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To evaluate the effectiveness of a 2020 nationwide helmet promotion campaign, in terms of helmet wearing and correct helmet wearing, aimed at electric bike riders and motorcyclists in China.We obtained 192 hours of film of traffic before (2019) and after (2021) implementation of the campaign at eight road intersections in Changsha, recording cyclist (traditional and electric) and motorcyclist helmet-wearing behaviour during both weekdays and the weekend, and peak and off-peak traffic. We extracted data on rider characteristics and helmet-wearing behaviour. We applied a logistic regression to obtain estimates of helmet wearing and correct helmet wearing, and calculated odds ratios adjusted for rider variables.We filmed 11 525 cyclists and motorcyclists, 5256 (45.6%) before and 6269 (54.4%) after the campaign. We estimated a substantial increase in the overall percentage of helmet wearing from 8.8% (95% confidence interval, CI: 8.0-9.6) to 62.0% (95% CI: 60.8-63.2). After controlling for covariates, we noted that helmet wearing increased in all groups. However, we observed a decrease in the overall percentage of correct helmet wearing from 91.9% (95% CI: 89.4-94.3) to 83.5% (95% CI: 82.3-84.7). Post-campaign, we estimated the highest percentage of helmet wearing for delivery riders (88.8%) and lowest for traditional cyclists (3.8%); we estimated the lowest percentage of correct helmet wearing for three-wheeled motorcyclists (58.8%).To increase helmet wearing and correct helmet wearing, we recommend amending the campaign to include traditional cyclists as well as education and legislation on the correct fastening of helmet chinstraps.Mesurer l'efficacité d'une campagne nationale organisée en 2020 afin de promouvoir l'adoption et le port adéquat du casque pour les motocyclistes et les cyclistes utilisant un vélo électrique en Chine.Nous avons obtenu 192 heures de vidéos provenant de caméras de surveillance routière placées sur huit carrefours à Changsha, avant (2019) et après (2021) la mise en œuvre de la campagne. Ces caméras ont filmé le comportement des motocyclistes ainsi que des cyclistes (sur vélo traditionnel et électrique) vis-à-vis du casque, en semaine et durant le week-end, mais aussi pendant les heures de pointe et les heures creuses. Nous y avons trouvé des informations sur les caractéristiques de ces usagers et leur attitude par rapport au casque. Enfin, nous avons appliqué un modèle de régression logistique en vue de formuler des estimations sur l'adoption et le port adéquat du casque, puis nous avons calculé l'odds ratio ajusté pour les variables relatives à ces usagers.Nous avons filmé 11 525 cyclistes et motocyclistes, 5256 (45,6%) avant et 6269 (54,4%) après la campagne. Nous avons observé une importante augmentation du pourcentage total d'usagers portant un casque, de 8,8% (intervalle de confiance de 95%, IC: 8,0–9,6) à 62,0% (IC de 95%: 60,8-63,2). Après avoir pris en compte les covariables, nous avons remarqué que le port du casque avait augmenté dans toutes les catégories. Néanmoins, nous avons constaté une baisse du pourcentage total d'usagers portant correctement leur casque, de 91,9% (IC de 95%: 89,4-94,3) à 83,5% (IC de 95%: 82,3-84,7). À l'issue de la campagne, la catégorie d'usagers enregistrant le pourcentage le plus élevé de port du casque était celle des coursiers à vélo (88,8%), tandis que celle des cyclistes traditionnels affichait le plus faible pourcentage (3,8%). Nous avons également noté que les motocyclistes à trois roues constituaient la catégorie la moins bien représentée en matière de port adéquat (58,8%).Afin d'améliorer l'adoption et le port adéquat du casque, nous recommandons de modifier la campagne et d'y inclure les cyclistes traditionnels, mais aussi d'adapter la législation et l'éducation pour apprendre aux usagers à attacher correctement la mentonnière de leur casque.Evaluar la eficacia de una campaña de promoción del uso del casco a nivel nacional en 2020, en lo que respecta al uso del casco y a su correcta utilización, cuyo grupo objetivo son los conductores de bicicletas eléctricas y motociclistas en China.Se obtuvieron 192 horas de filmación del tráfico antes (2019) y después (2021) de la aplicación de la campaña en ocho intersecciones viales de Changsha, en las que se registró el comportamiento de los ciclistas (con bicicletas tradicionales y eléctricas) y de los motociclistas en relación con el uso del casco, tanto en días laborables como en fin de semana, y en horas pico y no pico de tráfico. Se extrajeron datos sobre las características de los ciclistas y el uso del casco. Se aplicó una regresión logística para obtener estimaciones del uso del casco y de su correcto uso, y se calcularon las razones de posibilidades ajustadas a las variables de los conductores.Se filmaron a 11 525 ciclistas y motociclistas, 5256 (45,6 %) antes y 6269 (54,4 %) después de la campaña. Se estimó un aumento sustancial del porcentaje global de uso del casco, que pasó del 8,8 % (intervalo de confianza del 95 %, IC: 8,0-9,6) al 62,0 % (IC del 95 %: 60,8-63,2). Tras controlar las covariables, se observó que el uso del casco aumentó en todos los grupos. No obstante, se observó una reducción en el porcentaje global de uso correcto del casco del 91,9 % (IC del 95 %: 89,4-94,3) al 83,5 % (IC del 95 %: 82,3-84,7). Después de la campaña, se estimó que el porcentaje más alto de uso del casco correspondía a los repartidores (88,8 %) y el más bajo a los ciclistas que utilizan bicicletas tradicionales (3,8 %); se estimó que el porcentaje más bajo de uso correcto del casco correspondía a los motociclistas con vehículos de tres ruedas (58,8 %).Para aumentar el uso del casco y su correcta utilización, se sugiere modificar la campaña para incluir a los ciclistas con bicicletas tradicionales, así como la educación y la legislación sobre la correcta sujeción de las correas de la barbilla del casco.تقييم فعالية حملة الترويج لارتداء للخوذة على المستوى الوطني في عام 2020، من حيث ارتداء الخوذة والارتداء الصحيح للخوذة، والتي استهدفت راكبي الدراجات الكهربائية وراكبي الدراجات النارية في الصين.حصلنا على 192 ساعة من شريط تصوير لحركة المرور قبل تنفيذ الحملة (عام 2019)، وبعد تنفيذها (عام 2021) في ثمانية تقاطعات للطرق في تشانجشا، مع تسجيل سلوك راكبي الدراجات (التقليدية والكهربائية) وراكبي الدراجات النارية المرتدين للخوذة خلال أيام الأسبوع وعطلة نهاية الأسبوع، وأثناء ذروة حركة المرور، وغير أوقات الذروة. استخرجنا بيانات عن خصائص الراكب وسلوكه أثناء ارتداء الخوذة. قمنا بتطبيق انحدارًا لوجستيًا للحصول على تقديرات لارتداء الخوذة، والارتداء الصحيح للخوذة، مع حساب نسب الأرجحية المعدلة لمتغيرات الراكب.قمنا بتصوير 11525 راكبًا للدراجات التقليدية والنارية، منهم 5256 (45.6%) قبل الحملة، و6269 (54.4%) بعد الحملة. قمنا بتقدير زيادة هائلة في النسبة المئوية الإجمالية لارتداء الخوذة من 8.8% (بفاصل ثقة مقداره 95%: 8.0 إلى 9.6) إلى 62.0% (بفاصل ثقة مقداره 95%: 60.8 إلى 63.2). بعد التحكم في المتغيرات المشتركة، لاحظنا أن ارتداء الخوذة قد ازداد في كل المجموعات. مع ذلك، لاحظنا انخفاضًا في النسبة المئوية الإجمالية لارتداء الخوذة بطريقة صحيحة من 91.9% (بفاصل ثقة مقداره 95%: 89.4 إلى 94.3) إلى 83.5% (بفاصل ثقة مقداره 95%: 82.3 إلى 84.7). بعد الحملة، قمنا بتقدير أعلى نسبة مئوية لارتداء الخوذة لدى راكبي توصيل الطلبات (88.8%)، وأدنى نسبة مئوية لراكبي الدراجات التقليدية (3.8%)؛ وكذلك تقدير أقل نسبة مئوية للارتداء الصحيح للخوذة لراكبي الدراجات النارية ذات العجلات الثلاث (58.8%).لزيادة ارتداء الخوذة والارتداء الصحيح للخوذة، فنحن نوصي بتعديل الحملة لتشمل راكبي الدراجات التقليدية، فضلًا عن التوعية والتشريع الخاص بالتثبيت الصحيح لأشرطة الخوذة على الرأس.评估 2020 年全国头盔推广活动的效果，包括头盔佩戴和正确佩戴头盔情况，针对人群为中国电动车骑行者和摩托车骑行者。.我们获取了长沙市 8 个路口（2019 年）在该推广活动实施之前和（2021 年）之后 192 个小时的交通录像，录像记录了骑行者（传统自行车和电动车）和摩托车骑行者在工作日和周末、高峰和非高峰时段的头盔佩戴情况。我们提取了有关骑行者特征和头盔佩戴行为的数据。我们应用逻辑回归来获得头盔佩戴和正确佩戴头盔的估计值，并计算根据骑手变量调整的优势比。.我们拍摄了 11,525 名自行车和摩托车骑行者，其中活动之前 5,256 (45.6%) 人以及活动之后 6269 (54.4%) 人。我们估计头盔佩戴的总体百分比从 8.8% （95% 置信区间，CI：8.0–9.6）大幅增加到 62.0%（95% CI: 60.8–63.2）。在控制协变量后，我们注意到所有组的头盔佩戴率都有所增加。但是，我们也注意到正确佩戴头盔的总体百分比从 91.9%（95% CI: 89.4-94.3）下降至 83.5%（95% CI: 82.3-84.7）。活动结束后，我们估计快递骑手佩戴头盔的比例最高（88.8%），而传统骑行者佩戴头盔的比例最低（3.8%）；我们估计三轮摩托车骑行者正确佩戴头盔的比例最低（58.8%）。.为了增加头盔佩戴和正确佩戴头盔，我们建议修改活动纳入传统骑行者，以及教育和制定有关正确固定头盔下颏带的法规。.Оценить эффективность общенациональной кампании 2020 года по поощрению использования шлемов с точки зрения их использования и правильного ношения водителями электровелосипедов и мотоциклистами в Китае.Авторы получили 192 часа видеозаписи дорожного движения до (2019 г.) и после (2021 г.) реализации кампании на восьми перекрестках дорог в городском округе Чанша, на которой отображено поведение велосипедистов (на обычных и электрических велосипедах) и мотоциклистов в шлемах в будние и выходные дни как в часы пик, так и вне часов пик. Авторы извлекли данные о характеристике водителей и их поведении в отношении использования шлема. Авторы применили логистическую регрессию для получения оценки использования шлемов и правильного их ношения, а также рассчитали отношение шансов с поправкой на переменные водителя.Авторы засняли 11 525 велосипедистов и мотоциклистов, из них 5256 (45,6%) до и 6269 (54,4%) после кампании. Авторы оценили существенное увеличение общего процента водителей, которые использовали шлем, с 8,8% (95%-й ДИ: 8,0–9,6) до 62% (95%-й ДИ: 60,8–63,2). После учета ковариат авторы отметили, что использование шлема увеличилось во всех группах. Однако авторы наблюдали снижение общего процента водителей, которые использовали шлем правильно, с 91,9% (95%-й ДИ: 89,4–94,3) до 83,5% (95%-й ДИ: 82,3–84,7). После проведения кампании авторы оценили, что самый высокий процент водителей, которые использовали шлем, наблюдался среди водителей доставки (88,8%), а самый низкий – у обычных велосипедистов (3,8%). Авторы оценили, что самый низкий процент водителей, которые использовали шлем правильно, имел место среди водителей трехколесных мотоциклов (58,8%).Чтобы увеличить количество водителей, которые используют шлем и носят его правильным образом, авторы рекомендуют внести изменения в кампанию, включив в нее обычных велосипедистов, а также использовать просвещение и законодательные акты о правильном креплении подбородочных ремней шлемов.

