Incidence and causes of dental trauma in children living in the county of Värmland, Sweden.

AIM: The aims of this study were to determine the incidence of injuries to permanent incisors in 2011-2013 in children aged 8-10 years living in the county of Värmland, Sweden, and to compare it with the incidence rates in 1989/1990 in the county of Västmanland, as well as to determine the cause of dental trauma in relation to time and place. METHOD: The study analysed the patient records from dental visits (2011-2013) of trauma to the permanent incisors in children aged 8-10 years. The incidence rates were the incidence per 1000 children at risk. Standardized incidence rates were calculated for the comparison between different years. Information about month, location where the trauma occurred as well as cause of trauma was recorded. RESULTS: A total of 2.2% of 21 721 children aged 8-10 years had experienced at least one trauma. The incidence rate in Värmland increased from 18.9 in 2011 to 21.3 in 2012 to 28.5 in 2013. The standardized incidence rate in Värmland in 2011 and 2012 was not significantly different than in Västmanland in 1989/1990 (P > 0.05), but the standardized rates in 2013 were significantly higher than in 1989/90 (P < 0.001). Dental trauma occurred most often outdoors, followed by sports arenas/sports fields, and more often at school than at home. Falling and slipping was the most common cause of trauma, followed by accidents during leisure activities, playing and sports. CONCLUSION: The incidence rate for dental trauma has not decreased in the past 20 years, and there is an indication that parents and teachers should be more aware of the risks of dental trauma at leisure times and at school as well as during sports and exercise.

The effect of the transition from the ninth to the tenth revision of the International Classification of Diseases on external cause registration of injury morbidity in Sweden.

BACKGROUND: Revisions of the International Classification of Diseases (ICD) have previously been shown to cause dramatic effects with regard to injury mortality data when implemented. However, limited knowledge exists on the effects on the coding of external causes of injury morbidity, despite this being an important aspect with regard to injury prevention. METHOD: Hospitalised injuries in Sweden were studied using time series intervention analysis to observe the effect of the ICD change from ICD-9 to ICD-10 in 1997 on external cause coding. RESULTS: The results would suggest considerable coding issues with a large spike in the proportion of injury admissions registered without an external cause code in 1997, with continuing, although gradually diminishing, problems up to 2002. The coding change seems to have had an immediate effect on all external cause of injury categories, although the categories that were not directly convertible from ICD-9 to ICD-10 were seemingly more greatly affected. DISCUSSION: The study illustrates the potential issues associated with changes between ICD revisions and the importance of data quality control both during surveillance and collection of data, but also when presenting injury trends across ICD versions.

Are national injury prevention and research efforts matching the distribution of injuries across sectors?

In 2011, 88% of all unintentional injury fatalities occurred in home and leisure environments in Sweden, while transportation fatalities accounted for 10% and work/school injuries for 2%. The corresponding proportions among non-fatal injuries were 75, 12 and 13%, respectively. However, 83% of the national governmental expenditure on unintentional injury prevention in 2011 was allocated to transportation safety, 7% to home and leisure, and 10% to the work sector including schools. Likewise, around 85% of the governmental research budget aimed for unintentional injury research was allocated to the transportation sector, 9% to home and leisure environments, and 6% to the work and school sector. Our results reveal a striking lack of correspondence between problem profile and governmental countermeasures.

Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results.

BACKGROUND: Fall-related injuries affect the lives of elderly to a substantial degree. This quasi-experimental study investigates the fall-injury reducing effect of impact absorbing flooring among female nursing home residents. METHODS: The intervention site is a nursing home in Sweden where impact absorbing flooring was installed in parts of one of six wards (six out of 10 apartments (excluding bathrooms), the communal dining-room and parts of the corridor). The impact absorbing flooring is a 12 mm thick closed cell flexible polyurethane/polyurea composite tile (500×500 mm) with an exterior surface of polyurethane/polyurea. A generalised linear model (log-binomial) was used to calculate the RR of injury from falls on impact absorbing flooring compared to falls on regular flooring, adjusted for age, body mass index, visual and cognitive impairments. RESULTS: During the study period (1 October 2011 to 31 March 2014), 254 falls occurred on regular flooring and 77 falls on impact absorbing flooring. The injury/fall rate was 30.3% for falls on regular flooring and 16.9% for falls on impact absorbing flooring. Adjusted for covariates, the impact absorbing flooring significantly reduced the RR of injury in the event of a fall by 59% (RR 0.41 (95% Cl 0.20 to 0.80)). CONCLUSIONS: This is, to our knowledge, the first study evaluating the injury-reducing effect of impact absorbing flooring in a nursing home showing statistically significant effect. The results from this study are promising, indicating the considerable potential of impact absorbing flooring as a fall-related injury intervention among frail elderly.

