High Injury Burden Research Articles

"Health is Just the Basic Requirement for Optimal Performance and Winning": Stakeholders' Perceptions on Testing and Training in Competitive Alpine Skiing, Snowboarding and Freestyle Skiing.

Competitive alpine skiing, snowboarding and freestyle skiing, all different in nature and risks, are known for their high injury and illness burden. Testing measures and training methods may be considered for athletes' preparation to support performance enhancement while safeguarding their health. We explored the perspectives and perceptions of competitive alpine skiing, snowboarding and freestyle skiing stakeholders regarding testing and training practices in their competitive snow sports. We conducted an exploratory qualitative study based on grounded theory principles through 13 semi-structured interviews about testing and training practices with athletes, on-snow and off-snow coaches, managers and healthcare providers from different national teams. The interviews were inductively analysed through a constant comparative data analysis. Participants described winning as the end goal of testing and training practices, which requires athletes to perform in their best condition. To do so, they mentioned two main targets: performance enhancement and health protection. Participants acknowledged health as a premise to perform optimally, considering testing and monitoring approaches, goal setting, and training to support and protect athlete performance. This continuous cyclic process is driven by communication and shared decision making among all stakeholders, using testing and monitoring outputs to inform goal setting, training (e.g. on-snow and off-snow) and injury prevention. Such an approach helps athletes achieve their goal of winning while being fit and healthy throughout their short-term and long-term athletic career development. The ultimate goal of testing measures and training methods in such competitive snow sports is winning. Performance enhancement and health protection act as pillars in systematic, tailored and flexible processes to guarantee athletes' best preparation to perform. Moreover, athletes' assessments, goal setting, monitoring tools, open communication and shared decision making strongly guide this cyclic process.

Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review.

Pregnancy-related kidney injury contributes to a high burden of acute kidney injury in low-resource settings and causes maternal and perinatal morbidity and mortality. Few studies have examined the impact of acute kidney injury in resource-limited countries, with very limited research on pregnancy-specific disorders in Ethiopia. This study aimed to determine the characteristics of pregnancy-related acute kidney injury, outcomes and associated factors. A retrospective study was conducted to evaluate the clinical profile and maternal-fetal outcome of pregnancy-related acute kidney injury at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Maternal and fetal outcomes were analyzed using descriptive statistics. Multivariate logistic regression was used to determine the association between the dependent and independent variables. Of 27,350 mothers who delivered at Ayder Comprehensive Specialized Hospital between January 1, 2017, and December 31, 2021, a total of 187 women developed pregnancy-related acute kidney injury, a prevalence rate of 68 per 100,000 births. Preeclampsia, sepsis and pre-renal causes due to dehydration and hemorrhage were the most common causes of pregnancy-related acute kidney injury in this study. Hemodialysis was needed in 8.6% (n = 16) of patients. Of the 187 pregnancy-related acute kidney injuries, 143 (76.5%) recovered completely and 30 (16%) partially. The mortality rate was 7.5%. Preexisting chronic kidney disease (AOR = 30.13; 95% CI: 2.92, 310.84), use of vasoactive agents (AOR = 5.77; 95% CI: 1.47, 22.67), increase in creatinine per unit (AOR = 1.65; 95% CI: 1.11, 2.45) and complications related to acute kidney injury (AOR = 5.26; 95% CI: 1.73, 16.00) were determinants of the composite endpoints (partial renal recovery and death). This study emphasizes acute kidney injury in resource-limited settings is a significant cause of maternal and fetal morbidity and mortality. The vast majority of patients with pregnancy-related acute kidney injury recovered completely from kidney injury. The main causes of pregnancy-related acute kidney injury were preeclampsia, sepsis and pre-renal associated with hemorrhage and dehydration. Preexisting renal disease, use of vasopressors, increase in creatinine per unit and complications associated with acute kidney injury were determining factors for concomitant fetomaternal mortality. Appropriate preventive strategies during prenatal care and prompt treatment are needed for pregnancy-related acute kidney injury.

PERSIAN traffic safety and health cohort: a population-based precrash cohort study

PurposeDespite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort...