Purpose This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 – to halve the number of global deaths and injuries from road traffic accidents by 2020. Methods Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. Results Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%–16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68–1.90 per 100,000 population) and morbidity (110.45–112.72 per 100,000 population for incidence and 487.48–491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07–4.50 per 100,000 population) but the highest morbidity (428.74–467.78 per 100,000 population for incidence and 1025.70–1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. Conclusion Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Online media reports provide valuable information for road traffic injury prevention, but technical challenges concerning data acquisition and processing limit analysis and interpretation of such data. Integrating injury epidemiology theory and big data technology, we developed a data platform consisting of four layers (data acquisition, data processing, application and data storage) to automatically collect reports from online Chinese media concerning road traffic crashes every 24 h. We built a text classification model using 20,000 manually annotated news stories based on the Bidirectional Encoder Representations from Transformers (BERT) and then used natural language processing algorithms to extract data concerning 27 structured variables from the news sources. The accuracy of the BERT-based text classification model was 0.9271, with information extraction accuracy exceeding 80% for 22 variables. As of November 30, 2021, the data platform collected 244,650 eligible media reports covering all 333 prefecture-level divisions in China. These reports were from 37,073 websites or social media accounts, which were geographically located in all 31 provinces and over 98% of prefecture-level divisions. Data availability varied greatly from 0.9% to 100% across the 27 structured variables. Additionally, the platform identified 645,787 potentially relevant keywords when applying natural language processing techniques to the textual media reports. Platform data were highly correlated with road police data in province-based road traffic crash statistics (crashes, r

Background Compared to urban children, children living in rural areas of most countries, including China, are at higher risk of suffering unintentional injuries. Most proven injury prevention interventions, however, are rarely implemented in rural China due to lack of resources. Mobile health interventions are low-cost and easy-to-implement, facilitating implementing injury prevention in resource-limited areas (e.g., rural areas). This study is designed and implemented to examine the effectiveness of an app-based intervention for unintentional injury prevention among rural preschoolers in China. Methods A single-blind, 18-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be implemented in 2 rural areas of China (Yang County, Shaanxi Province, and Shicheng County, Jiangxi Province). In total, at least 3508 rural caregivers of preschoolers aged 3–6 years old who own a smartphone will be recruited from 24 preschools. Clusters will be randomized at the preschool level and allocated to the control group (receiving routine school-based education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (receiving routine school-based education plus app-based parenting education including unintentional injury prevention). External support strategies will be adopted by local partners to minimize user fatigue, non-compliance, and attrition. Data collection will be conducted at baseline and then every 3 months during the 18-month follow-up time period. Intention-to-treat data analysis will be implemented. Missing values will be imputed by using the Expectation Maximization algorithm. Generalized estimating equation will test the overall effectiveness of the app-based intervention. A per-protocol sensitivity analysis will be conducted to test the robustness of results. Subgroup analyses will follow the strategies for primary analyses. The primary outcome measure is the incidence rate of unintentional injury among preschoolers during the study period. Secondary outcome measures comprise longitudinal changes in caregiver’s attitudes, caregiver-reported supervision behaviors, and caregiver-assessed home environment safety surrounding child unintentional injury prevention in the last week using a standardized audit instrument. Discussion The app-based intervention is expected to be feasible and effective over the 18-month intervention period. If the app is demonstrated effective as hypothesized, we will initiate processes to generalize and popularize it broadly to rural child caregivers across China. Trial registration ChiCTR2000037606, registered on August 29, 2020.

BackgroundCompared to urban children, children living in rural areas of most countries, including China, are at higher risk of suffering unintentional injuries. Most proven injury prevention interventions, however, are rarely implemented in rural China due to lack of resources. Mobile health interventions are low-cost and easy-to-implement, facilitating implementing injury prevention in resource-limited areas (e.g., rural areas). This study is designed to examine the effectiveness of an app-based intervention for unintentional injury prevention among rural preschoolers in China. MethodsA single-blind, 18-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be implemented in 2 rural areas of China (Yang County, Shaanxi Province, and Shicheng County, Jiangxi Province). In total, at least 3508 rural caregivers of preschoolers aged 3-6 years old who own a smartphone will be recruited from 24 preschools. Clusters will be randomized at the preschool level and allocated to the control group (receiving routine school-based education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (receiving routine school-based education plus app-based parenting education including unintentional injury prevention). External support strategies will be adopted by local partners to minimize user fatigue, non-compliance, and attrition. Data collection will be conducted at baseline and then every 3 months during the 18-month follow-up time period. Intention-to-treat (ITT) data analysis will be implemented. Missing values will be imputed by using the Expectation Maximization algorithm (EM). Generalized estimation equations (GEE) will test the overall effectiveness of the app-based intervention. A per-protocol (PP) sensitivity analysis will be conducted to test the robustness of results. Subgroup analyses will follow the strategies for primary analyses.ResultsThe primary outcome measure is the incidence rate of unintentional injury among preschoolers during the study period. Secondary outcome measures comprise longitudinal changes in caregiver’s attitudes, caregiver-reported supervision behaviors, and caregiver-assessed home environment safety surrounding child unintentional injury prevention in the last week using a standardized audit instrument.ConclusionThe app-based intervention is expected to be feasible and effective over the 18-month intervention period. If the app is demonstrated effective as hypothesized, we will initiate processes to generalize and popularize it broadly to rural child caregivers across China. Trial registrationChiCTR2000037606, registered on August 29, 2020.