A comparison of hip fracture incidence rates among elderly in Sweden by latitude and sunlight exposure.

BACKGROUND: Research has shown that hip fracture risk increases with latitude; hypothetically due to reduced sunlight exposure and its effect on bone quality. Sweden, with large differences in latitude and UV radiation, is ideal to study in order to analyse the association between latitude and UV radiation on age- and sex-specific hip fracture rates among elderly. METHOD: Aggregated (2006-2008) age- and sex-specific hip fracture data was obtained for each Swedish municipality as well as the municipality's latitudinal coordinates and aggregated (2006-2008) UV radiation levels. Pearson correlations were calculated between hip fracture incidence rates, latitude and UV radiation. Independent t tests were calculated on tertile-categorized latitudinal data in order to investigate the difference in hip fracture risk between these categories. RESULTS: Statistically significant correlations were seen in all groups between hip fracture incidence rates and latitude as well as UV radiation. The independent t tests showed that this correlation was mainly due to high incidence rates in high latitude municipalities. CONCLUSIONS: Statistically significant correlations are seen between hip fracture incidence rates and latitude as well as UV radiation in Sweden and the northern parts of Sweden have an increased risk of hip fractures compared to the middle and southern parts. To our knowledge this is the first study using a national discharge register that shows this relationship and provides a starting point for further research to investigate why populations in northern Sweden have a higher risk of hip fractures compared to other Swedish regions.

Trends in hip fracture incidence rates among the elderly in Sweden 1987-2009.

BACKGROUND: Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied. METHODS: Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates. RESULTS: The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women. CONCLUSIONS: This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.

Economic development as a determinant of injury mortality - a longitudinal approach.

Cross-sectional studies have produced clear inverted U-shaped curves between injury mortality and economic development; yet, this does not mean that single countries will necessarily follow similar curves as they grow richer over time. This study was conducted to examine whether previous cross-sectional findings can be verified using a longitudinal approach. Data for both injury mortality and gross domestic product (GDP) per capita were obtained from an official health database for the member countries of the Organization for Economic Cooperation and Development (OECD) for the period of 1960-1999. Regression models were then used to examine the longitudinal relationship between these two variables. Substantial improvements in injury mortality were observed in all income categories in the selected countries. For higher and middle high-income countries, injury mortality rates (all causes) increased until 1972, peaking in 1972 and then declining. For industrialized countries with relatively low GDP, injury mortality rates increased until 1977 and then declined. Using cubic regression lines for injury mortality rates, for all income categories, injury mortality rates increased up to a GDP per capita of USD 3,000-USD 4,000, then decreased significantly. The rising trends of suicide and homicide rates were observed until countries attained a GDP per capita of around USD 13,000-USD 14,000 for all income categories. It is noteworthy that compared to the intentional injury categories, mortality due to road traffic accidents and injuries from falls declined earlier on in the economic development process. Longitudinal analysis among high-income countries confirms earlier cross-sectional findings; that is, most injury categories seem to follow inverted U-shaped trend lines, with declining trends after peaking at various stages of temporal and economical development. A comparison between time and economy suggests that differences in peaking time between countries for the same injury category is partly a reflection of temporal differences in economic development.

Hospitalized fall-related injury trends in Sweden between 2001 and 2010.