Musculoskeletal Injury Patterns among Korean Professional Women Soccer Players: A Retrospective Descriptive Study

Female Korean professional soccer players endure a high burden of injuries throughout their careers. This retrospective study investigated their injury history characteristics by surveying 181 players across eight Korea Women’s Football Federation teams. The survey covered demographics, playing positions, career spans, dominant legs, national team memberships, and detailed information on previous injuries, including location, type, mechanism, and severity. Analysis revealed lower extremities as the most vulnerable region, injured in 44.7% of competitions, and 46.6% of practice sessions, followed by foot and ankle injuries. Joint and ligament injuries dominated, comprising 45.0% of competition-related incidents, and 55.2% of those sustained during practice. Notably, contact was the primary mechanism for practice injuries (49.8%), while overuse (33.4%) and contact (33.2%) shared the blame in competitions. Interestingly, severe injuries were significantly more prevalent in practice (65.2%) compared to competitions (48.2%). Almost all players had at least one previous injury, often affecting the lower extremities. This highlights the need for targeted preventive measures addressing the high prevalence of severe joint and ligament injuries, often exacerbated by aggressive situations. These findings emphasize the crucial need for tailored injury prevention strategies specifically designed for the unique demands and challenges faced by women’s soccer players.

Lost in transition: Exploring injury risk in academy footballers shifting between the second and first teams

ObjectivesTo compare the injury profiles of football players shifting between second and first teams with those of second- and first-team players, and to examine the opinions of shifting players. DesignProspective cohort study. Methods170 male players from Athletic Club (second team = 90, shifting = 20, first team = 60) were followed over eight seasons. Injuries and exposure time were recorded following the FIFA consensus, and 18 shifting players answered a seven-item questionnaire on their experience. Results35 % shifting players became full-time first-team players, in contrast to only 8 % of second-team players (odds ratio = 6.4, p < 0.01). There were no differences in the overall injury incidence, but the overall burden of injuries was higher in second-team (172 days lost/1000 h) and shifting players (194 days lost/1000 h) compared with first-team players (114 days lost/1000 h, p < 0.01). Shifting players had a higher burden of knee joint/ligament injuries compared with first-team players (137 vs. 18 days lost/1000 h, p < 0.01) and anterior cruciate ligament (ACL) ruptures (122 vs. 10 days lost/1000 h, p < 0.01). There was a trend towards a higher burden of ACL ruptures in shifting players than in second-team players (122 vs. 41 days lost/1000 h, p = 0.07). Shifting players reported constant pressure and better communication with the second-team coaching staff than with the first-team staff. ConclusionsThe high burden of injuries in shifting players, particularly from ACL ruptures, highlights the need for action. Ensuring high-quality communication between second- and first-team staff remains a key challenge.

Traumatic head injuries in Moldova: a cross-sectional analysis of medical registry data.

The aims of this study were to evaluate the demographics and crash profiles of road traffic-related traumatic brain injury (TBI) patients treated at two emergency departments in the Republic of Moldova, and to identify areas for prevention.

Occupational Injuries Among Road Construction Workers In Ghana: Burden, Mechanism And Severity

Objective: Road construction work involves diverse activities relying on the use of both skilled and unskilled manpower, posing serious risks to workers. This study sought to determine the burden, mechanism and severity of occupational injuries among road construction workers.&#x0D; Methodology: The study design was institution-based descriptive cross-sectional using a questionnaire with closed- and open-ended questions. From Ashanti, Ahafo and Western North regions, 353 road workers reported on work-related injuries, types of injury, body parts injured, day(s) lost to activity and cause of injury from 27th January, 2020 to 4th March, 2020.&#x0D; Results: The workers were primarily young (mean age 32.4 years) and male (97.7%). Most (70.2%) workers were contract/casual staff. Nearly 88% experienced injury the past year with 67.5% experiencing multiple injuries. The body parts most affected included&#x0D; waist/low back (29.9%), forearm/palm (18.9%), leg/foot (17.5%), chest (8.9%) and joints (7.1%). Mechanism of injury included slips/trips (18.5%), use of tools/equipment (13.8%) and overexertion during lifting (10.2%). For injury severity, 88.0% of workers had minor injuries, 8.8% moderate and 3.2% severe injuries. Conclusion: There is high burden of injury among road construction workers in Ghana. Most experienced injury during the past year, with over 4-in-5 having minor injuries. Leading mechanisms were slips/trips, use of tools/equipment and overexertion during lifting. Limitations include biases like memory decay, purposive selection of construction sites and driver over-representation. Hence, recommendations deriving from this study include enforcement of personal protective equipment use, proficiency training in use of tools/equipment and inter-lacing manual handling-related activities with activities that vary worker-postures.

Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed?

Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.

Governance for injury care systems in Ghana, South Africa and Rwanda: development and pilot testing of an assessment tool

ObjectivesThis study aims to evaluate health systems governance for injury care in three sub-Saharan countries from policymakers’ and injury care providers’ perspectives.SettingGhana, Rwanda and South Africa.DesignBased on Siddiqi et al’s...

Epidemiological pattern and management of dog bite injuries in Karachi, Pakistan: A cross-sectional study

BackgroundDog bite injuries are a common problem globally; however, little is known about the epidemiology of dog bite injury from a low-and-middle-income country like Pakistan. This study aims to determine the epidemiology of dog bite injuries among children and adults from a tertiary care hospital in Karachi, Pakistan. MethodsWe conducted a cross-sectional study on dog bite patients visiting the emergency department from November 2015 to August 2016 of a major public tertiary care hospital. Data was collected using a structured questionnaire on demographic details, bite history, and management of dog bite victims. Descriptive analysis was reported. Chi-square test was applied to check the associations between age-specific dog bite cases and independent variables. Results2178 participants were included in the analysis. 715 (38.8%) were children less than 18 years old, and 1463 (61.2%) were adults over 18 years. A majority of the patients were males (1909, 87.7%). Results show that most dog bite injuries (2052, 94.2%) tend to occur outside the house by stray dogs biting without provocation. People aged 18 years and above (61.2%) and males (children: 84.6%, adults: 89.1%) tend to be bitten more often. Lower limbs are most frequently bitten (children: 69.5%, adults: 85.8%). Free-roaming stray dogs (children: 73.4%, adults: 74.9%) were involved in reported biting cases. Many of the patients did not receive appropriate first aid and instead just washed the wound with soap and water (children: 45.1%, adults: 43.7%). 99% of the victims received Tetanus toxoid, Rabies vaccine, and immunoglobulins while in the emergency department. ConclusionThere is a high burden of dog bite injuries from stray dogs in Karachi, Pakistan. Efforts should be made to create awareness among the general public on the risks of dog bites and on seeking appropriate first aid and medical attention for a dog bite injury.

Lower Extremity Strains in the US National Football League, 2015-2019

Background: Lower extremity (LEX) strains, including hamstring, quadriceps, adductor, and calf strains, are among the most common injuries in sports. These injuries lead to high burden, resulting in significant missed participation time. Purpose: To describe the incidence of LEX strains in professional American football. Study Design: Descriptive epidemiology study. Methods: This study included all players who played in ≥1 National Football League (NFL) game or sustained a LEX strain during participation in the 2015-2019 seasons. LEX strain frequency was calculated by setting (game, practice, conditioning), timing in season (offseason, preseason, regular season, postseason), and roster position. Game incidence rates were calculated for season, roster position, and play type. LEX strains were identified in the standardized leaguewide electronic health record (n = 32 teams). Results: Across 5 years, 5780 LEX strains were reported among 2769 players (1-year risk, 26.7%; 95% CI, 26.0%-27.3%); 69% (n = 4015) resulted in time loss. Among all LEX strains, 54.7% were hamstring (n = 3163), 24.1% adductor (n = 1393), 12.6% calf (n = 728), 8.3% quadriceps (n = 477), and 0.3% multiple muscle groups (n = 19). Most were reported during preseason practices (n = 1076; 27%) and regular season games (n = 1060; 26%). The 2-week period of training camp practices comprised 19% of all time-loss strains. Among game injuries, preseason games had the highest rate of LEX strain (2.9/10,000 player-plays; 95% CI, 2.6-3.2). Defensive secondary players accounted for the highest proportion of time-loss LEX strains (27%; n = 1082). In games, punt plays had nearly twice the injury rate of kickoff plays (14.9/1000 plays [95% CI, 13.1-17.0] vs 7.5/1000 plays [95% CI, 6.2-8.9], respectively) and >3 times the rate of pass plays (4.3/1000 plays; 95% CI, 4.0-4.7) and run plays (2.6/1000 plays; 95% CI, 2.3-2.9). In aggregate, LEX strains led to an estimated 16,748 participation days missed each year and a median 12 days missed per injury. Conclusion: LEX strains affected 1 in 4 NFL players each year, resulting in a high burden of injury in terms of time lost from practice and competition. Safe return to the NFL season during training camp and reduction of injuries during regular season games are key focuses for future injury reduction.

