Caregiver experiences, contextualizations and understandings of the burn injury to their child. Accounts from low-income settings in South Africa.

BACKGROUND: Childhood burn injury is a widespread phenomenon with a disproportionate concentration in Sub-Saharan Africa. Burn injuries may have far-reaching and traumatic interpersonal, social and occupational effects for young children. There has been scant attention to the caregiver's experience of these events. This study sought to explore the caregiver's understanding of the injury to their children, the injury causes and its preventability. METHODS: The study is based on interviews with 13 caregivers. All informants were the female parents or grandparent of children who had sustained a moderate to severe burn injury and presented at a children's hospital in Cape Town. The interviews were audio-recorded, transcribed verbatim and analysed using a synthesis of the grounded theory approach with core content analytic steps. RESULTS: Analysis of data indicates that information related to the injury event can be separated into the child's activities, the activity undertaken by the caregiver at the time of the event and the environmental hazards coming into play. The remote factors associated with the event were related to the individual caregiver, family circumstances, the area's living conditions and the cultural context. The caregivers' suggestions for the future focused on the isolation of heat sources, caregiver supervision and environmental renovations. CONCLUSIONS: Caregivers emphasized the multifactorial nature of the burn injury event and highlighted the adverse environmental, domestic and personal circumstances to their child's burn injury. Their recommendations for burn prevention avoidance and control are consistent with their understanding of the injury aetiology and demonstrate a synergy with public health recommendations for environmental and technological interventions.

Pupil injury risks as a function of physical and psychosocial environmental problems experienced at school.

OBJECTIVES: To investigate relations between physical and psychosocial environmental problems in schools, as perceived by school principals, and injuries among pupils. METHOD: Proportionate injury ratios (PIRs) were computed for 77 public sector Swedish schools (33,248 pupils), and divided into four classes based on types of environmental problems reported. Sports related injuries, injuries during recesses, and violence related injuries were considered. RESULTS: The schools reporting psychosocial problems (9.1% of schools and 7.3% of pupils) had more injuries than expected by chance than all types of injuries aggregated (PIR = 1.92; 95% confidence interval (CI) 1.64 to 2.27), and in the case of sports related injuries (PIR = 1.79; 95% CI 1.37 to 2.34) and injuries due to physical violence (PIR = 2.20; 95% CI 1.33 to 3.65). There were no significant excess risks of injuries for schools facing physical problems or a combination of physical and psychosocial problems. CONCLUSIONS: Psychosocial problems may exacerbate the risk of intentional and unintentional injuries among pupils. The results offer a reminder that school environment must be planned as part of any assessment of youth safety.

Injuries to boys and girls in Swedish schools: different activities, different results?

The study examines gender-related injury frequency by the type of school activity. Data were taken from an injury register created during the school year 1996/97 with the help of 79 Swedish public-sector schools. Injury ratios (IRs) by gender, type of municipality, and type of school were computed for injuries during all types of activities, for sports-related injuries, and for injuries sustained during recess periods. IRs were higher among boys for recess activities, and among girls for sports activities. IRs showed major variation by type of school, and minor variation by type of municipality. Schools catering for pupils aged 7-12 years had the highest IRs for all groups of injuries, both on aggregate and by gender. Gender-related injury-event occurrence at school clearly varies with kind of activity, but less so with age of pupils. The extent to which this reflects individual differences rather than varying exposure is uncertain.

Risk indicators for reported over-exertion back injuries among female nursing personnel.

We conducted a case-referent study to identify and quantify work-related and non-work-related risk indicators for reported over-exertion back injuries among nursing personnel. The source population was all nursing personnel employed in the Stockholm County hospitals during a 32-month period. The 240 cases and 614 referents completed questionnaires about occupation, type of clinic, working hours, shift work, patient transfers, perceived exertion, back pain, prior back injury, job strain, body mass index (BMI), smoking, immigrant status, physical training, and self-rated fitness. The highest relative risks (RR) were observed for work-related factors: working at an orthopedic clinic (RR = 5.2; 95% CI = 2.7-10.2), > or =1 patient transfer/shift (RR = 2.7; 95% CI = 1.6-4.5), and working full-time (RR = 2.4; 95% CI = 1.6-3.6). Training in the use of transfer devices, and regular use of transfer devices, reduced the relative risk from patient transfer. Among the non-work-related factors, only body mass index > or =25 kg/m2 and immigrant status was associated with a slight increase in relative risk.

The accident process preceding overexertion back injuries in nursing personnel. PROSA study group.

