[Sport accidents in Haute-Savoie: Results from the EPAC 2004-2013 survey]. / Accidents de sport en Haute-Savoie : données de l'Enquête EPAC 2004-2013.

Regular physical activity and sport have many health benefits but they can also result in injury, which can be quite severe. Data recorded from 2004 to 2013 in an Haute-Savoie emergency department for the home and leisure injuries survey (EPAC) were analyzed in order to describe the characteristics of sport related injuries in an area particularly attractive for winter and air sports. A total of 43,505 sport related injuries were recorded: team sports (30%), winter sports (25%) and cycling (23%) accounted for the most accidents. Men were more at risk than women (sex ratio = 2.3), and the age group 10-14 years were mostly injured (21% of all injuries). Overall, falls were the most frequent mechanism of injury. Climbing, winter sports and air sports led to the most hospitalizations. The risk of hospitalization following a sport related injury was higher in men, when age increased and when the place of residence was located outside Haute-Savoie. Complementary surveys are necessary to estimate the impact on injury incidence of the use of protective equipment (helmet, gloves), the level of sporting proficiency, level of supervision, or whether or not the victim was a member of a sport club.

[Effective interventions to prevent child injuries: a review of the literature]. / Les interventions efficaces en prévention des accidents de la vie courante chez les enfants: une synthèse de littérature.

Child injuries represent an important public health problem. The aim of this paper is to review the current scientific knowledge on interventions designed to prevent child injuries. The current state of knowledge in this area was assessed by means of a specific method involving a review of literature reviews and a classification of health promotion interventions identified in these reviews (rapid reviews). We found a large number of effective or promising programmes devoted to the prevention of the most common child injuries: drowning, burns, falls, poisoning, electrocution, sports and leisure injuries. Some interventions are based on environmental measures, while others are educational or use law and regulatory processes. Some are primary prevention measures, others are secondary prevention measures, while others are multidimensional and can effectively reduce several types of injuries. For example, home safety education and provision of safety equipment, or home-based parenting interventions, can have an impact on injury rates. These findings present a number of limitations due to the marked diversity of the quality of the documents reviewed. It should also be stressed that interventions that are not listed in this article are not necessarily ineffective: they may simply lack a rigorous evaluation enabling them to be identified in our review.

Estimates of home and leisure injuries treated in emergency departments in the adult population living in metropolitan France: a model-assisted approach.

BACKGROUND: Home and leisure injuries (HLIs) are currently a major public health concern, because of their frequency, associated consequences, and considerable medical costs. As in many other countries in Europe, in France the population coverage of the surveillance system of HLIs is low. In this study, a model-assisted approach is developed to estimate the incidence rates of HLIs in adults treated in emergency departments (EDs) in metropolitan France between 2004 and 2008. METHODS: Using a sample of the hospitals participating in the French ED-based surveillance system, a generalized linear mixed model was applied, which describes the relationship between the numbers of ED visits for HLIs and the sex and age of the patients on the basis of the number of injury-related stays recorded by the hospitals. Statistics on hospital stays were provided by the French hospital discharge databases in the participating hospitals. The same statistics were available at the national level, which made it possible to extrapolate national incidence estimates. RESULTS: Over the 2004-2008 period, the estimated incidence rate of HLIs age-standardized on the European population aged 15 years and over was 48.7 per 1,000 person-years (95% confidence interval: 39.4-58.0), and displayed little variability over time. This rate corresponded to an average of 2.5 million emergency hospital visits each year due to an HLI in people aged over 15 in France. CONCLUSIONS: The method made it possible to use medico-administrative datasets available nationwide to provide informative estimates despite the small number of participating EDs. The consequences and costs generated by hospital emergency visits can sometimes be onerous, and these estimated rates confirm the scale of the problem and the need to continue investing in preventive actions.

[Six-month outcome of 795 patients admitted to Annecy hospital emergency department for mild traumatic brain injury]. / Devenir à six mois de 795 victimes de traumatisme crânien léger pris en charge aux urgences de l'hôpital d'Annecy.

INTRODUCTION: Mild traumatic brain injuries (mTBI) are common, but their outcomes are not very well known. A prospective study was conducted in Annecy hospital, France (CHRA), to assess the incidence of disorders 6 months after the injury and to identify risk factors for persistent disorders. METHOD: All patients admitted to the emergency department after a mild brain injury between February 2006 and July 2007 were included. They were contacted by telephone 6 months later to detect (by questionnaire) the presence of persistent disorders. Patients reporting disorders were referred to the l ocal brain injury centre for a follow-up check-up. RESULTS: Ninety three of the 795 patients contacted reported disorders: memory disorders (80%), sleep disorders (79%), headaches (65%), irritability (64%), speech disorders (64%) and concentration disorders (62%). Disorders at 6 months were independently associated with age, female gender, presence of headache at the initial examination and CT scan performed in the emergency department. DISCUSSION: The disorders reported in this study were consistent with the results of previous studies. As these disorders are usually nonspecific, a case-control study or an exposed-unexposed study would be necessary to determine whether or not these disorders are linked to mTBI.