Background The Chinese population has aged significantly in the last few decades. Comprehensive health losses including both fatal and non-fatal health outcomes associated with ageing in China have not been detailed. Methods Based on freely accessible disability adjusted life years (DALYs) estimated by the Global Burden of Diseases (GBD) 2017, we adopted a robust decomposition method that ascribes changes in DALYs in any given country across two time points to changes resulting from three sources: population size, age structure, and age-specific DALYs rate per 100,000 population. Using the method, we calculated DALYs associated with population ageing in China from 1990 to 2017 and examined the counteraction between the effects of DALYs rate change and population ageing. This method extends previous work through attributing the change in DALYs to the three sources. Results Population ageing was associated with 92.8 million DALYs between 1990 and 2017 in China, of which 65.8% (61.1 million) were years of life lost (YLLs). Males had comparatively more DALYs associated with population ageing than females in the study period. The five leading causes of DALYs associated with population ageing between 1990 and 2017 were stroke (23.6 million), chronic obstructive pulmonary disease (COPD) (18.3 million), ischemic heart disease (13.0 million), tracheal, bronchus, and lung cancer (6.1 million) and liver cancer (5.0 million). Between 1990 and 2017, changes in DALYs associated with age-specific DALY rate reductions far exceeded those related to population ageing (− 196.2 million versus 92.8 million); 57.5% (− 112.8 million) of DALYs were caused by decreases in rates attributed to 84 modifiable risk factors. Conclusion Population ageing was associated with growing health loss in China from 1990 to 2017. Despite the recent progress in alleviating health loss associated with population ageing, the government should encourage scientific research on effective and affordable prevention and control strategies and should consider investment in resources to implement strategies nationwide to address the future challenge of population ageing.

To quantify how changes in reporting of specific causes of death and of selecting underlying cause from among multiple causes of death contribute to trends in mortality from unintentional injury in Americans aged 65 years or older.We extracted age-standardized unintentional injury mortality data in the United States Centers for Disease Control and Prevention online databases from 1999 to 2016. We used an attribution method to calculate two indicators: the proportion of mortality with specific codes out of all mortality; and the proportion of mortality with underlying cause of death selected from multiple causes of death. We conducted a linear regression to examine the changes over time in these proportions and in reported and age-adjusted mortality.From 1999 through 2016, the proportion of cause-specific unintentional injury mortality in this age group increased from 74% in 1999 (136.9 out of 185.0 per 100 000 population) to 85% in 2016 (143.0 out of 169.1 per 100 000 population) based on multiple causes of death codes. The proportions of mortality with underlying cause of death selected out of multiple causes of death rose in all specific causes of unintentional injury except motor vehicle crash. Age-standardized mortality attributed to reporting changes increased steadily between 1999 and 2016. The increases for overall unintentional injury, fall, motor vehicle crash, suffocation, poisoning and fire or hot object were 24.2, 13.5, 2.1, 2.3, 1.6 and 0.4 deaths per 100 000 persons, respectively.Changes in data reporting affect trends in overall and specific unintentional injury mortality over time for older Americans.Quantifier la manière dont les changements dans l'enregistrement des causes spécifiques des décès et dans le choix de la cause sous-jacente parmi des causes multiples de décès contribuent aux tendances observées en matière de mortalité par traumatisme accidentel chez les Américains de 65 ans et plus.En utilisant les bases de données en ligne des Centres pour le contrôle et la prévention des maladies aux États-Unis (Entre 1999 et 2016, la proportion de la mortalité par traumatisme accidentel associée à une cause spécifique a augmenté dans cette tranche d'âges, en passant de 74% en 1999 (136,9 cas sur 185,0 pour 100 000 habitants) à 85% en 2016 (143,0 cas sur 169,1 pour 100 000 habitants) sur la base des codes de causes multiples de décès. Les proportions de la mortalité associée à une cause sous-jacente de décès choisie parmi des causes multiples de décès a augmenté pour toutes les causes spécifiques de traumatismes accidentels, à l'exception des accidents impliquant des véhicules à moteur. La mortalité standardisée selon l'âge attribuée aux changements dans l'enregistrement des décès a augmenté de façon continue entre 1999 et 2016. Les augmentations pour: tous les types de traumatismes accidentels; les chutes; les accidents impliquant un véhicule à moteur; les étouffements; les intoxications et les expositions à des incendies ou à des substances brulantes ont été respectivement de 24,2; 13,5; 2,1; 2,3; 1,6 et 0,4 décès pour 100 000 habitants.Les changements dans l'enregistrement des données affectent les tendances observées en matière de mortalité générale par traumatisme accidentel et de mortalité par traumatisme accidentel spécifique, au fil du temps, chez les Américains les plus âgés.Cuantificar cómo los cambios en el reporte de las causas específicas de muerte y de la selección de la causa subyacente de entre las múltiples causas de muerte contribuyen a las tendencias en la mortalidad por lesiones no intencionales en los estadounidenses de 65 años de edad o más.Se extrajeron datos de mortalidad por lesiones no intencionales estandarizados por edad de las bases de datos en línea de los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos desde 1999 hasta 2016. Se utilizó un método de atribución para calcular dos indicadores: la proporción de mortalidad con códigos específicos de entre toda la mortalidad; y la proporción de mortalidad con causa subyacente de muerte seleccionada entre múltiples causas de muerte. Se realizó una regresión lineal para examinar los cambios a lo largo del tiempo en estas proporciones y en la mortalidad informada y ajustada por edad.De 1999 a 2016, la proporción de mortalidad por lesiones no intencionales por causas específicas en este grupo de edad aumentó del 74 % en 1999 (136,9 de 185,0 por 100.000 habitantes) al 85 % en 2016 (143,0 de 169,1 por 100.000 habitantes) sobre la base de los múltiples códigos de defunción. Las proporciones de mortalidad con causa subyacente de muerte seleccionada de entre las múltiples causas de muerte aumentaron en todas las causas específicas de lesiones involuntarias, excepto en los accidentes automovilísticos. La mortalidad normalizada por edad atribuida a los reportes sobre los cambios aumentó constantemente entre 1999 y 2016. Los aumentos por lesiones involuntarias generales, caídas, choques de vehículos de motor, asfixia, envenenamiento e incendios u objetos calientes fueron de 24,2, 13,5, 2,1, 2,3, 1,6 y 0,4 muertes por cada 100.000 personas, respectivamente.Los cambios en el reporte de datos afectan las tendencias en la mortalidad general y específica por lesiones no intencionales a lo largo del tiempo para los estadounidenses mayores.توضيح كيف أن التغيرات في الإبلاغ عن الوفاة محددة الأسباب، وفي اختيار السبب الكامن من بين عدة أسباب للوفاة، يسهم في اتجاهات الوفيات الناجمة عن الإصابات غير المتعمدة في الأمريكيين الذين تبلغ أعمارهم 65 سنة أو أكثر.قمنا باستخلاص بيانات الوفيات الناتجة عن الإصابات غير المتعمدة، والقائمة على معيار السن، في قواعد بيانات الإنترنت الخاصة بمراكز مكافحة الأمراض والوقاية منها في الولايات المتحدة الأمريكية من عام 1999 إلى عام 2016. واستخدمنا طريقة الإسناد لحساب اثنين من المؤشرات: نسبة الوفيات مع رموز محددة من جميع الوفيات؛ ونسبة الوفيات مع السبب الأساسي للوفاة المختار من عدة أسباب للوفاة. لقد أجرينا تحوفاً خطيًا لفحص التغيرات بمرور الوقت في هذه النسب وفي معدل الوفيات المُبلّغ عنه والقائم على السن.من عام 1999 حتى عام 2016، ارتفعت نسبة الوفيات الناجمة عن الإصابات غير المتعمدة في هذه الفئة العمرية من 74٪ في عام 1999 (136.9 من 185.0 لكل 100000 نسمة) إلى 85٪ في عام 2016 (143.0 من 169.1 لكل 100000 نسمة) بناء على أسباب متعددة من رموز الموت. ارتفعت نسب الوفيات ذات الأسباب الكامنة للوفاة والمختارة من عدة أسباب للوفاة، في جميع الأسباب المحددة للإصابة غير المتعمدة باستثناء حوادث المركبات. ارتفع معدل الوفيات القائمة على معيار السن، والمنسوبة للتغيرات في الإبلاغ، بشكل مطرد بين عامي 1999 و2016. وكانت الزيادات في إجمالي حالات الإصابات غير المتعمدة، أو السقوط، أو حوادث المركبات، أو الاختناق، أو التسمم والحريق، أو الأشياء الساخنة: 24.2 و13.5 و2.1 و2.3 و1.6 و0.4 حالة وفاة لكل 100000 شخص، على التوالي.تؤثر التغيرات في الإبلاغ على البيانات في اتجاهات وفيات الإصابات غير المتعمدة بشكل عام ومحدد مع مرور الوقت بالنسبة للأمريكان المسنين.旨在量化特定原因死亡和从多个致死原因中选取主要死因的报告变化是如何影响 65 岁或以上的美国人意外伤害死亡率的趋势变化。.我们提取了美国疾病控制和预防中心在线数据库中 1999 年至 2016 年年龄标准化的意外伤害死亡率数据。我们使用归因法来计算两个指标：在所有死亡中使用因特定原因死亡的部分；以及从多个致死原因中选取主要死因的部分。我们采取线性回归的分析方法来探讨这些比例、报告的死亡率以及年龄标准化死亡率随时间推移的变化。.从 1999 年到 2016 年，基于死亡中的多重原因，这一年龄组的特定死因的意外伤害死亡率从 1999 年的 74%（每 10 万人中，185.0 人中有 136.9 人死亡）上升到 2016 年的 85%（每 10 万人中，169.1 人中有 143.0 人死亡）。至于从多个致死原因中选取主要死因的死亡率，除机动车碰撞事故外，其在所有特定意外伤害原因的死亡率中均有所上升。1999 年至 2016 年间，报告的变化导致年龄标准化死亡率稳步上升。每 10 万人中，意外伤害、坠落、机动车辆碰撞事故、窒息、中毒以及火灾或烧伤的死亡率分别上升了 24.2、13.5、2.1、2.3、1.6 以及 0.4 。.随着时间的推移，数据报告的变化影响美国老年人意外伤害死亡率的总体和特定趋势。.Количественно оценить, каким образом изменения в отчетности с указанием конкретной причины смерти и выбор основополагающей причины из нескольких возможных причин смерти вносят вклад в тенденции смертности от непредумышленных травм у американцев в возрасте от 65 лет и старше.Авторы воспользовались данными о смертности от непредумышленных травм, стандартизированными по возрасту, из онлайновых баз данных Центров США по контролю и профилактике заболеваний за период с 1999 по 2016 год. С помощью методов атрибуции были рассчитаны два показателя: доля смертей с определенными кодами среди всех случаев смерти и доля смертей, для которых основополагающая причина выбиралась из ряда возможных причин смерти. Была выполнена линейная регрессия для изучения изменений этих пропорций во времени, а также в составе отчетности по смертности в целом и по смертности с поправкой на возраст.За период с 1999 по 2016 год доля случаев смерти от непредумышленных травм, имеющих определенную причину, выросла в указанной возрастной группе с 74% в 1999 г. (136,9 из 185,0 случая на 100 000 населения) до 85% в 2016 г. (143,0 из 169,1 случая на 100 000 населения) на основании кодов смертных случаев с несколькими причинами. Доля случаев смертности, в которых основополагающую причину смерти выбирали из списка нескольких возможных причин, выросла для всех отдельно рассматриваемых причин гибели от непредумышленных травм, кроме случаев аварий автотранспортных средств. Стандартизированная по возрастному показателю смертность вносила вклад в постепенный рост изменений в отчетности с 1999 по 2016 год. Рост общего количества непредумышленных травм, падений, аварий автотранспортного средства, удушений, отравлений и смертей от пожара или горячего предмета составил соответственно 24,2; 13,5; 2,1; 2,3; 1,6 и 0,4 случая смерти на 100 000 человек.Изменения в отчетности с течением времени влияют на тенденции общей смертности от непредумышленных травм и отдельных конкретных групп внутри этого общего показателя для пожилых американцев.