OBJECTIVES: This prospective dynamic-population-based study investigated factors involved in the accident process preceding overexertion back injuries among nursing personnel. METHODS: The study covered all reported occupational overexertion back injuries due to accidents among of the approximately 24 500 nurses in the Stockholm County hospitals during 1 year. It was assumed that several factors interact in the accident process. Detailed information was obtained for each injury by interviews with the injured nurse and head nurse. Risks in the physical environment were identified using an ergonomic checklist. RESULTS: During the study 136 overexertion back injuries were reported. Of the 130 nurses participating in the study, 125 had been injured in connection with patient work. Cluster analysis yielded 6 clusters and their pattern of contributing factors. The most frequent injury occurred during patient transfer in the bed or to or from the bed, without the use of transfer devices, when the patient suddenly lost his or her balance or resisted during the transfer and the nurse had to make a sudden movement. However, there were physical conditions, such as shortcomings in the physical work environment or a lack of a transfer device, that compelled the nurses to perform the tasks under unsafe conditions. CONCLUSIONS: The clusters showed a complexity of different kinds of accidents and indicated that the measures for preventing accidents, or for blocking an accident process once started, have to be of different kinds and placed at several different levels in the organization of a workplace.

School-injury determinants and characteristics: developing an investigation instrument from a literature review.

The school constitutes an environment of public-health concern since it is the location of occurrence of a major proportion of injuries sustained by children. This paper reviews a total of 42 empirical studies dealing with the determinants and characteristics of injuries to school pupils. On the basis of the review, a proposal is made for a specialized instrument (SIIR) dedicated to the analysis and registration of injuries and incidents at school. It addresses the 'who?', 'where?', and 'what?' questions usually posed in traditional instruments for injury surveillance but places far greater emphasis on the 'how?' and 'why?' questions of injury. SIIR enables the injury phenomenon to be subjected to greater scrutiny, and is designed to support preventive work at school level. For one school-year, it is also being employed for the creation of a data register for research and development purposes.

The physical and psychosocial environments in Swedish schools: quality aspects and relations to pupil-injury determinants as perceived by school principals.

The study investigated relations between the quality of the physical and psychosocial environments in Swedish schools and pupil-injury determinants as perceived by school principals. Data came from a representative sample of public-sector Swedish schools. Schools were divided into four classes on the basis of the types and magnitudes of environmental problems they experienced. Associations between problems and type of school, type of district, and degree of importance attributed to various pupil-injury determinants were measured. Two schools in three were classified as having no environmental problems, and one in 20 as having both types. Significant associations were found between type of problem (environmental load), type of district and perceptions of some injury-inducing factors. Improvements to the school environment may benefit pupils' education and development as well as their safety and well-being. The study provides an aid for the setting of priorities in these respects.

Violence in the Swedish school environment: extent of the problem and its manifestations.

The current importance of school violence due to its recent increase, and also its association with school-specific psychosocial and physical environmental problems were considered as part of a recent survey of Swedish public-sector schools. The responses of the principals of a representative sample of schools (68.4% response rate) revealed that, for the school year 1995-1996, violence was a problem regarded as 'moderate' or 'large' in 15% of schools, 'small' in 62%, and as 'non-significant' in 20%. There has been a non-uniform trend in perceptions of violence across types of schools and municipalities since 1990. Schools where violence has been a problem for some time were more likely to express dissatisfaction with the psychosocial and physical environment of the school, and to emphasize individual and adult-supervision factors as injury determinants. Prevention of intentional injuries requires a variety of interventions, adapted according to factors associated with the problem at local level.

School injuries in an occupational health perspective: what do we learn from community based epidemiological studies?

OBJECTIVE: The paper reviews community based epidemiological studies of injuries at school. It discusses their main findings in the light of a frame of analysis that emphasizes multidimensionality of causes, and in a Swedish context, where school injuries are legally regarded as occupational injuries. METHODS: A frame of analysis, inspired by research in the arena of occupational accident, was developed. It employs four key concepts to distinguish between injury and accident sequence, and between situational and structural factors as potential injury determinants. It also stresses the interaction between pupil, school, and community, in injury genesis. In parallel, a review of community based epidemiological studies of school injuries was undertaken after searching the relevant literature. The knowledge gathered from these studies is appraised in the light of the frame of analysis. RESULTS: In general, the studies point to potential risk groups, and to hazardous locations and activities. They address injury characteristics, but largely fail to define typical mechanisms. The literature sheds little light on whether there are particular characteristics of the community, school, or pupil(s)--other than gender and age--that influence injury event occurrence. CONCLUSIONS: Further research should devote attention to the sequences of events culminating in school injuries, and to the structural determinants of accident sequences. In this, surveillance systems might prove to be of great utility.

The prevention of back injuries in Swedish health care--a comparison between two models for action-oriented feedback. PROSA Study Group.

This paper considers two different models for action-oriented feedback designed to prevent back injuries in Swedish health care. Feedback was provided by physiotherapists/ergonomists from Occupational Health Services. The models tested were feedback to work groups, and feedback solely to supervisors. Both generated a considerable number of accident-prevention proposals. Proposals of supervisors were implemented to a greater extent. Supervisors tended to advocate training, while work groups were more concerned with improved technical aids. Otherwise, only minor differences were detected between the models in application. The active involvement promoted by feedback, in particular to work groups, was considerable.

