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Injury prevention theory, research, policy and practice have provided a rich basis for the consensus that injuries are not unavoidable ‘accidents’, but rather the result of predictable and preventable events.1–8 Yet unintentional injuries remain a leading cause of morbidity and mortality worldwide.9 Thus, there remains a persistent global burden of injury that appears resistant to the efforts of conventional science, and a growing recognition that injury is a complex problem requiring complex solutions.10–12 In response to the recognition of this complexity, recent authors have noted the advantages of systems thinking approaches to injury prevention research.13–15 This shift holds that intrapersonal, interpersonal, organisational, community and societal determinants combine together into a highly complex ‘web of determinants’ that influences the likelihood of injury occurrence.13–16 Systems thinking thus offers much promise for further improvements in understanding injury and its prevention as a complex problem. The move to systems thinking is a promising one. However, the growing support for systems thinking as a valid way to approach complex, intractable injury problems has an unintended unhelpful consequence. This being an overemphasis on the epistemological question of how multifactorialism is accounted for in research, and a corresponding underemphasis on the ontological considerations and assumptions we make about the world. This dissonance in how complexity is understood and applied has been explored in a recent systematic review of systems thinking approaches in public health, which concluded that (1) close to half the papers identified by the review process are commentaries, (2) systems thinking in public health suffers from methodological weaknesses that need to be addressed, (3) …

ObjectivesTo assess crash risk and driving habits associated with chronic medical conditions among drivers entering old age.DesignProspective cohort study.SettingFrench cohort GAZEL.Participants12 460 drivers in the analysis of road traffic crash, among whom 11 670 completed the follow-up period (2007–2014). We assessed driving cessation among 11 633 participants over the same period, and mileage and driving avoidance among the 4973 participants who returned a road safety questionnaire in 2015.Main outcome measuresYearly occurrence of at least one road crash as a driver; time to driving cessation; mileage; driving avoidance: at night, with bad weather, in heavy traffic, with glare conditions, over long distances.ResultsSeveral potentially risky conditions (angina, myocardial infarction, coronary disease; stroke; nephritic colic, urinary stones; glaucoma) were associated with lower mileage and/or driving avoidance and did not increase crash risk. Neither driving avoidance nor lower mileage was found for other conditions associated with an increased crash risk: hearing difficulties (adjusted OR 1.19, 95% CI 1.06 to 1.34); joint disorders (1.17, 95% CI 1.06 to 1.30). Depression, anxiety and stress was associated with an increased crash risk (1.23, 95% CI 1.01 to 1.49) despite increased driving avoidance. Parkinson’s disease was associated with driving cessation (adjusted HR 32.61, 95% CI 14.21 to 65.17).ConclusionsDepending on their condition, and probably on the associated risk perception, drivers entering old age report diverse driving habits. For example, hearing difficulties is a frequent condition, rarely considered a threat to road safety, and nonetheless associated with an increased crash risk.

ObjectiveStudent-inflicted injury to staff in the educational services sector is a growing concern. Studies on violence have focused on teachers as victims, but less is known about injuries to other employee groups, particularly educational assistants. Inequities may be present, as educational assistants and non-educators may not have the same wage, benefits, training and employment protections available to them as professional educators. We identified risk factors for student-related injury and their characteristics among employees in school districts.MethodsWorkers’ compensation data were used to identify incidence and severity of student-related injury. Rates were calculated using negative binomial regression; risk factors were identified using multivariate models to calculate rate ratios (RR) and 95% CIs.ResultsOver 26% of all injuries were student-related; 8% resulted in lost work time. Special and general education assistants experienced significantly increased risk of injury (RR=6.0, CI 5.05 to 7.15; RR=2.07, CI 1.40 to 3.07) as compared with educators. Risk differed by age, gender and school district type. Text analyses categorised student-related injury. It revealed injury from students acting out occurred most frequently (45.4%), whereas injuries involving play with students resulted in the highest percentage of lost-time injuries (17.7%) compared with all interaction categories.ConclusionStudent-inflicted injury to staff occurs frequently and can be severe. Special education and general assistants bear the largest burden of injury compared with educators. A variety of prevention techniques to reduce injury risk and severity, including policy or environmental modifications, may be appropriate. Equal access to risk reduction methods for all staff should be prioritised.

ObjectivesWhile Japan has socioeconomic issues, such as income inequality, little is known about the association between socioeconomic factors and the risk of unintentional childhood injuries. The purpose of the study was to evaluate the influence of socioeconomic factors on the risk for unintentional injuries among preschool children in Japan.DesignCross-sectional study using data from a web-based questionnaire survey.SettingJapan (January 2015).Participants1000 households with preschool children under 6 years of age.Outcome measuresMultivariate logistic regression was performed to analyse the influence of socioeconomic factors on the incidence of unintentional injuries.ResultsOverall, 976 households were eligible for the analysis, with 201 households reporting unintentional injuries. The incidence rates for unintentional injury were estimated to be constant across all strata constructed using combinations of socioeconomic factors. The multivariate logistic regression analysis showed no significant differences in socioeconomic factors between households that reported unintentional injuries and those that did not.ConclusionThe findings of our study demonstrated that unintentional injuries among preschool children occurred at approximately fixed rates, independent of socioeconomic factors. Accordingly, prevention strategies for unintentional injuries that concern socioeconomic disadvantages should be avoided in Japan.