Bus safety represents an important topic for injury prevention. When drivers experience conflict with their passengers, it likely distracts them from the driving task, both physically and mentally, and jeopardizes the safety of all passengers. However, detailed information concerning the frequency and type of conflicts between bus drivers and passengers is unavailable. We conducted a driver-reported cross-sectional survey to investigate the characteristics of driver-passenger conflict in the past month. The survey was completed in Changsha city, China in August 2019. In total, 779 bus drivers were surveyed. Of 732 drivers who completed the questionnaire, 635 (86.7%; 95% confidence interval: 84.3-89.1%) drivers reported experiencing at least one conflict with passengers in the past month. After adjusting for other demographic variables, drivers who were male, younger, less educated, less experienced as a bus driver, and with a comparatively high self-reported work intensity were more likely to report experiencing conflicts. Of the reported conflicts, verbal quarrels and abuses were most common, followed by "passengers attacked driver with physical objects like sticks or knives" and "passengers spat on or threw objects toward the driver". Most drivers reported that they had experienced only conflicts causing no physical injury or financial loss in the past month, but a small portion experienced conflicts causing injuries to themselves. The most frequent reasons for driver-passenger conflicts were "passenger refused to pay fare", "passenger requested to get off the bus at a location that was not a bus stop", and "passenger was drunk or deliriously attacked the driver". Bus drivers responded to some of the passengers' verbal or physical attacks, but not all. Some preventive measures were adopted frequently by bus companies (e.g., bus alarms, protective shields for drivers) but others were not. Least often adopted were efforts to offer safety training for drivers (46.6%) and to offer psychological counseling services for drivers (39.1%). We conclude that bus driver-passenger conflicts are common in Changsha city, China. The conflicts impose a substantial threat to the safety of both drivers and passengers. We recommend multiple preventive actions to reduce driver-passenger conflicts and improve bus safety.

Background High attrition rates threaten evaluation of the effectiveness of mobile health interventions. We explored the factors associated with attrition of study participants in an app-based clinical trial. Methods This six-month cluster randomized control trial (RCT) implemented two app-based interventions: an unintentional child injury prevention app in the intervention group (Bao Hu San) and a nutrition app in the control group. The study included 2,920 caregivers of 3–6 year-old preschoolers in Changsha, China. Follow-up surveys were conducted 3 and 6 months after baseline, and data on app engagement was collected electronically during the RCT. Associations within intervention and control groups were tested and quantified separately using adjusted odds ratio (aOR) based on logistic regression models. Results The six-month attrition rate was 32.2%. Attrition rates differed significantly between control and intervention groups (35.7% vs. 28.9%, p Conclusions Demographic characteristics and app engagement were associated with attrition. Learning Outcomes Researchers and practitioners should consider demographic factors and engagement when designing app-based interventions.

Background Media reports may influence criminal behavior that leads to violence against doctors. Little is known about the characteristics of media reports on patient violence against their doctors. Methods Based on the international and domestic guidelines for media reports, we developed a checklist to assess adherence of Chinese media reports to recommended principles. We adopted a seed approach to search influential violence stories. Reports were assessed using the unified coding scheme by different coders; the conflicts between raters were resolved through discussion. Results In total, 17,222 media reports were captured; 788 met inclusion criteria. 49.5% and 52.7% of 788 included reports mentioned real and complete names of writer and editor, respectively. of 329 reports including quotes or opinions from doctors, patients, and hospital administrative personnel, only 15.79%, 11.25% and 18.62% respectively specified they had obtained the consent of the interviewees. 21.6% of reports including all specifically-coded details of the violent acts against doctors (time, place, methods and perpetrators), and 43.5% of reports included some details. Only 18.7% of media reports offered suggestions for seeking professional help in case doctors are threatened by violence and 11.3% offered contact information for third parties who mediate doctor-patient conflicts. Conclusion Most internet-based media reports did not strictly follow media recommendations from authoritative bodies. Strong efforts are needed to require journalists to increase adherence so risk of violence against doctors is reduced in China. Learning Outcomes Most Chinese internet-based media sources did not appropriately report stories concerning violence against doctors.

Background Distracted walking is a major risk factor for pedestrian injury, but it is unknown whether pedestrians have different risks of distracted walking in some road environments compared to others. Methods An observational study was conducted at 20 intersections in Changsha, China. We developed a composite measure distracted behavior (called the ‘distraction index’) based on types and duration of pedestrian distraction. Another composite indicator, ‘road environmental risk score’, was constructed on the basis of eight variables on road environment and traffic volumes. The mediating effect of distraction index was examined while studying the impact of road environmental risk score on the risk of near-crash events. Results In total, 8729 of 25436 (38.9%) pedestrians were distracted by mobile phone use, interaction with others, or eating/drinking/smoking while walking. A higher distraction index was related to higher risk of near-crash event (p Conclusion Specific road traffic environments raise the severity of distracted walking, which further threatens pedestrian safety. Learning Outcomes Specific road environmental risk increases the severity of distracted walking, additionally creating an indirect impact on near-crash event.

