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Funding information: Grant funding for this analysis was provided by the: (1) Centre for Surveillance and Research, Public Health Agency of Canada (6D016-123071/001/SS); 2) Canadian Institutes of Health Research (Project Grant PJT 162237); 3) Polish National Science Centre (2013/09/B/HS6/03438). Corresponding author, Valerie F. Pagnotta, is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship. Background Strong variations in injury rates have been documented cross-nationally. Historically, these have been attributed to contextual determinants, both social and physical. We explored an alternative, yet understudied, explanation for variations in adolescent injury reporting-that varying access to medical care is, in part, responsible for cross-national differences. Methods Age-specific and gender-specific rates of medically treated injury (any, serious, by type) were estimated by country using the 2013/2014 Health Behaviour in School-aged Children study (n=209 223). Available indicators of access to medical care included: (1) the Healthcare Access and Quality Index (HAQ; 39 countries); (2) the Universal Health Service Coverage Index (UHC; 37 countries) and (3) hospitals per 100 000 (30 countries) then physicians per 100 000 (36 countries). Ecological analyses were used to relate injury rates and indicators of access to medical care, and the proportion of between-country variation in reported injuries attributable to each indicator. Results Adolescent injury risks were substantial and varied by country and sociodemographically. There was little correlation observed between national level injury rates and the HAQ and UHC indices, but modest associations between serious injury and physicians and hospitals per 100 000. Individual indicators explained up to 9.1% of the total intercountry variation in medically treated injuries and 24.6% of the variation in serious injuries. Conclusions Cross-national variations in reported adolescent serious injury may, in part, be attributable to national differences in access to healthcare services. Interpretation of cross-national patterns of injury and their potential aetiology should therefore consider access to medical care as a plausible explanation. Postprint

Motor vehicle collisions are one of the leading causes of death and morbidity in children and young adults in the USA, and suboptimal child restraint use is an important risk factor for severe childhood injury and death. The restrictions due to the COVID-19 pandemic have presented unique challenges to the public health community, including how to use certified child passenger safety technicians through car seat checks. This case series assessed the feasibility of performing remote car seat checks and parental satisfaction with them. It provides preliminary evidence that remote car seat checks are feasible in a real-world environment and acceptable to caregivers during times in which in-person car seat checks are not safe or accessible.

Background Unintentional childhood injury is a major cause of mortality and morbidity among children (upto 18 years) across the globe and contributes to over 875,000 deaths annually worldwide. Global Childhood Unintentional Injury Surveillance estimates that nearly 50% of children under 12 years suffered severe unintentional injuries leading to some form of disability. Unintentional childhood injury is an under-reported public health problem in India. This study was undertaken to estimate the incidence and assess economic impact and medical consequences of unintentional childhood injuries among children between 0–14 years. Methods This is a non-concurrent cohort study, conducted in 13 clusters of a rural block in Vellore. Double stage cluster sampling method was used to screen 1600 children with injury. Information regarding the impact and consequences of injury was obtained. Results Childhood injury related morbidity was 292.5/1000/year. Children between 10–14 years (4.6%) and boys (4.5%) had a higher rate of injury. Majority of injuries occurred at home (44.8%) and most commonly on the lower extremity (51.7%). Falls (43.1%) was the most common cause of injury followed by RTIs (27.6%). The direct medical and non medical cost of treatment ranged from $US0.14 to $US74. The wages lost by the primary caregiver ranged from $US1.4 to $US90 and absenteeism from work ranged from 1–60 days. Sick absenteeism ranged from 0–45 days with a mean of 5.17 days. 50% of children missed school after an injury. The days spent with temporary disability ranged from 1–60 days with a mean of 4.08 days and 7.73% had permanent disability. Conclusion Unintentional childhood injuries is an emerging public health problem which leads to significant injury related sickness absenteeism and disability. Boys and older children are the most common victims of injury. Prospective trials on the economic impact and medical consequences will help to gain a clear understanding of DALY and loss of productivity.