Previous studies have indicated increasing trends of hospitalized fall-related injuries amongst elderly. Whether this is true also in Sweden is unknown though it is important to study considering the potential societal impact. Data were obtained regarding hospitalized injuries with falls as external cause among those aged 65 years and above with information on injury type, gender and age, on a yearly basis, from 2001 to 2010. Age- and sex-specific incidence rates were calculated (per 100,000 population) for all fall-related injuries, and for each injury type and trend lines were drawn. Linear regression analyses and percentage change were calculated for the types of fall-related injuries. A decreasing incidence was observed in the younger age groups (65-79 years) with greater decreases amongst women (women: -14.6%, men 65-79 years: -10.5%). However, increasing rates were observed in the older age group (80 years and above), with greater increases amongst men (women: 4.3%, men: 11.4%). Superficial injuries showed greater increases than fractures amongst those aged 80 years and above. This study indicates that older elderly in Sweden are increasingly being hospitalized for less serious injuries. This changing injury panorama is important to include in the future planning of both health care and fall-related prevention.

Suicides and other fatalities from train-person collisions on Swedish railroads: a descriptive epidemiologic analysis as a basis for systems-oriented prevention.

PROBLEM: Suicide is a dominating, although hidden, safety problem on Swedish railroads. The aim of this paper is to describe the epidemiology of fatal train-person collisions as a basis for systems-oriented prevention. METHOD: Data on collision circumstances were collected from narrative reports at the Swedish National Rail Administration. RESULTS: The events were evenly distributed by months and weekdays, however, most suicides occur during the day while unintentional events usually occur at night. Most train-person collisions happened in densely populated areas, and 75% of the suicide victims were waiting on the track before the collision. Significance test between types of injury event (suicide, accident, or unknown intent) showed small or no differences. CONCLUSION: Traditional approaches to accident prevention by systems modification seem largely applicable to combat railroad suicide as well. IMPACT ON INDUSTRY: Our findings show promising preventive potentials.

Assessing the number of fire fatalities in a defined population.

INTRODUCTION: Fire-related fatalities and injuries have become a growing governmental concern in Sweden, and a national vision zero strategy has been adopted stating that nobody should get killed or seriously injured from fires. There is considerable uncertainty, however, regarding the numbers of both deaths and injuries due to fires. Different national sources present different numbers, even on deaths, which obstructs reliable surveillance of the problem over time. We assume the situation is similar in other countries. This study seeks to assess the true number of fire-related deaths in Sweden by combining sources, and to verify the coverage of each individual source. By doing so, we also wish to demonstrate the possibilities of improved surveillance practices. METHOD: Data from three national sources were collected and matched; a special database on fatal fires held by The Swedish Contingencies Agency (nationally responsible for fire prevention), a database on forensic medical examinations held by the National Board of Forensic Medicine, and the cause of death register held by the Swedish National Board of Health and Welfare. RESULTS: The results disclose considerable underreporting in the single sources. The national database on fatal fires, serving as the principal source for policy making on fire prevention matters, underestimates the true situation by 20%. Its coverage of residential fires appears to be better than other fires. CONCLUSIONS: Systematic safety work and informed policy-making presuppose access to correct and reliable numbers. By combining several different sources, as suggested in this study, the national database on fatal fires is now considerably improved and includes regular matching with complementary sources.

The effect of stricter licensing on road traffic injury events involving 15 to 17-year-old moped drivers in Sweden: A time series intervention study.

INTRODUCTION: This study aimed to evaluate and quantify the effect of the introduction of the AM driving license on non-fatal moped-related injuries in Sweden. With the introduction of the new license category in October 2009, prospective moped drivers are now required to pass a mandatory theory test following a practical and theoretical course. In addition, obtaining a license to operate a moped is now considerably more costly. METHODS: Time series intervention analysis on monthly aggregated injury data (1st Jan 2007-31st Dec 2013) was performed using generalized additive models for location, shape and scale (GAMLSS) to quantify the effect size on injury events involving teenage (15-17 years) moped drivers, while controlling for trend and seasonality. Exposure was adjusted for by using the number of registered mopeds in traffic as a proxy. RESULTS: The introduction of AM license was associated with a 41% reduction in the rate of injury events involving 15-year-old moped drivers (IRR 0.59 [95% CI: 0.48-0.72]), and a 39% and 36% decrease in those involving 16-year-old (IRR 0.61 [95% CI: 0.48-0.79]) and 17-year-old drivers (IRR 0.64 [95% CI: 0.46-0.90]), respectively. The effect in the 15-year-old stratum was decreased roughly by half after adjusting for exposure, but remained significant, and the corresponding estimates in the other age groups did not change noticeably. CONCLUSIONS: This study provides quasi-experimental evidence of an effect on non-fatal moped-related injuries as a result of stricter licensing rules. Only part of the effect could be explained by a reduction in the number of mopeds in traffic, indicating that other mechanisms must be studied to fully understand the cause of the reduction in injuries.