Arm injury in youth baseball players: a 10-year cohort study.

Arm injuries are commonly encountered in baseball as young athletes play into adulthood. The purpose of this study was to examine the incidence of arm injury and risk for surgery in adolescent baseball players followed over a 10-year period from scholastic, age-group, and travel baseball leagues through their highest level of competition. A prospective study was conducted enrolling middle and high school baseball players in 2010-2012, then followed for 10 years or until retirement from competitive baseball. Players were included if fully participating in team activities at the time of preseason study enrollment. Players with prior arm (shoulder or elbow) surgery or those diagnosed with time loss arm injury within the past year were excluded. Only shoulder and elbow overuse problems resulting in time-loss from sport and medical attention from a sports medicine physician or orthopedic surgeon were documented as injuries in this study. Musculoskeletal overuse injuries were classified based on the orchard injury classification system. Incidence proportion and risk ratio (RR) and 95% confidence intervals (CIs) for initial injury and injuries requiring surgery were calculated. A total of 261 pitchers (age: 14.2±2.6 years; follow-up: 4.2±2.7 years) were enrolled. Twenty percent of the cohort was followed for ≥7 years. The overall injury incidence was 25.6/100 athletes (95% CI21-31) with a cumulative surgical incidence of 5.4/100 athletes (95% CI3.2-8.8). The risk of experiencing shoulder injury (n=25) and elbow injury (n=38) were similar (n=38) (RR0.7, 95% CI0.4-1.1). The athletes also presented with a similar frequency of requiring surgery regardless of the injured body part. However, the risk of surgery in those playing beyond the high school level was 4.3 times greater (95% CI 1.2-15.0) than those only playing high school. This is the first study to follow a large cohort of youth baseball players as they progress, showing a relatively high arm injury incidence. Shoulder and elbow injury incidence was similar but surgical risk increased playing beyond high school, specifically for the elbow. The high injury frequency and burden of care required by young baseball players as reported in this study is concerning, and strategies to reduce injury should be investigated.

Lessons Learned From Integrating Anti-Oppression Pedagogy in a Graduate-Level Course in Epidemiology.

Despite the high burden of injury and violence globally and disproportionate burden on marginalized communities, few US schools of public health and departments of epidemiology offer classes focused on injury and violence, and even fewer are taught with an antiracist or anti-oppression framework. Recent years have brought renewed focus to incorporating antiracist and anti-oppression principles to pedagogy. Public health professionals have increasingly grappled with how we teach, conduct research, and advocate for just policies, which are shaped by interlocking systems of oppression. Although all areas of epidemiology are shaped by these structures, motivations for those who study injury and violence ought to be especially keen. In this commentary, we illustrate how anti-oppression can be integrated into course development and delivery with a case study of a graduate-level course at the University of Washington School of Public Health on injury and violence epidemiology. We include feedback from an epidemiology faculty reviewer, as well as narratives from students describing what worked and what did not. We offer our reflections and lessons learned, hoping to encourage others within public health and epidemiology to adopt an anti-oppression framework in developing classes and programs, particularly those related to injury and violence.

