Baby walker injury, disability, and death in a high-income middle eastern country, as reported by siblings.

BACKGROUND: Baby walkers (BWs) are frequent causes of infant injuries. Little research is reported from the Middle East and few population-based studies anywhere. METHODS: Using multistage random sampling in a city of the United Arab Emirates, 4 of 8 female Arab government high schools and 3 final-year classes each from science and arts tracks were selected. Structured self-administered questionnaires assessed prevalence, frequency, severity, and external causes of BW incidents and injuries, and residential hazards. RESULTS: Response was 100 %, 696 students, 55 % (n = 385) Emirati citizens. 87 % (n = 605) of families used/had used BWs. Among 646 injuries were 118 ER (emergency) visits, 42 hospitalizations, 11 disabilities, and 3 deaths. Average risk was 1 incident/user, 1 injury/4 users, 1 ER visit/20, 1 hospitalization/55, 1 disability/200, 1 death/1000. Odds ratios for >1:1 floor levels were 2.3 (95 % confidence interval: 1.2, 4.3) for hospitalization, 16.8 (95 % CI: 2.1, 132.5) disability. Incidents included hitting objects 48 % (n = 1322), overturning 23 % (n = 632), accessing hazardous objects 17 % (n = 473), and falling down stairs 11 % (n = 300); 1 % (n = 32) fell into swimming pools. In 49 % (n = 297/605) of user families, ≥1 child had been injured. CONCLUSIONS: Despite causing many injuries including disabilities and fatalities, BWs were used by nearly all families. Governments should consider Canada's lead in prohibiting importation, sales, and advertising of BWs.

Home and other nontraffic injuries among children and youth in a high-income Middle Eastern country: a trauma registry study.

A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry's value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products.

Baby walker injury awareness among grade-12 girls in a high-prevalence Arab country in the Middle East.

Baby walkers (BWs) are a consumer product frequently associated with infant injuries. With little research in the Middle East and few population studies anywhere, female students in grade 12 in the United Arab Emirates were surveyed, assessing the prevalence of use, perceived safety, and interventions. The study population included grade-12 students in a large UAE city. Multistage random sampling selected 4/8 female Arab government schools and 3 classes each from science and arts tracks for interview by self-administered questionnaire. Response was 100%, with a total of 696 students, 55% (n = 385) of whom were Emirati citizens; 90% (n = 619) of the families used/had used BWs. Among the reasons for use, 92% reported "keeping baby safe," with 11% perceiving BWs as very safe and 74% as moderately safe. Only 16% perceived that BWs could cause injuries. Despite causing many injuries, including fatalities, BWs were perceived to be safe and used by nearly all families. Effective education of professionals, patients, the public, and decision makers is needed. Governments should consider countermeasures such as prohibiting importation, sales, and advertising, together with public education and provision of stationary activity centers.

Vehicle occupant restraint systems impact on eye injuries: a review.

Vehicle occupant trauma to the eyes and associated facial structures has evolved rapidly in conjunction with safety-oriented vehicle design, including restraint systems. Trends vary worldwide with culture, personal factors, vehicle safety equipment, and the traffic environment-including physical, legislative, and enforcement. Wearing safety belts is essential to occupant protection. Airbags were designed as a supplement to protect the head from hard surfaces in frontal crashes, not as a primary countermeasure. Even where vehicle fleets are new with high airbag prevalence, but safety culture and knowledge of restraints is less than robust, injury attributable to not wearing seatbelts is frequent, especially in countries where high-powered vehicles are prevalent. Upper bodies of rapidly forward-moving unrestrained occupants collide with rearward-accelerating airbags. Airbag deployment produces injuries such as corneal abrasions, alkali burns, and the effects of globe compression.

Child and youth traffic-related injuries: use of a trauma registry to identify priorities for prevention in the United Arab Emirates.