Bicycle helmet wearing and the risk of head, face, and neck injury: a French case--control study based on a road trauma registry.

BACKGROUND: Previous case-control studies on bicycle helmet efficacy are mostly Anglo-Saxon, and based on data from the early 1990s when hard-shell helmets were common. METHODS: In France, the Rhône county (1.6 million inhabitants) is covered by a road trauma registry that includes emergency department visits, hospital admissions, and fatalities. Over the 1998-2008 period, 13,797 cyclist casualties were identified. The injuries sustained were coded using the Abbreviated Injury Scale (AIS) for injuries to the head (AIS1+ and AIS3+), face (AIS1+), or neck (AIS1+). The study uses a case-control design where the control group includes cyclists injured below the neck-that is, not injured in the region associated with the helmet. We first adjusted for age, gender, and type of crash, as in a previously published Cochrane review. Then we adjusted for injury severity based on non-head, face, or neck injury, and when relevant, for crash location: type of road, urban/rural area. RESULTS: The fully adjusted ORs of helmeted versus unhelmeted cyclists are: for AIS1+ head injuries, 0.69 (95% CI 0.59 to 0.81); for AIS3+ head injuries sustained in urban areas, 0.34 (95% CI 0.15 to 0.65), those sustained in rural areas, 0.07 (95% CI 0.02 to 0.23); for AIS1+ facial injuries, 0.72 (95% CI 0.62 to 0.83); and for AIS1+ neck injuries, 1.18 (95% CI 0.94 to 1.47). CONCLUSION: This study confirms the protective effect for head and facial injuries, even though soft-shell helmets have now become more common. The reduction of risk is greater for serious head injuries. The study is inconclusive about the risk for neck injuries.

The injury epidemiology of cyclists based on a road trauma registry.

BACKGROUND: Bicycle use has increased in some of France's major cities, mainly as a means of transport. Bicycle crashes need to be studied, preferably by type of cycling. Here we conduct a descriptive analysis. METHOD: A road trauma registry has been in use in France since 1996, in a large county around Lyon (the Rhône, population 1.6 million). It covers outpatients, inpatients and fatalities. All injuries are coded using the Abbreviated Injury Scale (AIS). Proxies were used to identify three types of cycling: learning = children (0-10 years old); sports cycling = teenagers and adults injured outside towns; cycling as means of transport = teenagers and adults injured in towns. The study is based on 13,684 cyclist casualties (1996-2008). RESULTS: The percentage of cyclists injured in a collision with a motor vehicle was 8% among children, 17% among teenagers and adults injured outside towns, and 31% among those injured in towns. The percentage of serious casualties (MAIS 3+) was 4.5% among children, 10.9% among adults injured outside towns and 7.2% among those injured in towns. Collisions with motor-vehicles lead to more internal injuries than bicycle-only crashes. CONCLUSION: The description indicates that cyclist type is associated with different crash and injury patterns. In particular, cyclists injured in towns (where cycling is increasing) are generally less severely injured than those injured outside towns for both types of crash (bicycle-only crashes and collisions with a motor vehicle). This is probably due to lower speeds in towns, for both cyclists and motor vehicles.

[Home and leisure injuries among fifth-grade schoolchildren in 2004-2005]. / Les accidents de la vie courante chez les enfants scolarisés en CM2 en 2004-2005.

A survey was conducted among a representative national sample of fifth-grade schoolchildren between September 2004 and June 2005. 97% of all injuries reported by 6,836 schoolchildren interviewed in Metropolitan France were home and leisure injuries (HLI). Quarterly incidence was established at 9.2 HLIs or traffic accidents per 100 children (confidence interval [8.3; 10.1]). One third of HLIs were found to occur at school, 20% at home, and 54% during a sport or physical activity. HLIs involved treatment in an emergency department in 60% of cases, a limitation of activities in 76% of cases, and exemption from physical education and sports in 57% of cases. The occurrence of severe HLIs was 1.4 times higher in children aged 11 and over ([1.03; 1.8] and in children who take part in sport on a regular basis ([1.1; 1.8]). The risk of a severe HLI was 1.8 times higher in children from families of four children or more ([1.1; 3.0]). No association was found between the occurrence of HLIs and gender, visual acuity and parents' occupational status. Based on data relating to fifth-grade schoolchildren, the results of this study require further research on specific age groups. Prevention efforts will need to reduce morbidity and mortality as a result of HLIs (over 250 child deaths per year).

[An economic evaluation of intimate partner violence in France]. / Evaluation économique des violences conjugales en France.