Background Posioning is the leading causes of childhood injury told by China National Injury Surveillance System (NISS). There is no research on children’s medicine safety issue in China. This research includes a retrospetive study on hospital data, a questionnaire survey among paediatricians, parents and behaviour tests among children. Methods 603 medical cases that related to medication poisoning among were collected through from Beijing Capital Children’s Hospital and Shanghai Children’s Medical Centre during the year 2012 to 2014. Opinions of 146 paediatricians from 114 hospitals in 35 cities were collected through a questionnaire during a national seminar. Awareness of 1760 kindergarten children’s parents’ in 4 cities were collected through questionnaires. Ideas of 218 children were collected through one-on-one dialogue by the trained teachers and every child was asked to open medicine bottles with or without child-proof, the time was recorded. Results Medication accounted over half of all poisoning cases in children’s hospitals; 1–4 age group was the leading victims. Main cause is mistaking by children (79.2%); There is an out-standing increase on cardiovascular medicines mistaken by children such as anti-hypertension. Half parents have placed home medicine in an easier way for adult’s reach. 98% of kindergarten children could opened non child-proofing bottles in 2.5 seconds while 16.7% of them opened child-proofing bottles in 9.6 seconds; 41% paediatricians thought it a must to talk with parents on medication safety while almost all paediatricians admitted that they barely have time to do so. Conclusions There is a strenuous need on Child medication safety in China. Safe storage is the key action for the intervention. Paediatricians have a great opportunity to be involved in medication safety promotion. There is another opportunity to engage grandparents as they are one of the main caregivers.

Background Diving related injuries are often catastrophic and result in life altering effects for victims and their families. One common approach to alerting people to diving hazards and injury risks is through the posting of warning signs. Of course, whether warning signs are effective for these purposes depends in part on how well viewers understand the intended message. The current study examined children’s understanding of various features of No Diving warning signs. Methods Normally developing 7 to 10 year olds were asked questions to assess their understanding of text, images, and main messages on No Diving warning signs. These structured interviews were audio recorded and responses were later coded, with excellent resulting reliability (Kappa = 0.91). Results Children understood the behaviour advised against (diving), why it is prohibited (can hit head on the bottom), and what can happen (serious injury including hospitalisation). They understood that breaking your neck results in limitations in mobility and can occur from diving, but they did not anticipate that such an injury is likely to occur. There were no gender and few age differences, but diving experience was associated with children significantly downplaying their risk of injury. Conclusions Having No Diving warning signs explicitly mention a broken neck, may serve to remind children of this potential consequences at the time of decision making. Active adult supervision is particularly important for children who have prior positive diving experiences.

Background We contributed to the revision of a Japanese safety standard of bicycle wheel guard for preventing childhood injury due to wheel spoke, by showing the actual situation of the injury based on our injury data and clarifying reachable range of child’s foot based on experimental measurement. In this study, the purpose is to evaluate impact of the revision based on our injury database. Methods Our injury data base includes injured body part data which is recorded as 3 dimensional area data on the 3 dimensional child model by our developed system. The system can calculate the frequency distribution by overlaying multiple data. To evaluate the impact, we compared probability distribution of injury cases due to bicycle before and after the revision. Results The number of cases before the revision is 325 and the number of cases before the revision is 159. We compared them by calculating injured probability distribution of body parts. As for all injury cases due to bicycle, injured probability of knees and heels is reduced after the revision. As for injury cases of foot which is injured due to wheel spoke, average of injured probability is decreased by approximately 55.3% after the revision. The result indicates that the revision is effective for preventing injury due to wheel spoke. Conclusions We evaluated impact of the revision at this time. We showed that we can evaluate impact of preventive measure quantitatively based on injury database. We think that the impact will increase because bicycle which is fulfilled the revised safety standard will become widespread over time. We will continue to evaluate the impact of it and try to evaluate impact of other preventive measures.