Age-related overexertion injuries among Swedish nursing auxiliaries over a 10-year period.

This study examines the age-related risk of overexertion injuries among Swedish nursing auxiliaries. Overexertion ratios (ORs) and injury severity were measured over time, for males and females separately, all injuries aggregated and for three injury patterns, employing five age categories and three time periods. OR values varied by time period, age and gender. The number of injuries by overexertion-injury pattern varied over time, and the ORs of particular age groups were related to pattern. Female auxiliaries aged 16-24 and 45-54, and also male auxiliaries aged 25-34 consistently showed ORs greater than 1.0. Injuries of all types tended to be more severe with increasing age. These findings provide grounds for reconsidering auxiliaries' occupational tasks and work aids, and methods for safety promotion. They suggest that preventive programs should be targeted so as to address several different overexertion-injury patterns, depending on age group and gender.

The age-related risk of occupational accidents: the case of Swedish iron-ore miners.

The paper examines age-related accident risks faced by Swedish male iron-ore miners. A retrospective longitudinal analysis of national registers was conducted over a ten-year period using three times periods of five years and five age categories. Age-related accident frequency, characteristics and severity were examined. High accident ratios were rare among older miners whatever the time period, but some accident patterns became substantially more frequent in some older age cohorts over the years. Injuries tended to be more severe in older age groups, all accidents aggregated as well as by accident pattern. It is concluded that inequality in risk exposure between age groups may explain the lower accident ratios found among older workers, but also that the aging of a working population may lead to the application of task-assignment principles that penalize older workers, at least with regard to certain specific accident risks.

Age and occupational accidents in the light of fluctuations on the labor market: the case of Swedish non-ferrous ore miners.

This study examines non-specific and specific age-related accident frequencies among Swedish non-ferrous are miners. Age-related accident ratios (ARs) were calculated for all accidents aggregated and for different accident types over a ten-year period, using five age categories and three time intervals. ARs tended to be lower among older workers but they varied between age groups and time periods for almost all accident types. They were higher at the end than at the start ofthe study period for the age cohort 25-34 for all accident types, and for the cohort 16-24 for two accident types. The results suggest that age-related risks are influenced by labor-market factors. In physically demanding jobs, reductions in personnel may expose middle-age and younger workers to higher risks, because of 'basic capacities' being exceeded or due to a lack of relevant experience.

On the prevention of accidents and injuries. A comparative analysis of conceptual frameworks.

The meaning of prevention has changed as new applications of the concept have appeared. Ideas presented in eleven different conceptual frameworks are compared. Identification of the frameworks took place through searches in databases and relevant literature. Five are general by nature, while six relate to injuries and accidents. All are supported by just a few parameters, the time dimension being the most prominent. Compatibility was established on three additional dimensions: level (individual, organizational or societal); direction ("bottom-up" or "top-down"); and in relation to the trichotomy "host-agent-environment". An attempt to synthesize all these dimensions into one general model of accident and injury prevention is presented.

Interview protocols and ergonomics checklist for analysing overexertion back accidents among nursing personnel.

No documented strategy, including preventive strategies, for systematic investigation of overexertion back accidents among nursing personnel has yet been published. One aim of the present study was to develop standardized instruments for the systematic investigation of back accidents among nursing personnel in order to develop preventive strategies. Another aim was to produce a screening tool that could easily be used for identifying potential overexertion back accident hazards. Two structured interview protocols were developed, one for the injured person and one for the supervisor. An ergonomics checklist was designed for the most important spaces according to accident statistics: patient's room, corridor, toilet, and also one for 'other space', eg X-ray and treatment rooms. The instruments were developed by frequent discussions and adjustments in a task force of researchers and occupational health personnel. The protocols were tested in two steps before a final version was established. The construct validity and interobserver reliability of the checklist were tested by ten ergonomists, who checked a patient's room, a toilet and a corridor with some known hazards. The constructed validity agreement was 90% in 19 of 26 items in the checklist. The interobserver reliability had the same figures as the validity for all items in the checklist. The interview protocols and checklist appear to be suitable for systematic investigation of overexertion back accidents.

Occupational health nurses and accident prevention: an inventory of activities in one industrial sector in Sweden.

Swedish occupational health nurses with responsibility for slaughterhouse/meat industry companies (the sector with the highest rate of occupational accidents in the country) devote only 5% of their working time, at most, to accidents and accident risks. The nurse, in comparison with the physiotherapist and safety engineer at the same Occupational Health Services (OHS) unit: works in a greater number of work environment areas; works with primary prevention and provides post-accident assistance; and works more frequently and extensively with other people. The strengths of the occupational health nurse's role are such that they can make an active contribution to the development and expansion of accident prevention activities, and promote further cooperation within OHS and between OHS and employees.