OBJECTIVE: Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (<19 years) and its value for prevention. METHODS: One hundred ninety-three children and youth with traffic injuries were admitted for more than 24 h at surgical wards of the main trauma hospital in the Al-Ain region during a 36-month period (2003-2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS). RESULTS: Traffic injuries represented 40 percent (n = 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3 injuries in 23 percent of occupants and 26 percent of nonoccupants. Sixty-seven percent of rear occupants had head injuries. CONCLUSIONS: Male drivers and vulnerable road users were at an unusually high risk relative to females. A relatively high frequency of traffic-related head injuries among UAE children and youth, including rear-seat passengers and other vehicle occupants, suggests that considerable preventable morbidity is associated with nonuse of safety restraints and/or other factors such as excess speed and rollovers of 4-wheel drive vehicles. Trauma registries can be useful for prevention; inclusion of data on safety restraints and helmet use by road user type is essential.

Motorcycle-related injuries in the United Arab Emirates.

OBJECTIVES: To study the anatomical distribution, severity, outcome, and age by nationality of hospitalized motorcycle-related injured patients in Al-Ain, United Arab Emirates so as to improve preventive measures. METHODS: All motorcycle riders involved in a road traffic collision and admitted to Al-Ain Hospital for more than 24 h or who died in hospital after arrival were studied. Patient data were retrieved from Al-Ain Hospital Trauma Registry. Data had been prospectively collected during four and half years (March 2003-October 2007). Demography of patients, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Hospital stay, mortality, nationality, time, day of week, and month of occurrence were analyzed. RESULTS: There were 95 patients (93 males). Mean (SD) age was 29.8 (11.5) years. 35% were United Arab Emirates (UAE) nationals. Upper limbs were most frequently involved (54%) followed by lower limbs (48%), head (41%), and face (30%). On arrival at hospital, median (range) ISS was 4.5 (1-36) and median (range) GCS was 15 (3-15). Mean (range) hospital stay was 8.8 (1-79) days. 14 patients (15%) were admitted to the Intensive Care Unit. In-hospital mortality was 6%. UAE national victims were significantly younger and had more abdominal injuries than expatriates, who had lower limb injuries. CONCLUSIONS: The most common mechanism of motorcycle crashes was hitting a moving vehicle. Young UAE national motorcyclists are at a higher risk of being injured compared with non UAE nationals. This may be due to risk-taking behavior of young motorcyclists who are mainly riding for leisure. Extremities were the most common injured body region. Severe head injury was the main cause of death. This signifies the need for effective application of motorcycle helmet law in the UAE along with other preventive measures that might include increasing the licensing age.

Midwifery training in post-conflict Afghanistan: tensions between educational standards and rural community needs.

OBJECTIVE: To compare the performance of students selected for midwifery education by three methods: community mobilization in rural Afghanistan, a regional examination by the Institute of Health Sciences (IHS), and the National University Entrance Examination (NUEE). METHODS: A retrospective survey was conducted in January 2009 on academic records of 178 midwives trained at the IHS in Herat, including 147 graduates from 2003-08 and the cohort of 31 final-semester students graduating in March 2009. An interview survey of the 31 final semester students was also conducted. Outcome variables included knowledge, skills and employment status, stratified by method of selection. Individual attributes including completion of high school, marital status, age and urban/rural residence were also assessed. Data analysis used STATA version 2009. Significance was measured by appropriate statistical tests. Findings were verified by key informant interviews. RESULTS: Ninety-six per cent of midwifery graduates selected by communities were employed, compared with 74% chosen by the IHS and 82% by the NUEE. Sixty-three per cent of community-selected graduates were working in rural locations, compared with 43% recruited by IHS and 9% by the NUEE. While fewer midwifery graduates selected by communities had completed high school and their academic performance was slightly lower during training, there was no difference in their pass rates and acquisition of practical skills. CONCLUSIONS: Community mobilization for local selection of trainees achieved significantly higher employment levels of trained midwives in high-risk rural communities than usual selection methods, without compromising quality of skills.

Carbon monoxide poisoning in the United Arab Emirates.