Background Suicide is a significant public health problem internationally. Recent suicide mortality by method is unexamined. Methods Using mortality data from the WHO mortality database, we compared sex-, age-, and country-specific suicide mortality by method for 58 countries worldwide between 2000 and 2015. Changes in suicide mortality were quantified using negative binomial models among three age groups for males and females separately. Results Suicide mortality declined substantially for both sexes and all three age groups studied in 37 of the 58 included countries between 2000 and 2015. Males consistently had much higher suicide mortality rates than females in all 58 countries. Hanging was the most common suicide method in the majority of countries. Sex-specific suicide mortality varied across the countries significantly for all three age groups. The spectrum of suicide method generally remained stable for 28 of the 58 included countries; notable changes occurred in the other 30 countries, including especially Colombia, Finland and Trinidad and Tobago. Conclusion Likely as a result of prevention efforts as well as sociodemographic changes, suicide mortality decreased substantially in 37 of the included 58 countries between 2000 and 2015. Further action is recommended to explore specific drivers of recent changes (particularly for increasing suicide rates in eight countries), to understand substantial disparities in suicide rates across countries, and to develop interventions to reduce suicide rates globally. Learning Outcomes Between 2000 and 2015, suicide mortality decreased in 37 countries but increased in 8. Suicide spectrum by method experienced substantial changes over time in several countries.

Background Internet-based big data may offer important and timely information concerning road traffic injury data, supplementing official government statistics. We developed computer-based approaches to define, extract and automatically collect internet-based Chinese language big data on road traffic injuries. Methods Based on injury prevention matrices and ICD-10, we established a thesaurus set and analysis framework for data extraction. A dilated convolutions neural network classifier was developed to filter eligible news stories based on 10,000 researcher-annotated news sources, and algorithms were built to extract information concerning relevant variables. Word frequency was reported using a Python Chinese word segmentation module (Jieba). Pearson correlation coefficients examined relations between internet-based big data and official statistics. Results 650,140 media reports were captured from 27 Chinese news websites, and 92,813 news pieces were filtered as eligible reports (accuracy=86%). Searches captured information about 71,829 traffic crashes from January 2013-September 2019. The words ‘crash’, ‘vehicle’ and ‘scene’ were the most frequently used words in the stories. Our results revealed characteristics that official statistics did not cover, such as changes in travel patterns for the elderly. The number of media-reported crashes was highly correlated with official statistics (r=0.84, p=0.035). Conclusion Internet-based big data offers information about traffic crashes that can supplement official government statistics and aid in road traffic injury prevention strategies. Extension to countries where government data and statistics are unreliable, but news reporting is reliable, appeals in particular. Learning Outcomes Internet-based big data offers data that can supplement existing road traffic injury sources and guide prevention efforts.

Background Simple and valid measures are important for studying distracted walking, an important and emerging risk factor for pedestrian injury. Based on common epidemiological indicators for distracted walking, we developed and validated an indicator to measuring distracted walking, called the ‘distraction index’. Methods A large, video-based, observational study was conducted at 20 intersections in Changsha, China. To develop a ‘distraction index’ that would quantify safety risks based on distracted walking, we calculated relationships between 7 observed distraction indicators and 3 safety outcomes. This allowed us to assess the discriminant validity of the 7 indicators and create a ‘distraction index’ that best predicts street-crossing safety based on distracted behavior. Results In total, 8,729 distracted pedestrian crossings were identified. Discriminant validity varied greatly across the distraction indicators. Compared to each individual indicators, the distraction index demonstrated the strongest capacity to discriminate all three safety measures of street-crossing. Using the three levels in the ‘distraction index’, distracted pedestrians had much higher risks of experiencing near-crash events compared to undistracted pedestrians, with odds ratios of 1.3 (95% CI: 1.1, 1.4) for low index scores, 1.6 (95% CI: 1.4, 1.9) for medium, and 1.9 (95% CI: 1.6, 2.3) for high. Conclusion The distraction index predicted pedestrian crossing safety more accurately than any of the seven individual measures of distracted walking. We recommend use of this index in future research. Learning Outcomes No widely recognized epidemiological measure exists to observe distracted walking. The newly-created ‘distraction index’ shows excellent discriminant validity compared to individual indicators of distraction.

BACKGROUND Given the permeation of social media throughout society, rumors spread faster than ever before, which significantly complicates government responses to public health emergencies such as the COVID-19 pandemic. OBJECTIVE We aimed to examine the characteristics and propagation of rumors during the early months of the COVID-19 pandemic in China and evaluated the effectiveness of health authorities’ release of correction announcements. METHODS We retrieved rumors widely circulating on social media in China during the early stages of the COVID-19 pandemic and assessed the effectiveness of official government clarifications and popular science articles refuting those rumors. RESULTS We show that the number of rumors related to the COVID-19 pandemic fluctuated widely in China between December 1, 2019 and April 15, 2020. Rumors mainly occurred in 3 provinces: Hubei, Zhejiang, and Guangxi. Personal social media accounts constituted the major source of media reports of the 4 most widely distributed rumors (the novel coronavirus can be prevented with “Shuanghuanglian”: 7648/10,664, 71.7%; the novel coronavirus is the SARS coronavirus: 14,696/15,902, 92.4%; medical supplies intended for assisting Hubei were detained by the local government: 3911/3943, 99.2%; asymptomatically infected persons were regarded as diagnosed COVID-19 patients with symptoms in official counts: 322/323, 99.7%). The number of rumors circulating was positively associated with the severity of the COVID-19 epidemic (ρ=0.88, 95% CI 0.81-0.93). The release of correction articles was associated with a substantial decrease in the proportion of rumor reports compared to accurate reports. The proportions of negative sentiments appearing among comments by citizens in response to media articles disseminating rumors and disseminating correct information differ insignificantly (both correct reports: χ12=0.315, P=.58; both rumors: χ12=0.025, P=.88; first rumor and last correct report: χ12=1.287, P=.26; first correct report and last rumor: χ12=0.033, P=.86). CONCLUSIONS Our results highlight the importance and urgency of monitoring and correcting false or misleading reports on websites and personal social media accounts. The circulation of rumors can influence public health, and government bodies should establish guidelines to monitor and mitigate the negative impact of such rumors.

Background Given the permeation of social media throughout society, rumors spread faster than ever before, which significantly complicates government responses to public health emergencies such as the COVID-19 pandemic. Objective We aimed to examine the characteristics and propagation of rumors during the early months of the COVID-19 pandemic in China and evaluated the effectiveness of health authorities’ release of correction announcements. Methods We retrieved rumors widely circulating on social media in China during the early stages of the COVID-19 pandemic and assessed the effectiveness of official government clarifications and popular science articles refuting those rumors. Results We show that the number of rumors related to the COVID-19 pandemic fluctuated widely in China between December 1, 2019 and April 15, 2020. Rumors mainly occurred in 3 provinces: Hubei, Zhejiang, and Guangxi. Personal social media accounts constituted the major source of media reports of the 4 most widely distributed rumors (the novel coronavirus can be prevented with “Shuanghuanglian”: 7648/10,664, 71.7%; the novel coronavirus is the SARS coronavirus: 14,696/15,902, 92.4%; medical supplies intended for assisting Hubei were detained by the local government: 3911/3943, 99.2%; asymptomatically infected persons were regarded as diagnosed COVID-19 patients with symptoms in official counts: 322/323, 99.7%). The number of rumors circulating was positively associated with the severity of the COVID-19 epidemic (ρ=0.88, 95% CI 0.81-0.93). The release of correction articles was associated with a substantial decrease in the proportion of rumor reports compared to accurate reports. The proportions of negative sentiments appearing among comments by citizens in response to media articles disseminating rumors and disseminating correct information differ insignificantly (both correct reports: χ12=0.315, P=.58; both rumors: χ12=0.025, P=.88; first rumor and last correct report: χ12=1.287, P=.26; first correct report and last rumor: χ12=0.033, P=.86). Conclusions Our results highlight the importance and urgency of monitoring and correcting false or misleading reports on websites and personal social media accounts. The circulation of rumors can influence public health, and government bodies should establish guidelines to monitor and mitigate the negative impact of such rumors.