This study aims to carry out an economic evaluation of intimate partner violence in France. Using published data, institutional sources, field studies and expert opinions, the cost of intimate partner violence is estimated in terms of the overall cost to society. A range of different economic approaches are used (micro-economic, meso-economic and macro-economic approaches). The total cost of intimate partner violence in France is estimated at 2.5 billion Euros per year (between 1.7 and 3.5 billion Euros). The total cost of intimate partner violence includes healthcare costs (483 ? million), social and justice services (355 ? million), production losses as a result of deaths, imprisonments and absenteeism (1099 ? million), and the human costs of rape and prejudice (535 ? million). By increasing the budget allocated to the prevention of domestic violence by one euro, it is estimated that the state, health insurance and local authorities could make savings of up to 87 Euros of social spending, including 30 Euros of direct expenses.

Defenestration in children younger than 6 years old: mortality predictors in severe head trauma.

PURPOSE: This study aims to describe the characteristics of severe head injuries in children less than 6 years old, victims of falls from windows, and identify the main predictive factors of mortality in this population. PATIENTS AND METHODS: A cross-sectional study was designed through data derived from medical records of less than 6-year-old children victims of falls from windows presenting with a severe head injury defined by an initial Glasgow coma scale (GCS) < or =8, hospitalized at a Pediatric Trauma center level III, between January 2000 and December 2005. Statistical analysis used univariate analysis and multiple logistic regressions. RESULTS: We identified 58 severe head injuries in children victims of falls from windows. The mean age was 2.8 +/- 1.4 years, with a male prevalence (64%); 48% of patients had a GCS < or =5; 62.1% had a Pediatric Trauma Score (PTS) < or =3 at hospital admission. The mortality rate was 41% (24/58) and most of them (88%; 21/24) died within 48 h. An increased death rate was noted in children admitted with hypoxemia (p = 0.001), low systolic blood pressure (p = 0.002), hypothermia (p = 0.0001), GCS < or =5 (p = 10(-5)), PTS < or =3 (p = 0.008), hyperglycemia (p = 0.023), coagulation disorders (p = 0.02), and initial intracranial pressure > or =20 mmHg (p = 0.03). Initial hypothermia, hyperglycemia, and coagulation disorders were the only independent predictive factors of mortality. CONCLUSION: Severe head injuries resulting from falls from windows carry a high risk of mortality in less than 6-year-old children. Hypothermia, hyperglycemia, and coagulation's disorders are independent predictive factors of mortality. Early deaths could be considered as direct consequences of uncontrollable brain lesions.

Assessment of 16-month Sequelae Due to Dog Bites Originally Studied in a French Multicenter Survey from 2009 to 2011.

INTRODUCTION: Every year in France dog bites lead to several thousand visits to emergency departments and numerous hospital admissions. OBJECTIVE: This study aims to describe the sequelae 16 months after dog bites. MATERIALS AND METHODS: Following an initial epidemiological study on the severity of 485 dog bites carried out in 8 hospital emergency departments between May 1, 2009, and June 30, 2010, a second study investigating sequelae 16 months after the bite was conducted among 298 patients between September 2010 and December 2011. Data concerning patients' sequelae were collected by telephone or email. RESULTS: Almost half of respondents (47%) reported sequelae; of those patients, most of these reports were aesthetic (9/10). There were more sequelae when the bite was located in the head region or the lower limbs. Sequelae were more frequent among women, when the weight of the biting dog was higher, and when the initial severity of the bite was greater. On the other hand, the link between the patient and the dog, the sex of the dog, the type of aggression, and the age of the patient (< 15 years or ≥ 15 years) had no impact on the occurrence of sequelae. One patient in 7 still experienced pain 16 months after the bite; women were more likely to experience pain at that timepoint. No articles on dog bite sequelae were found in the literature. CONCLUSIONS: The dissemination of these results among professionals (veterinarians and doctors) and the general population will contribute to making dog owners more aware of the risk of bites and the means of avoiding them.

Evolution of bicycle helmet use and its determinants in France: 2000-2010.

This paper aims to analyse helmet use in France, as a voluntary behaviour rather than a legal requirement, promoted by public awareness campaigns. It aims to investigate the determinants of helmet wearing and to explore its evolution from 2000 to 2010. The analysis relies on data from a series of general population surveys called "Health Barometers": 2000 (n=13,163), 2005 (n=25,651) and 2010 (n=8573). Multivariate logistic regressions were used to identify factors associated with helmet use and time trends. Nearly half of the 15-75 year olds surveyed reported that they rode a bicycle, and among these cyclists, 22.0% reported that they wore a helmet on their last ride. Further analysis by gender reveals that twice as many men than women wore helmets. Over the last decade, helmet use among cyclists has clearly increased, from 7.3% in 2000 to 22.0% in 2010, whereas the influence of social and economic factors, such as unemployment and wage disparities, appears to have decreased. Several determinants of bicycle helmet use were highlighted. To improve the effectiveness of further public information campaigns on helmet use, the key target groups should include women, under 25 year olds and people living in urban areas. Promoting the wearing of helmets among families should also be enhanced, given the higher rate of helmet use by parents as well as children.