Carbon monoxide (CO) poisoning is rare in the Arabian Peninsula and occurs almost exclusively during the winter months. Knowledge and perception of the hazards of carbon monoxide is limited. Migrant workers from warm climates appear particularly at risk. We investigated 46 cases of carbon monoxide poisoning presenting at emergency departments from 2007-2009 of the two main hospitals in Al Ain city, United Arab Emirates. Interviews, hospital records, and administered questionnaires were used to collect the data. Among the 46 cases investigated, 24 (52%) were males. Foreign nationals compromised 80% of the cases and the incidence was 3.1 cases per 100,000 residents per year. Burning charcoal in poorly ventilated residences was the predominant source of the carbon monoxide poisoning. Almost all cases (98%) were admitted during the winter months, most in the early morning hours. Carboxyhaemoglobin (COHb) was significantly increased in cases with loss of consciousness and depressed consciousness. There were no reported fatalities.

Occupational injury in the United Arab Emirates: epidemiology and prevention.

BACKGROUND: The United Arab Emirates (UAE) is developing rapidly, with many foreign construction, farm and industrial workers. AIMS: To assess the epidemiology of occupational injury hospitalizations using a trauma registry. METHODS: Surgical admissions from March 2003 to April 2005 were recorded in the registry at the main trauma hospital in Al Ain city (population 348,000). Prevention-related variables were analysed using SPSS and severity was quantified by injury severity scores (ISS). RESULTS: There were 614 occupational injury hospitalizations, an incidence of approximately 136/100,000 workers/year. Males accounted for 98% of injuries, the 25-44 age group for 69% and non-nationals for 96%. External causes included falls 51%, falling objects 15%, powered machines 11%, animal-related 7% and burns 6%. Median ISS was 4 for all six main external causes. Extremities were most frequently injured, followed by chest, head and neck, abdomen and face. Mean hospitalization duration was 9.4 days, with 36% hospitalized for >1 week. CONCLUSIONS: The main external causes were proportionately much more frequent than in industrialized countries. Effective countermeasures are needed to reduce the incidence and severity of occupational injury among vulnerable migrant workers in the UAE.

Effects of a rapid peer-based HIV/AIDS educational intervention on knowledge and attitudes of high school students in a high-income Arab country.

INTRODUCTION: In response to low knowledge about HIV and intolerant attitudes toward persons living with HIV among Arab university students, a peer-based educational intervention was developed and impact evaluated on knowledge and attitudes of high school students in 2 of 4 main cities of United Arab Emirates. METHODS: Four small teams of final year medical students, 3 female and 1 male, were trained. Multistage random sampling selected 14 female and 5 male Arab schools, then 56 female and 14 male grade 12 classes in Al Ain and Abu Dhabi. The 90-minute intervention included a factual presentation and 3 attitude workshops. Baseline and postintervention knowledge and attitudes were assessed. Significance was tested by McNemar, Wilcoxon signed rank, and multilevel regression tests. RESULTS: Response was 99.6%, 1398 females and 505 males. Misconceptions about modes of transmission and intolerant attitudes were evident. Mean knowledge score improved from 65% to 82% and attitude 51% to 64%, that is, relative increase 26% (P < 0.0005). Females had slightly lower baseline knowledge than males but showed greater improvement in knowledge and attitudes (P < 0.0005) CONCLUSIONS: Grade 12 students' knowledge about HIV/AIDS was inadequate and attitudes stigmatizing. Peer-based knowledge workshops were effective, especially among females. Concise integrated teaching and workshops designed to address key knowledge and attitudinal deficiencies can be highly effective.

Severe childhood burns in the Czech Republic: risk factors and prevention.