Background Several studies have assessed the reporting quality of all-cause mortality data from the WHO Mortality Database, but little is known about coding quality and its impact on elderly unintentional fall mortality data worldwide. We aimed to assess the coding quality of deaths and its impact on elderly unintentional fall mortality. Methods Using data from the WHO Mortality Database, 1990–2019, we calculated the number of countries/territories that had mortality data in the database, and the proportion of deaths with five types of problematic codes based on the 10th International Classification of Disease (unspecified deaths, injury deaths with undetermined intent, unspecified unintentional injury, unintentional falls with unspecified mechanism, unintentional falls with unknown occurrence place). We estimated age-adjusted unintentional fall mortality before and after correcting problematic codes. Results Only 64% (124/194) of WHO member states had at least 1 year of mortality data in the database during 1990–2019, and data unavailability was more common for underdeveloped countries/territories than for developed countries/territories. Coding quality was poor for many countries/territories. Among the study years when countries/territories possessed mortality data, 80, 53, 51, and 63% had a proportion of unintentional fall deaths with unspecified mechanism over 50% in low-income, lower middle-income, upper middle-income, and high-income countries/territories, respectively; comparable proportions for unintentional fall deaths with unknown occurrence place were 100, 42, 71, and 62%. Among the 94 countries/territories having mortality data, problematic codes caused a relative mortality difference ≥ 50% in 59 countries/territories (63%). After correcting problematic codes, 5 of 55 countries/territories with data witnessed a reverse in mortality changes between 2005 and 2015. Among the 82 countries/territories with mortality data for 5 or more years, 18 countries/territories (22%) experienced a directional reverse in linear regression coefficient. Conclusions The availability and coding quality of global data related to elderly unintentional fall mortality was poor between 1990 and 2019. When data are available, varying coding quality across countries/territories and over time have a substantial impact on mortality estimates and mortality comparisons. Global agencies plus each individual government should be aware of the importance of collecting and sharing high-quality mortality data, and take action to improve data quality for inclusion in the WHO Mortality Database.

Background Mobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. Objective We explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. Methods The cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. Results In total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P Conclusions Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-018-5790-1

Background As the number of older people globally increases, health systems need to be reformed to meet the growing need for medical resources. A few previous studies reported varying health impacts of population ageing, but they focused only on limited countries and diseases. We comprehensively quantify the impact of population ageing on mortality for 195 countries/territories and 169 causes of death. Methods and findings Using data from the Global Burden of Disease Study 2017 (GBD 2017), this study derived the total number of deaths and population size for each year from 1990 to 2017. A decomposition method was used to attribute changes in total deaths to population growth, population ageing, and mortality change between 1990 and each subsequent year from 1991 through 2017, for 195 countries/territories and for countries grouped by World Bank economic development level. For countries with increases in deaths related to population ageing, we calculated the ratio of deaths attributed to mortality change to those attributed to population ageing. The proportion of people aged 65 years and older increased globally from 6.1% to 8.8%, and the number of global deaths increased by 9 million, between 1990 and 2017. Compared to 1990, 12 million additional global deaths in 2017 were associated with population ageing, corresponding to 27.9% of total global deaths. Population ageing was associated with increases in deaths in high-, upper-middle-, and lower-middle-income countries but not in low-income countries. The proportions of deaths attributed to population ageing in 195 countries/territories ranged from −43.9% to 117.4% for males and −30.1% to 153.5% for females. The 2 largest contributions of population ageing to disease-specific deaths globally between 1990 and 2017 were for ischemic heart disease (3.2 million) and stroke (2.2 million). Population ageing was related to increases in deaths in 152 countries for males and 159 countries for females, and decreases in deaths in 43 countries for males and 36 countries for females, between 1990 and 2017. The decreases in deaths attributed to mortality change from 1990 to 2017 were more than the increases in deaths related to population ageing for the whole world, as well as in 55.3% (84/152) of countries for males and 47.8% (76/159) of countries for females where population ageing was associated with increased death burden. As the GBD 2017 does not provide variances in the estimated death numbers, we were not able to quantify uncertainty in our attribution estimates. Conclusions In this study, we found that population ageing was associated with substantial changes in numbers of deaths between 1990 and 2017, but the attributed proportion of deaths varied widely across country income levels, countries, and causes of death. Specific preventive and therapeutic techniques should be implemented in different countries and territories to address the growing health needs related to population ageing, especially targeting the diseases associated with the largest increase in number of deaths in the elderly., Guoqing Hu and colleagues estimate the contribution of population aging on mortality across 195 countries over the past two decades., Author summary Why was this study done? Evidence on the change in number deaths related to population ageing is important for each individual government to improve its healthcare system to address the increasing healthcare needs of older adults. Previous research assessing changes in health indicators (e.g., number of deaths, mortality) influenced by population ageing was limited to specific countries or specific diseases. Quantitative methods for decomposing changes in the total number of deaths that were adopted by previous studies are sensitive to the choice of the decomposition order of the 3 factors—population growth population ageing, and age-specific mortality rate—and the selection of reference group. What did the researchers do and find? Using a decomposition method that is not influenced by the selection of decomposition order of the 3 factors and the choice of the reference group, we conducted a comprehensive analysis to quantify the impact of population ageing on changes in the number of deaths in 195 countries/territories, and for 169 causes of death, from 1990 to 2017. Changes in the number of deaths related to population ageing varied greatly across the 195 countries/territories; the attributed proportion ranged from −43.9% to 117.4% for males and −30.1% to 153.5% for females. The causes of death for which population ageing was associated with the greatest increases in global deaths between 1990 and 2017 were ischemic heart disease (3.2 million) and stroke (2.2 million). The decreases in deaths attributed to mortality change exceeded the increases in deaths related to population ageing between 1990 and 2017 for the whole world, as well as in 55.3% (84/152) of countries for males and 47.8% (76/159) of countries for females where population ageing was associated with increased death burden. What do these findings mean? Globally, population ageing was related to increases in deaths, highlighting the importance and urgency of improving health systems to meet the health needs of older adults. Varying death burden related to population ageing suggests flexible health policies should target the leading causes of attributed death burden in different countries/territories. The death burden related to population ageing could be alleviated or even overcome through implementation of evidence-based interventions to reduce mortality.

Background: Recent overweight and obesity prevalence data are lacking for China. Methods: Data were from provincially representative surveys conducted in 2013 and 2018 in Hunan Province, China. Overweight and obesity were defined according to the Chinese standard. Complex sampling weights were considered in statistical analyses. 95% confidence interval (95% CI) of rate was calculated. Results: The overall prevalence rate between 2013 and 2018 significantly increased from 20.81% (95% CI: 17.68&ndash, 23.95) to 26.97% (95% CI: 23.48&ndash, 30.45) for overweight and from 4.09% (95% CI: 3.21&ndash, 4.96) to 7.13% (95% CI: 5.10&ndash, 9.15) for obesity in Hunan Province of China, respectively. Urban residents and males had higher crude prevalence rates of overweight and obesity than rural residents and females in 2013 and in 2018. Notably, the peak age groups of overweight and obesity both became younger between 2013 and 2018. After controlling for Engel coefficient, level of education and frequency of physical exercise per week, the overweight prevalence significantly increased in urban males aged 65+ (adjusted OR: 1.52) and rural males aged 45&ndash, 54 years (adjusted OR: 1.52) and 65+ (adjusted OR: 1.88) and the obesity prevalence rate rose significantly in many groups (urban males: 18&ndash, 24 years, 25&ndash, 34 years, 35&ndash, 44 years and 55&ndash, 64 years, urban females: 25&ndash, 44 years, 45&ndash, 54 years, rural males: 18&ndash, 34 years, rural females: 35&ndash, 44 years, 55&ndash, 64 years), with adjusted OR varying from 1.56 to 5.52. Conclusion: The adult prevalence rates of overweight and obesity significantly increased between 2013 and 2018 in Hunan Province, China. The increasing prevalence rates and varying prevalence changes across groups warrantee further research and policy interventions.