Background/Purpose Based on our collected 17 966 cases of injury data, frequency distributions of injured parts of body (figure 1) can be calculated and it is useful for understanding trends of injuries. One of the most frequently injured parts due to bicycle is heel. We found more than 80% of the cases are injury due to wheel9s spoke when children sit on a rear seat. To improve bicycle, it is necessary to collect children9s body size data, especially data on the region that children9s heel can reach. Methods To clarify the reachable range of child9s foot when they sit on rear seat, we conducted an experiment for measuring child9s body size and we developed software for estimating reachable range based on the measured body size data. The subjects are 197 children aged from 1-year-old to 9-years-old. Results The result shows that the average value increases about 24 mm as a child9s age increases 1-year-old. The safety standard of bicycle wheel guard was revised in November 2011 based on our data. According to revised standard, distance between seating face of rear seat and rear wheel must be more than 350 mm. Conclusions We found that data on injured body parts is useful for identifying a problem due to a consumer product such as a bicycle since it allows us to analyse injury data statistically and visually. To solve the identified problem, systematic measurement of children9s body size is required.

To provide precise information about child injuries, intended to promote preventive actions, in keeping with the general pattern of a Safe Community program implemented in Boulogne-Billancourt (France) since 1997.Information about children under 16 injured in the city of Boulogne-Billancourt and its surroundings, are extracted in a database.The Boulogne-Billancourt database is the first permanent and specific childhood injury surveillance system in France integrated in a "Safe Community". It may constitute an "alarm system" by allowing rapid implementation of preventive action. The final evaluation of the collected data will be performed at the end of the program (after five years).

Objective—To delineate a role for pathologists in coordinating the study of childhood deaths due to injury and in developing public safety recommendations. Methods—Ongoing evaluation of cases of death due to injury occurring in children under 16 years, with formal review of all cases of fatal pediatric injuries recorded in the Department of Histopathology, Women’s and Children’s Hospital, over the past 35 years, has been undertaken as a part of the “Keeping Your Baby and Child Safe” programme. Results—Information obtained from these cases has been used to formulate a number of safety recommendations dealing with unsafe sleeping environments, unsafe eating practices, scalding, and dangerous farm environments. Some products have been withdrawn from sale and other products modified. Conclusions—Pathologists often have extensive knowledge of childhood injuries, which can contribute significantly to health promotion initiatives and community education programmes. (Injury Prevention 1999;5:292‐293)

This book deals with a standard public health topic. For the last 20 years or so, numerous countries have pondered over what strategies they should adopt to reduce childhood injuries. This recent French publication offers a distinctive viewpoint. One question some readers, especially those who may have to struggle with their high school French, may ask is: How useful is this book outside its country of origin? The answer is given in what follows, but in two words, it is potentially “very useful”. The authors' stated aims are to identify possible gaps in childhood injury prevention in France, to investigate their causes, and to make recommendations to improve prevention. The book is essentially concerned with children younger than 10 years of …

As in previous years, Child Injury Prevention Week (CHIP Week) in mid-August provided the Child Accident Prevention Foundation of Southern Africa (CAPFSA) with its annual opportunity to jockey for public attention, and to renew awareness of childhood injury. This short turn in the spotlight has become more and more of a challenge as the number of health related lobbies also demanding a piece of the action throughout the calendar year grows steadily, and the national Department of Health is always ready to oblige with a seven day slot—clearly oblivious to the fact that there are only 52 weeks in the year, and that the ability of the average citizen to absorb health propaganda has a certain saturation point. Last year we had to share the month of August with dental health …

I am constantly aware that most of my reports selfishly concentrate on happenings in Southern Africa. Occasionally, I am able to glean the odd item on what is happening further north from news reports, what little there is on the internet, or from that outstanding monthly, “BBC Africa”. Rather than bore readers with poor excuses for this imbalance, may I rather reconfirm that I would welcome news (in any form whatsoever) related to childhood injury in Africa, and inclusion of which would allow this column to become more representative of the entire continent …