OBJECTIVE: To assess risk factors for paediatric burn injuries in the Czech Republic and to suggest preventive measures. METHODS: This study included all children aged 0-16 years hospitalized during 1993-2000 at the Prague Burn Centre and data from the Czech Ministry of Health on national paediatric burn hospitalizations during 1996-2006. Personal, equipment and environmental risk factors were identified from hospital records. FINDINGS: The incidence of burn admissions among 0-14 year-olds increased from 85 to 96 per 100,000 between 1996 and 2006, mainly due to a 13% increase among 1-4 year-olds. Between 1993-2000 and 2006, the proportion of burn victims in the country hospitalized at the Prague Burn Centre increased from 9% to 21%. Detailed data were available on 1064 children (64% boys). Around 31% of all burn hospitalizations were in 1 year-olds. Some 79% of burns occurred at home: 70% in the kitchen, 14% in the living room or bedroom and 11% in the bathroom. Of the 18% occurring outdoors, 80% involved boys. Scalds from hot liquids accounted for 70% of all burns. The mean hospital stay was 22 days for boys and 18 days for girls. CONCLUSION: Most burns involved scalds from hot liquids at home: beverages in kitchens and water in bathrooms. There is a need for passive preventive measures, such as redesigned domestic cooking and eating areas, safer electrical kettles and temperature control devices for bathrooms. Educational programmes should be developed for parents and caregivers. A national plan for child burn prevention with specific targets would be helpful.

Factors affecting anatomical region of injury, severity, and mortality for road trauma in a high-income developing country: lessons for prevention.

OBJECTIVES: To study the factors affecting anatomical region of injury, severity, and mortality among road users in United Arab Emirates so as to improve preventive measures. METHODS: Data of the Trauma Registry of Al Ain city were collected prospectively over 3 years (2003-2006) at the main trauma hospital. For traffic injuries, the following were assessed: gender, nationality, road user type, anatomical region(s) of injury, systolic blood pressure on admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and mortality. Analysis included frequencies, cross-tabulations, and logistic regression. RESULTS: There were 1070 patients, 89% male, 25% UAE nationals, and with a mean age of 31 years. Expatriates, mainly from non-Arabic speaking, low-income countries, accounted for 88% of injured pedestrians, whilst nationals were overrepresented among vehicle occupants (29%), and motorcyclists 37%. Injuries of the extremities and head were frequent among pedestrians, motorcyclists, and bicyclists, whilst head and spine injuries were most common among front and rear vehicle occupants and drivers. The median ISS was five for pedestrians and four for all other road user types, including rear vehicle occupants. The mean hospitalisation was 9.7 days; 13% of patients were admitted to ICU with mean stay of 6.5 days. Overall mortality was 4%; pedestrians accounted for 61% of deaths. Predictors of mortality were GCS (p<0.001), ISS (p<0.01) and systolic blood pressure on admission (p<0.03). CONCLUSIONS: Head injury was a major factor affecting mortality, followed by injury severity and hypotension. To reduce injury incidence and severity, legislation and education are needed to ensure use of seat belts by all vehicle occupants including rear passengers, high-visibility devices by other road users, helmets by motorcyclists and bicyclists, protective clothing and boots for motorcyclists, and traffic engineering for pedestrians.

Drowning in a high-income developing country in the Middle East: newspapers as an essential resource for injury surveillance.

Despite frequent media accounts of drownings in the United Arab Emirates, little was known about the epidemiology and prevention of such incidents. The research objective was to assess newspapers as a national source on incidence, activities, and risk factors for drowning in this high-income media-rich developing country where official sources do not include sufficient variables for injury prevention. The three main national English and six Arabic newspapers were assessed for electronic retrieval of incidents, which proved impractical; however, the largest English-language paper maintained a clipping file on drowning. Newspaper data, including incidence, activity, and purpose, together with personal, equipment, and environmental risk factors, were compared with Ministry of Health reports for 1998-2002. Incidence from clippings was 0.50drownings/100,000population/year and from Ministry reports, 0.27. Activity such as swimming or boating and purpose of activity such as recreational or occupational were unreported by the Ministry. Activity was reported in 100% of newspaper clippings. Swimming (49%) was the most common activity. The purpose of 17% of cases was classified as occupational. Gender was 100% complete in both sources. In newspaper reports, age was classifiable as child or adult, while the Ministry used age groups. National citizenship was 100% reported by Ministry; 91% of newspaper reports included nationality, providing details for expatriates. Swimming ability was unreported by Ministry, and by newspaper 52%, of whom 73% were non-swimmers. While the newspaper provided information on body of water, mainly ocean and pools, this was unreported by Ministry. Month was unspecified by Ministry, 100% by newspaper. Neither reported safety equipment. The newspaper proved the most useful resource for drowning prevention since there were more incidents and most included key variables; however, Ministry reports provided supplementary information. Newspapers with electronic searching on health terms, including injuries, would be a national asset for surveillance.