To assess the accuracy and influential factors for hypertension prevalence based on questionnaire interview by on-site measurement.Data were from the baseline surveys for chronic diseases among residents ages ≥18 years old in 4 districts/counties of Changsha between 2013 and 2014. All surveys adopted multi-stage random sampling to select samples. The Bootstrap resampling method was used to randomly select 1 000 repeated samples with replacement to obtain robust estimate of subgroup prevalence rates. Hypertension prevalence was calculated by using the data from both questionnaire interview and on-site measurement. Using the results of on-site measurement as the golden standard, the accuracy of questionnaire interview and 95% uncertainty interval were estimated. Multivariate logistic regression was used to investigate the influential factors for the underestimated hypotension prevalence based on questionnaire interview.The hypertension prevalence from on-site measurement among the residents in the 4 districts/counties of Changsha was significantly higher than that from questionnaire interview (prevalence ratio: 1.26-2.31). Taking the results of on-site measurement as the golden standard, the sensitivity of questionnaire interview on hypotension prevalence range from 41.76% to 74.83% among the 4 districts/counties, and the specificity fell between 98.51% and 99.46%. The underestimation in questionnaire interview was more likely to occur in the youngest age group (18-34 years old), males, and residents were at lower levels of education in all 4 districts/counties.Compared with the on-site measurement, questionnaire interview significantly under-estimate the hypertension prevalence, suggesting that the on-site measurement method should be firstly considered in epidemiological surveys for hypertension prevalence. If only the questionnaire method can be used to collect data due to conditions, it is necessary to make corresponding corrections to the questionnaire results with reference to relevant research evidence.

Background: Improper, unprofessional, or misleading media reports about violence against doctors may provoke copycat incidents. Little is known about the adherence of media reports about violence against doctors to professional journalism recommendations. Methods: We identified ten influential incidents of violence against doctors in China through a systematic strategy and used standardized internet-based search techniques to retrieve media reports about these events. Reports were evaluated independently by trained coders to assess adherence to professional journalism recommendations using a 14-item checklist. Findings: In total, 788 eligible media reports were considered. Of those, 50·5% and 47·3% respectively failed to mention the real and complete names of the writer and editor. Reports improperly mentioned specific details about the time, place, methods, and perpetrators of violence in 42·1%, 36·4%, 45·4% and 54·6% of cases, respectively. Over 80% of reports excluded a suggestion to seek help from professional agencies or mediation by a third party and only 3·8% of reports mentioned the perspectives of all three key informants about an event: doctors, patients, and hospital administrators. Of those that mentioned doctor, patient, and/or hospital administrator perspectives, less than 20% indicated they had obtained the interviewee’s consent to include their perspective. Interpretation: Most reports about violence against doctors in the Chinese media failed to strictly follow reporting recommendations from authoritative media bodies. Efforts are recommended to improve adherence to professional guidelines in media reports about violence against doctors in China, as adherence to those guidelines is likely to reduce future violent events against doctors. Funding Statement: None declared. Declaration of Interests: We have no conflicts of interest to declare. Ethics Approval Statement: This analysis was approved by the ethics committee of Xiangya School of Public Health, Central South University (NO. XYGW-2018-24).

ObjectiveTo examine recent changes in sex-specific and age-specific suicide mortality by method across countries.MethodsUsing mortality data from the WHO mortality database, we compared sex-specific, age-specific and country-specific suicide mortality by method between 2000 and 2015. We considered seven major suicide methods: poisoning by pesticides, all other poisoning, firearms and explosives, hanging, jumping from height, drowning and other methods. Changes in suicide mortality were quantified using negative binomial models among three age groups (15–44 years, 45–64 years, and 65 years and above) for males and females separately.ResultsSuicide mortality declined substantially for both sexes and all three age groups studied in 37 of the 58 included countries between 2000 and 2015. Males consistently had much higher suicide mortality rates than females in all 58 countries. Hanging was the most common suicide method in the majority of 58 countries. Sex-specific suicide mortality varied across 58 countries significantly for all three age groups. The spectrum of suicide method generally remained stable for 28 of 58 included countries; notable changes occurred in the other 30 countries, including especially Colombia, Finland and Trinidad and Tobago.ConclusionLikely as a result of prevention efforts as well as sociodemographic changes, suicide mortality decreased substantially in 37 of the included 58 countries between 2000 and 2015. Further actions are needed to explore specific drivers of the recent changes (particularly for increases in eight countries), to understand substantial disparities in suicide rates across countries, and to develop interventions to reduce suicide rates globally.

Background To examine trends in unintentional falls mortality from 2006 to 2016 in China by location (urban/rural), sex, age group and mechanism. Methods Mortality data were retrieved from the National Disease Surveillance Points system (DSPs) of China, a nationally representative data source. Percent change in mortality between 2006 and 2016 was calculated as "mortality rate ratio - 1" based on a negative binomial regression model. Results The crude unintentional falls mortality was 9.55 per 100 000 population in 2016. From 2006 to 2016, the age-adjusted unintentional falls mortality increased by 5% (95% confidence interval (CI) = 1%-9%), rising from 7.65 to 8.03 per 100 000 population. Males, rural residents and older age groups consistently had higher falls mortality rates than females, urban residents and younger age groups. Falls on the same level from slipping, tripping and stumbling (W01) was the most common mechanisms of falls mortality, accounting for 29% of total mortality. Conclusions Unintentional falls continued to be a major cause of death in China from 2006 to 2016. Empirically-supported interventions should be implemented to reduce unintentional falls mortality.

To examine differences in burden of disease among people aged ≥70 years old in countries with different developmental levels from 1990 to 2016. Methods: The sociodemographic index (SDI) of global burden of disease (GBD) was used to divide 195 countries into five developmental levels: high, high middle, middle, low middle and low. The results of the Global Burden of Diseases Study 2016 (GBD 2016) were extracted to examine disability-adjusted life years (DALY) and the health loss from the top 10 diseases and risk factors among the people aged ≥70 years old in countries with different SDIs. Results: Between 1990 and 2016, the age-standardized DALY rate among people aged ≥70 years old in countries with different SDIs all showed a downward trend. Different decreases in DALY rate in over-seventy old people were observed across countries with different SDI levels: -23.9% in high SDI, -21.3% in high-middle SDI, -23.4% in middle SDI, -18.8% in low-middle SDI and -16.3% in low SDI. In 1990, the age-standardized DALY rate among people aged ≥70 years old in low and low middle SDI countries was 1.67 and 1.49 times of that in high SDI countries; and the gaps rose to 1.83 and 1.59 times in 2016. The DALY rate of the aged people remained remarkably higher in low middle and low SDI countries in 2016, and the gap widened compared with that in 1990. The reduction of age-standardized DALY rate was mainly due to the decrease of years of life lost (YLL). In 2016, low SDI and low-middle SDI countries suffered much higher burden of disease from infectious diseases and chronic non-communicable diseases. Analysis of leading causes and risk factors of DALY showed significant disparities across different SDI countries; burden of disease caused by environmental pollution and adverse health conditions was much higher in the low SDI and lower-middle SDI countries than that in the other countries. Conclusion: During 1990-2016, the burden of disease in countries of all 5 SDI levels declined. But the reductions in the developing countries were less than those in the developed countries, widening health disparities for the elderly between low and high SDI countries. International organizations and individual governments should take measures to narrow health gaps among old adults across countries with different developmental levels.目的：分析1990—2016年全球不同发展水平国家≥70岁老年人口的疾病负担差异及变化趋势。 方法：采用全球疾病负担(global burden of disease，GBD)研究中社会人口学指数将全球195个国家分为高、偏高、中等、偏低和低5个发展水平。利用2016年GBD研究课题组估算数据，评价不同发展水平国家间≥70岁人口在伤残调整寿命年(disability-adjusted life years，DALY)上的差异及变化趋势，估算DALY排名居前十位的疾病及危险因素造成的健康损失比重。 结果：1990—2016年间，5类发展水平国家≥70岁人口的标化DALY率总体均呈下降趋势，高、偏高、中等、偏低和低5类发展水平国家DALY/10万人下降幅度分别为23.9%，21.3%，23.4%，18.8%和16.3%。1990年，低和较低发展水平国家≥70岁年龄标化DALY率分别为高发展水平国家的1.67倍和1.49倍，2016年分别为1.83倍和1.59倍，差距扩大。标化DALY率下降主要来自于过早死亡寿命损失年的降低。2016年，低和较低发展水平国家≥70岁人口面临着传染性疾病和慢性非传染性疾病均高发的疾病模式；环境污染和不良卫生条件相关的危险因素在低和较低发展水平国家中造成严重的疾病负担。 结论：1990—2016年间，尽管5类发展水平国家的疾病负担均有所下降，但发展水平较低国家的下降幅度低于发展水平偏高的国家，加剧了高发展水平国家和低发展水平国家之间的老年人健康差距。国际组织及各国政府应根据当前面临的主要疾病和危险因素采取措施，缩小不同发展水平国家之间老年人的健康差距。.