Measuring transport injuries in a developing country: an application of the capture-recapture method.

The purposes of this study are to provide an estimation of the incidence of transport injuries in a defined local community in Nicaragua by using the capture-recapture method, and to compare results using this method when data at different levels of severity are utilized. Two sources of injury data were used to monitor injuries: hospital data (inpatient and outpatient) and traffic police records. Characteristics available for matching included name, age, sex, and date of occurrence. The methodology of capture-recapture was used to estimate the ascertainment degree of both sources of data and the estimate mortality and incidence rates. Estimates were calculated both when all hospital data were taken into account (inpatient and outpatient combined) and when only inpatient records were matched against police records.First, including police records and all hospital data, the mortality and morbidity estimates were 35.5/100000 and 43.7/1000 per year, respectively. Second, when outpatients were excluded from the analysis, the corresponding estimates were 28.6/100000 and 7.5/1000, respectively. In non-fatal cases, the ascertainment-corrected coverage through police records was 2.6% and through hospital surveillance 19.0% when both inpatients and outpatients were included. In fatal cases, the corresponding rates were 56.1 and 22.8%, respectively. The combined data set pointed out pedestrians and cyclists as the main risk groups. Most fatalities were due to head injuries. Our results show that neither police records nor hospital records nor the aggregate database provided acceptable coverage of transport-related injuries. Combining police and hospital data by means of capture-recapture analysis produces more valid estimates, but caution must be given to the issue of severity heterogeneity between the two sources.

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.

[Swedish study of home accidents: children with young mothers and children in families on welfare are at greater risk]. / Svensk studie av olyckor i hemmet: barn i familjer med unga mödrar eller socialbidrag löper ökad risk att skadas.

In this study we used data from Swedish national registers to describe socio-demographic patterns of hospital admissions after injuries in the home (poisonings, falls, scald injuries and ingestion/intrusion of foreign objects) in children 0-2 years of age. Infants and toddlers in families with young mothers and in families on social welfare were at particular risk, while children with foreign-born parents and children in single parent households were at greater risk for scald injuries only. The relative risk for poisonings, scald injuries and ingestion of foreign objects respectively was found to be correlated to quite specific ages, a finding which should be used in timing of parent counseling.

The effect of the Swedish bicycle helmet law for children: an interrupted time series study.

BACKGROUND: Previous population-based research has shown that bicycle helmet laws can reduce head injury rates among cyclists. According to deterrence theory, such laws are mainly effective if there is a high likelihood of being apprehended. In this study, we investigated the effect of the Swedish helmet law for children under the age of 15, a population that cannot be fined. METHOD: An interrupted time series design was used. Monthly inpatient data on injured cyclists from 1998-2012, stratified by age (0-14, 15+), sex, and injury diagnosis, was obtained from the National Patient Register. The main outcome measure was the proportion of head injury admissions per month. Intervention effect estimates were obtained using generalized autoregressive moving average (GARMA) models. Pre-legislation trend and seasonality was adjusted for, and differences-in-differences estimation was obtained using adults as a non-equivalent control group. RESULTS: There was a statistically significant intervention effect among male children, where the proportion of head injuries dropped by 7.8 percentage points. There was no evidence of an intervention effect on the proportion of head injuries among female children. CONCLUSION: According to hospital admission data, the bicycle helmet law appears to have had an effect only on male children. PRACTICAL APPLICATIONS: This study, while quasi-experimental and thus not strictly generalizable, can contribute to increased knowledge regarding the effects of bicycle helmet laws.

Fall-related fracture trends among elderly in Sweden--exoring transitions among hospitalized cases.