A study of the chemical composition of traditional eye cosmetics ("kohls") used in Qatar and Yemen.

This study looks at the chemical composition of traditional eye cosmetics ("kohls") used in Qatar and Yemen. Of especial interest was how many samples in each country contain the toxic element lead. In Qatar 19 observably different kohl samples were obtained, and in Yemen ten such samples obtained. The analytical techniques of scanning electron microscopy (SEM) and X-ray powder diffraction (XRPD) were used to study the samples. For the samples from Qatar, six of the 19 (32%) contained galena (lead sulfide, PbS)--all as the main component. However, for the samples from Yemen, five of the ten (50%) samples contained galena as the main component, with another three having it present as a minor component. Overall, the other main components were found to be: amorphous carbon (3), iron oxides (hematite, Fe2O3; and goethite, FeO(OH)) (1), quartz (SiO2) (1), sassolite (H3BO3) (5), talc (Mg3Si4O10(OH)2) (1), and zincite (ZnO) (7).

Prevalence and issues in non-use of safety belts and child restraints in a high-income developing country: lessons for the future.

OBJECTIVE: In United Arab Emirates (UAE), a high-income developing country, safety belt (SB) legislation was implemented in 1998, covering only front-seated adults on highways outside cities. We assessed wearing of SBs after 5 years, together with use of safety restraints by rear passengers and children, perceptions about SBs, and use of tinted glass. METHODS: A cross-sectional survey in 2003-2004 in Al Ain, population 400,000 and the main desert city of UAE, used random sampling of petrol stations; about 80% of UAE's population is non-citizens. Five of 30 stations were selected, including 3 different speed zones; vehicles with children were over-sampled. Drivers were interviewed by questionnaire. Use of safety restraints and presence of tinted glass were verified by observation. Confounding and correlation were assessed by stratification and logistic regression. RESULTS: The sample included 500 vehicles, containing 959 adults and 876 children; 382 vehicles had children. SBs were used by 29% of drivers, 14% of front-seat and 2% of rear-seat adult passengers. 23% of children were in front; only 4% in front and 1% in the rear were restrained. SBs were worn by only 11% of UAE-citizen drivers and 10% of off-duty police and military. Odds ratio for non-use by citizens was 3.55 (95% CI 1.96-6.42). Use was greater among older drivers (p < 0.0005, X(2) trend). Reasons for non-use of SBs included discomfort 42%, forgetfulness 25%, uselessness 17%, carelessness 13%, and dangerous 3%. Among citizens, 15% believed SBs are dangerous. Tinted glass was present in 68% of vehicles. CONCLUSIONS: SB legislation failed to protect the population, with low use of restraints by citizens, military, and police, and virtually none among children and rear passengers. Lessons include the necessity of drafting laws that provide comprehensive and effective protection, study of cultural constraints to compliance with injury prevention measures, and locally effective interventions to prepare citizens and enforcers for the expected new behaviour. Highly tinted glass is widespread and poses a barrier to enforcement.

Nosocomial HIV infection: epidemiology and prevention--a global perspective.

Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and because of a long asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated 5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections. Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control, injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and Russian cited in PubMed and citations in Google Scholar in any language. MeSH keywords such as nosocomial, hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together with mode of transmission, such as "HIV and hemodialysis". References of relevant articles were also reviewed. The evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries continue to be reported, the situation in many low-income countries is alarming, with transmission ranging from frequent to endemic. Viral transmission in health facilities occurs by unexpected and unusual as well as more frequent modes. HIV can be transmitted to patients and to donors of blood products by specific vehicles and vectors during blood transfusion, plasma donation, and artificial insemination, by improperly sterilized sharps, by medical equipment during activities such as dialysis and organ transplantation, and by healthcare workers infected by occupational exposure to hazards such as blood-contaminated sharps. Personal, equipment, and environmental factors predispose to acquisition of nosocomial HIV and all are pertinent for prevention. For infection and injury control, poverty is often an underlying determinant. While sophisticated new tests offer improved HIV detection, increasingly higher marginal costs limit their feasibility in many settings. Modest investment in safer equipment and appropriate integrated training in infection control, injury prevention, and occupational safety should provide greater benefit.