766 Evaluating the Ethics of Comfort Care in Self-Immolation Burns

Abstract Introduction Self-Immolation injuries, although rare, incur a high mortality rate due to the high injury burden. These patients often require a long hospital stay including extended periods of time in the ICU due to the systemic burden of their burns. They often present with active suicidal ideation leaving medical decisions to be made by their next of kin who want to see everything done to preserve the life of their loved ones. Over the past several years our burn center has taken a more holistic approach to the care of these patients involving both the psychiatry team as well as the palliative care team to discuss concurrent treatment and prognosis with both patients and their families. Previous ICU dogma often discourage earlier palliative care consultation as many providers and families see such actions as the care team no longer wishing to provide care for patients Methods Single patient case study and review Results The early consultation of a supportive care team allowed the patient's family more access to resources to better make a better informed decision that was in keeping with the patient's wishes Conclusions Patients who commit self immolation often present with active suicidal ideations and are deemed unfit to make their own medical decisions. It is of utmost importance to not only treat their burns but also for early psychiatric treatment of their underlying condition when possible. These patients often are not coherent or are determined to not have the autonomy to make their own medical decision. Until the patient is deemed capable of making their own medical decision, it is up to the providers to determine a surrogate decision maker. The role of the surrogate decision maker is difficult as they must use substitute judgment in order to make decisions based on the subjective wishes of the patient. The difficulty in this situation arises from the fat that the decisions although made based upon the patient’s wishes can be at conflict with the patient’s best interest. When these conflicts arise it is up to medical providers to have an open dialogue and convey all revelevent information related to prognosis and outcome with the decision maker. There have been no studies that look at the ethics of palliative care among these patients and how to best honor their wishes. Applicability of Research to Practice This study is to help foster a discussion around the ethics of early discussion of palliative measures in regards to the treatment of self-immolation burns

The impact of a decentralised orthopaedic service on tertiary referrals in Cape Town, South Africa.

In South Africa (SA), district hospitals (DHs) have limited capacity to manage the high burden of traumatic injuries. Scaling up decentralised orthopaedic care could strengthen trauma systems and improve timely access to essential and emergency surgical care (EESC). Khayelitsha township in Cape Town, SA, has the highest trauma burden in the Cape Metro East health district. The primary objective of this study was to describe the impact of Khayelitsha District Hospital (KDH) on acute orthopaedic services in the health district, with a focus on the volume and type of orthopaedic services provided without tertiary referral. This retrospective analysis described acute orthopaedic cases from Khayelitsha and their management between 1 January 2018 and 31 December 2019. Orthopaedic resources and the proportion of cases referred to the tertiary hospital by all DHs in the Cape Metro East health district are described. In 2018 - 2019, KDH performed 2 040 orthopaedic operations, of which 91.3% were urgent or emergencies. KDH had the most orthopaedic resources and the lowest referral ratio (0.18) compared with other DHs (0.92 - 1.35). In Khayelitsha, 2 402 acute orthopaedic cases presented to community health clinics. Trauma (86.1%) was the most common mechanism of injury for acute orthopaedic referrals. Of clinic cases, 2 229 (92.8%) were referred to KDH and 173 (7.2%) directly to the tertiary hospital. The most common reason for direct tertiary referral was condition related (n=157; 90.8%). This study outlines a successful example of a decentralised orthopaedic surgical service that increased EESC accessibility and alleviated the high burden of tertiary referrals compared with other DHs with fewer resources. Further research on the barriers to scaling up orthopaedic DH capacity in SA is needed to improve equitable access to surgical care.

EVALUATION OF HAMSTRING MATCH INJURY FREQUENCY, INCIDENCE AND SEVERITY PATTERNS AMONG THE EUROPEAN TOP FIVE FOOTBALL LEAGUES DURING THE SEASON 2022/2023.

This study aims to explore the specific muscle injury types, nature of match injury frequency and match incidence of the European top five football leagues (UEFA, 2023), to compare match hamstring injury severity characteristics and to study differences in match injury, frequency and incidence between the five leagues during the season 2022/2023. The sample size was N= 2678 (SD ± 41.8) male players from the “Big Five” European professional football leagues with a mean age of 26.7 (SD ± 4.6) years and an average of 1303 minutes played per player with an average of a 27-player squad. A total number of 630 hamstring match injuries was recorded among the 98 clubs. Most of the injuries (N=298) required a two to four-week absence from football. The total playing exposure hours per league was 11,640.48, (SD ± 124.5). The severe injury patterns of severe injuries represent 28.6% of the total of all severity patterns, indicating an extremely high hamstring injury burden.

Incidence and burden of injury at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days

ObjectiveTo describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo.MethodsInjury data were obtained daily via the established...

Mapping access to care and identification of barriers for traumatic brain injury in a South African township.

