless of road type. Participants generally agreed with the apparent practice of fines for drivers and warnings for front seat passengers, especially on highways. Lack of seat belt comfort was elaborated on. Professional and taxi drivers were inconvenienced by the effort involved for short trips to put on seat belts and discomfort was greater for those who did not have or could not afford to operate air conditioning. There was lack of agreement on the need to use seat belts in the city areas. Crash video clips on the nonuse of seat belts were judged by participants as potentially effective for promotion of seat belt use, especially if scenarios were associated with relatively low speeds. Conclusions: The benefits of seat belt use for all seating positions and at low and medium speeds and awareness of passenger seat belt responsibility need to be promoted. Enforcement should be applied more consistently.

The WHO injury surveillance guidelines: a systematic review of the non-fatal guidelines' utilization, efficacy and effectiveness

OBJECTIVES To systematically assess the utilization, efficacy and effectiveness of the WHO Injury Surveillance Guidelines. STUDY DESIGN A systematic review of the literature. METHODS A comprehensive systematic search of peer reviewed and grey literature was conducted for relevant studies published between Jan 2002 and May 2013 reporting utilization of the Injury Surveillance Guidelines. Injury experts and government departments from low- and middle-income countries were contacted. RESULTS Forty-nine studies met the inclusion criteria. These were conducted in health facilities in five WHO regions, African Region (28%): Eastern Mediterranean and Western Pacific Regions, both 22%. The Guidelines were mostly used selectively: the minimum data set as a survey tool; process and system environment evaluation; categorizing injuries for data analysis; measuring injury severity and for data quality assessment or comparisons. Twenty-six studies used the Guidelines to collect overview injury data prospectively and/or retrospectively, or for Injury Surveillance System (ISS) feasibility studies, with four actually establishing an ISS or informing the establishment process. Few reported effects on injury policies and programs. Most studies used only the minimum dataset, limiting the level of detail for injury prevention. Other ISSs may have been established using the Guidelines, though no English language publications referencing this were found. CONCLUSIONS This review provides encouraging results that the Guidelines continue to be used, albeit mainly for short-term studies predominantly in low- and middle-income countries with very limited sustained ISS establishment and local injury prevention capacity building. It highlights the need to improve and expand the minimum dataset to at least include a meaningful narrative text and potentially to expand the mechanism codes to a second level of detail, as well as building local injury prevention capacity.