Risk factors and prevention for spinal cord injury from diving in swimming pools and natural sites in Quebec, Canada: a 44-year study.

BACKGROUND: Diving is the most frequent cause of spinal cord injury (SCI) from recreation and sport in Canada. This study was done to identify risk factors for SCI from diving in the province of Quebec. METHODS: An interview survey was done for a target population of 203 subjects with a SCI from diving treated in the two specialized rehabilitation centers in Quebec during 1961-2004. Telephone interviews of consenting individuals were used to collect pertinent personal, equipment, and environmental factors for each incident. RESULTS: Response was 44% (89/203); 92% were male and 85% <35 years old. Only 37% were aware prior to injury of the risk of SCI from diving, and only 33% had received water safety training. Swimming pools were the site of 51% (n=45) and natural bodies of water for 49% (n=44). 87% (n=39) of pools were single-unit home pools and 57% (n=26) above-ground. Depth indicators were absent for 100% of above-ground and 74% of in-ground pools. For SCI in in-ground pools, 63% resulted from striking the up-slope between deep and shallow ends. For dives at natural sites, a dock or wharf was the most frequent location, 36% (n=16). In 52% of pools and 79% of natural sites, depth was <1.4m (4.6ft). Signs prohibiting diving were absent in 96% of above-ground and 89% of in-ground pools. Alcohol was reported in 47% of SCIs. INTERPRETATION: The target for prevention of diving SCI is male youths and young adults. Above-ground pools are too shallow and small for diving. Deep ends of many in-ground pools are excessively shallow and short since many SCIs resulted from striking the up-slope. Prevention of SCI from diving needs to focus on education of potential victims, pool vendors and manufacturers, and regulations for safety norms in private pools. Water safety should highlight diving as a high-risk activity, and emphasize that most home pools and natural sites are unsafe. Safer evidence-based pool designs and more effective warnings need to be implemented.

Strengthening public health medicine training for medical students: development and evaluation of a lifestyle curriculum.

BACKGROUND: Lifestyle factors are major determinants for health and safety. Although many graduates lack interviewing and observational skills for prevention and student lifestyle often deteriorates during training, few medical schools teach comprehensive assessment of lifestyle, particularly in the context of the home environment. AIMS: A lifestyle curriculum was developed to teach basic causality and provide practical experience in assessing nutrition, exercise, safety, tobacco addiction, and food hygiene, together with generic skills in history taking, on-site observation, researching and presenting. METHODS: Lifestyle has been integrated into the first-year curriculum, evaluated, and improved at the United Arab Emirates University since 2001. After an introduction to determinants of health, students conduct a home interview and observational survey for family residential and traffic safety, smoking, and food hygiene. For nutrition and exercise, students assess personal lifestyle. Generic skills are developed in the context of lifestyle. Evaluations were by faculty and students, including assessed impact on knowledge, skills, and personal lifestyle. The lifestyle curriculum was compared with other countries by detailed search. RESULTS: Detailed evaluation found strong agreement/agreement among students that knowledge had improved on: counselling of patients and families 97%, promoting healthy lifestyles 100%; interviewing 88%; history taking 84%; using research for medical practice 89%; and importance of prevention 96%. Eighty six percent were stimulated to think in new ways about health. Improved personal diet was reported by 60% (p < 0.0004) and exercise by 55% (p < 0.0004), while 36% of non-users started wearing a safety belt in front (p < 0.0004) and 20% in the rear (p = 0.008). Literature review found comprehensive lifestyle curricula to be rare. CONCLUSIONS: A lifestyle curriculum developed prevention-oriented history-taking and observation skills for health maintenance, addressing health priorities, improving medical student lifestyle, and strengthening generic skills. Since lifestyle is a major determinant of health, medical schools should consider development of an appropriate curriculum to address their local and national health priorities.