South Africahas a high traumatic injury burden resulting in a significant number of persons suffering from traumatic brain injury (TBI). TBI is a time-sensitive condition requiring a responsive and organized health system to minimize morbidity and mortality. This study outlined the barriers to accessing TBI care in a South African township. This was a multimethod study. A facility survey was carried out on health facilities offering trauma care in Khayelitsha township, Cape Town, South Africa. Perceived barriers to accessing TBI care were explored using qualitative interviews and focus group discussions. The four-delay framework that describes delays in four phases was used: seeking, reaching, receiving, and remaining in care. We purposively recruited individuals with a history of TBI (n = 6) and 15 healthcare professionals working with persons with TBI (seven individuals representing each of the five facilities, the heads of neurosurgery and emergency medical services and eight additional healthcare providers who participated in the focus group discussions). Quantitative data were analysed descriptively while qualitative data were analysed thematically, following inductive and deductive approaches. Five healthcare facilities (three community health centres, one district hospital and one tertiary hospital) were surveyed. We conducted 13 individual interviews (six with persons with TBI history, seven with healthcare providers from each of the five facilities, neurosurgery department and emergency medical serviceheadsand two focus group discussions involving eight additional healthcare providers. Participants mentioned that alcohol abuse and high neighbourhood crime could lead to delays in seeking and reaching care. The most significant barriers reported were related to receiving definitive care, mostly due to a lack of diagnostic imaging at community health centres and the district hospital, delays in interfacility transfers due to ambulance delaysand human and infrastructural limitations. A barrier to remaining in care was the lack of clear communication between persons with TBI and health facilities regarding follow-up care. Our study revealed that various individual-level, communityand health system factors impacted TBI care. Efforts to improve TBI care and reduce injury-related morbidity and mortality must put in place more community-level security measures, institute alcohol regulatory policies, improve access to diagnostics and invest in hospital infrastructures.

Measuring the burden of accidental injuries in India: a cross-sectional analysis of the National Sample Survey (2017–18)

Globally, injuries are the leading cause of premature deaths and disability and account for nearly 9 per cent of total deaths worldwide. Like other countries, India also faces a very high burden of injuries, with the second most common cause of death and disability. Annually, 0.15 million people lose their lives due to accidental injuries/road traffic accidents in India, which is 11 per cent of the accident-related death worldwide. This study aims to analyse the socio-economic and demographic differentials in the magnitude of economic burden and coping strategies associated with accidental injuries in India. The study used the nationally representative cross-sectional data on the ‘Key Indicators of Social Consumption in India: Health, (2017–18)’ of the National Sample Survey Organisation (NSSO). Simple descriptive statistics have been used to measure the incidence and intensity of accidental injuries. The economic burden is estimated through out-of-pocket (OOP) health expenditure on accidental injuries and the use of different sources of finance to cope with the same. In addition, the logistic regression analysis has been used to analyse the association between socio-economic covariates and the likelihood of suffering from accidental injuries in India. The findings reveal that, unlike outpatient care, the high incidence in inpatient care reveals that hospitalisation is inevitable in most cases after accidental injuries. Among various socio-economic variables, the incidence of accidental cases is higher among individuals residing in urban areas, males, educated persons, and economically better-off sections of society. Also, the mean monthly OOP expenditure on the accidental injuries-affected population has been estimated at INR 2672 .46 (US$ 41.06) and INR 3041.64 (US$ 47.09) in inpatient and outpatient care, respectively. Almost the same sections and the individuals who received insurance spend more OOP expenditure on accidental injuries. However, OOP expenditure as a share of total consumption expenditure (TCE) is significantly high among their counterparts, such as rural inhabitants, illiterates, scheduled castes, the very poor and those who do not have any kind of health insurance coverage. In addition to savings/income, individuals depend more on the distress sources such as borrowings and selling of household assets to meet their OOP health expenditure in India. In conclusion, the high incidence of accidental injuries threatens people more than some of the other ailments in India. A strict motor vehicle act, administrative and political determination, awareness campaigns through various media platforms, diverse road lane systems and traffic norms can help reduce accidental fatalities in the country. Reducing the economic burden of accidental injuries requires increasing public spending on healthcare services as a percentage share of the country’s GDP. Furthermore, comprehensive universal health insurance coverage for all, including each component of healthcare expenditure, is the need of the hour.

Identifying latent classes of Relative Energy Deficiency in Sport (RED-S) consequences in a sample of collegiate female cross country runners

ObjectiveThe purpose of this study was to identify patterns of clustering of the 10 health consequences identified in the Relative Energy Deficiency in Sport (RED-S) framework among collegiate female Cross-Country...