PROBLEM: Fall-related injuries have been a cause of worry during the end of the 20th century with increasing trends among the elderly. METHOD: Using data from the Swedish National Patient Register (NPR) based on hospital admissions, this study explores the trends in fall-related fractures between 1998 and 2010. RESULTS: The data shows a decreasing trend in fall-related fractures in all age- and sex-specific groups apart from men 80 years and above. While hip fracture incidence rates decreased in all age- and sex-specific groups, both central fractures and upper extremity fractures have increased in all age- and sex-specific groups apart from women 65-79 years. Lower extremity fractures have increased in the older age groups and decreased in the younger. DISCUSSION: The differences found between the groups of fractures and by age- and sex-specific groups indicate a possible transition where more serious fractures are decreasing while less serious fractures increase among hospitalized cases. SUMMARY: Perhaps due to a focus on hip fracture prevention, this study shows that while the incidence rate of hospitalized hip fractures has decreased, other fall-related hospitalized fractures have increased. IMPACT ON INDUSTRY: Potentially, this could be indicative of a healthier younger elderly, coupled with a frailer older elderly requiring more comprehensive healthcare also for less serious injuries. Further research is needed to confirm our results.

The role of accident theory in injury prevention - time for the pendulum to swing back.

Injury prevention is a branch of safety sciences. While comprehensive theoretical developments occurred in the wider field in the last decades, little of these developments reached and influenced the injury prevention community. Instead, a clear retro trend 'back to basics' is seen among injury prevention scholars, especially to Dr William Haddon's pioneering work some 50 years ago. This paper intends to draw attention to this polarisation and discuss possible explanations. It is argued that the strong campaign against the accident concept among leading injury prevention groupings became a serious hindrance for theoretical exchange. The underlying process is interpreted in terms of a struggle for ownership over this truly interdisciplinary field of research, unfortunately at the expense of theoretical stagnation in injury prevention circles and lessened interest in collaboration from other scientific areas. This paper is written as a tribute to Professor Leif Svanström and his scientific contributions, with special regard to his genuine interest in interdisciplinary research.

Patterns of suicide and other trespassing fatalities on state-owned railways in greater Stockholm; implications for prevention.

Each year, approximately 80-100 people are killed on state-owned railways due to train-person collisions in Sweden. Underlying causes are suicide and accidents; suicide constituting a vast majority. Earlier Swedish studies at a national level revealed a relation between population density and incident frequency, however, with places of occurrence often located to the outskirts of cities some distance away from station areas where victims can await approaching trains in seclusion. The aim of this study was to investigate whether this national pattern also applies to larger urban areas such as greater Stockholm, and to discuss preventative implications based on these observations. All registered incidents (N = 41) where people were hit or run-over by trains with a fatal outcome over the four-year period 2005-2008 were investigated. Results deviating from the national pattern include that most incidents occur at station areas, and that most victims enter the tracks from platforms. Passing express trains appear to be overrepresented, compared to commuter trains. Due to a low number of cases, our observations must be interpreted with caution. However, they imply that preventative measures in this type of area should focus on platform safety foremost, especially protection against rapid trains passing by station areas.

Monitoring the "tip of the iceberg'': ambulance records as a source of injury surveillance.

AIMS: The aim of this study was to describe the epidemiology of moderate and severe injury morbidity in a defined population on the basis of ambulance records, and to validate ambulance records as a potential source of surveillance. METHODS: A geographical target area was defined; the county of Värmland, Sweden. All ambulance attendances and hospitalizations for unintentional and intentional injury in 2002 were selected, analysed, and compared. RESULTS: Ambulance data comprised 3,964 injury cases (14.5/1,000). Most injuries for which ambulance attention was sought occurred in road traffic areas (27%), followed by residential areas (20%), school and institutional areas (14%), and sports areas (8%). An ecological comparison between ambulance-based data and hospitalizations showed that ambulance services captured approximately the same amount of injury cases (3,235 ambulance reports, as compared to 3,456 hospital discharges) with a similar profile. CONCLUSIONS: This study provides epidemiological support for ambulance services as a potential source of regular surveillance data on moderate and severe injuries. However, at a population level, our results indicate that ambulance data tend to overestimate some injury categories, and underestimate others, as compared to hospital data. The significance of these differences for preventive work, as well as other practical aspects of the feasibility of regular injury surveillance, will be analysed and discussed on the basis of general criteria for evaluation of surveillance systems in a forthcoming paper.