Bus crashes are common in urban China, and bus company regulations are hypothesized to be related to bus crash risk. We conducted a retrospective survey to examine the association in four large Chinese cities (Changsha, Shenzhen, Fuzhou, and Wuhan). Four types of bus crashes were considered: (a) passengers injured while riding the bus, (b) bus colliding with or scraping other motor vehicles, (c) bus colliding with non-motorized vehicles or pedestrians, and (d) bus damaging public facilities. Based on regulations governing the drivers&rsquo, work, complete round trips per day, and their paid salary, three categories of companies were studied: type A: &ge, 14 h worked/day, &ge, 6 round trips/day, and &gt, 70% of salary based on performance, type B: 8&ndash, 13 h/day, 4 or 5 round trips/day, and 36&ndash, 70% of salary, and type C: &lt, 36% of salary and no other specified requirements. Of the 926 respondents, 20.7% reported one or more crashes or related risk events in the past month. Drivers from the three types of companies reported crash incidence rates of 31.9%, 8.8%, and 6.0%, respectively, in the past month. Type A crash rates were significantly higher than type C after controlling for relevant covariates (adjusted odds ratio (OR) = 7.1, 95% confidence interval (CI): 3.74&ndash, 13.47). We conclude that more stringent bus company regulations, which mandate drivers to work long hours and obtain salary based on job performance in meeting demanding metrics, are associated with elevated bus-related crash risks. Local governments in China should regulate bus companies to ensure drivers work reasonable hours and are paid based on the quality of their work (e.g., safety).

BACKGROUND App-based interventions have the potential to reduce child injury in countries with limited prevention resources, but their effectiveness has not been rigorously examined. OBJECTIVE This study aimed to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among Chinese preschoolers. METHODS A 6-month cluster randomized controlled trial was conducted from December 2017 to June 2018. Recruitment was conducted through preschools, which were randomly allocated to either the control group (ie, app-based parenting education excluding unintentional injury prevention) or the intervention group (ie, app-based parenting education including unintentional injury prevention). A total of 2920 caregivers of preschoolers aged 3-6 years from 20 preschools in Changsha, China, were recruited offline through the schools. The primary outcome was unintentional injury incidences among preschoolers in the past 3 months; this measure was assessed through an online caregiver-report at the baseline visit and at 3-month and 6-month follow-up visits. Secondary outcome measures included caregivers’ self-reported attitudes and behaviors concerning child supervision during the last week. Generalized estimating equations (GEEs) were used to assess the effectiveness of the app-based intervention on responses at 3 and 6 months after adjusting for sociodemographic variables, baseline level of the outcome variable, and engagement with interventions in the assigned group. All analyses were intention-to-treat. A per-protocol sensitivity analysis was also conducted. RESULTS In total, 1980 of the 2920 caregivers completed the study. The mean age of participants was 32.0 years (SD 5.5) and 68.99% (1366/1980) of them were female. During the 6-month follow-up visit, unintentional injury incidence did not change significantly in either group: incidence in the intervention group went from 8.76% (94/1073) to 8.11% (87/1073), P=.59; incidence in the control group went from 9.4% (85/907) to 7.5% (69/907), P=.15. The changes did not differ between the groups (odds ratio [OR] 1.14, 95% CI 0.80-1.62). Changes in the average score in attitude concerning unintentional injury prevention were also similar between the groups (B .05, 95% CI -0.03 to 0.13). Changes in unintentional injury prevention behaviors were greater in the intervention group than in the control group after the intervention (B .87, 95% CI 0.33-1.42). Analyses of individual injury prevention behaviors showed that the intervention reduced three risky behaviors: unsafe feeding of children (OR 0.73, 95% CI 0.60-0.89); incorrectly placing children in cars (OR 0.73, 95% CI 0.57-0.93); and allowing children to ride bicycles, electric bicycles, or motorcycles unsupervised (OR 0.80, 95% CI 0.64-0.99). The intervention also improved scores on three safety-focused behaviors: testing water temperature before giving children a bath (OR 1.26, 95% CI 1.05-1.52); properly storing sharp objects (OR 1.24, 95% CI 1.01-1.52); and safely storing medicines, detergents, and pesticides (OR 1.24, 95% CI 1.02-1.51). CONCLUSIONS The app-based intervention did not reduce unintentional injury incidence among preschoolers but significantly improved caregivers’ safety behaviors. This app-based intervention approach to improve caregiver behaviors surrounding child injury risk offers promise to be modified and ultimately disseminated broadly. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 (Archived by WebCite at http://www.webcitation.org/75jt17X84) INTERNATIONAL REGISTERED REPOR RR2-10.1186/s12889-018-5790-1

Summary Background Sustainable Development Goal (SDG) 3.6 is to halve the number of global deaths and injuries from road traffic accidents by 2020. We aimed to investigate progress in reducing mortality rates from road traffic injury in China from 2006 to 2016. Methods We obtained data from national disease surveillance points. Crude and age-standardised mortality were calculated, with SEs. Joinpoint regression analysis was used to examine and quantify trends in overall and subgroup road traffic mortality from 2006 to 2016. Subgroup analyses were done by place (urban and rural), sex, age group, geographical location (province), and road user, and by type of vehicle for motor vehicle occupant deaths. Findings In 2016 in China, crude road traffic mortality was 11·0 (SE 0·11) deaths per 100 000 population. Overall age-adjusted road traffic mortality increased from 12·6 (SE 0·03) deaths per 100 000 population in 2006 to 15·5 (0·03) deaths per 100 000 population in 2011 then decreased to 10·4 (0·03) deaths per 100 000 population in 2016. Subgroup mortality rates generally followed similar trends. Males, older adults, and rural areas consistently had higher road traffic mortality rates than did females, younger people, and urban areas. Mortality changes varied across urban and rural areas and by sex, age group, and province between 2006 and 2016, revealing large urban–rural and provincial disparities and highlighting pedestrians as the most vulnerable road users. Deaths among occupants of cars and three-wheeled motor vehicles constituted 48% and 20%, respectively, of total occupant mortality from road traffic accidents between 2006 and 2016. Interpretation Despite a substantial decrease in road traffic mortality since 2011, the SDG target to halve deaths and injuries from road traffic accidents by 2020 is unlikely to be reached in China. Systematic and sustainable efforts are needed to accelerate progress in road traffic safety in China. Funding National Natural Science Foundation of China.

Improper, unprofessional, or misleading media reports about violence against medical care providers (typically doctors and nurses) may provoke copycat incidents. To examine whether media reports about violence against medical care providers in China follow professional journalism recommendations, we identified 10 influential incidents of violence against medical care providers in China through a systematic strategy and used standardized internet-based search techniques to retrieve media reports about these events from 2007–2017. Reports were evaluated independently by trained coders to assess adherence to professional journalism recommendations using a 14-item checklist. In total, 788 eligible media reports were considered. Of those, 50.5% and 47.3%, respectively, failed to mention the real and complete names of the writer and editor. Reports improperly mentioned specific details about the time, place, methods, and perpetrators of violence in 42.1%, 36.4%, 45.4%, and 54.6% of cases, respectively. Over 80% of reports excluded a suggestion to seek help from professional agencies or mediation by a third party and only 3.8% of reports mentioned the perspectives of all three key informants about an event: medical care providers, patients, and hospital administrators. Of those that mentioned medical care providers, patient, and/or hospital administrator perspectives, less than 20% indicated they had obtained the interviewee’s consent to include their perspective. We concluded that most reports about violence against medical care providers in the Chinese media failed to strictly follow reporting recommendations from authoritative media bodies. Efforts are recommended to improve adherence to professional guidelines in media reports about violence against medical care providers in China, as adherence to those guidelines is likely to reduce future violent events against medical care providers like doctors and nurses.

BACKGROUND: Injury morbidity data are collected through hospital-based surveillance in many countries. We assessed the extent of non-fatal injures treated outside a hospital. METHODS: Data from the first provincial health household interview survey of Hunan, China, conducted in 2013, were used. Injury events were identified and included as medically significant when any of the following circumstances occurred in the prior 14 days: (i) receiving medical treatment from a doctor at a hospital following an injury; (ii) receiving medical treatment by self or others outside a hospital following an injury (e.g. taking medications, or receiving massage or hot compress); and/or (iii) being off work or school, or in bed for more than 1 day, following an injury. The 2-week prevalence of non-fatal injuries and 95% confidence intervals were calculated. We calculated the proportion of injury events treated outside a hospital and the reasons for not visiting a hospital for injury events occurring during the previous 2 weeks. RESULTS: We captured 56 injury events during the previous 2 weeks. The weighted injury prevalence was 4.9 per 1000 persons during the last 2 weeks (95% confidence interval: 2.9-6.9 per 1000 persons). Of the 56 events, 14 (weighted proportion 41.2%) were treated outside a hospital. Primary explanations for skipping hospital visits included perceiving injuries were too minor and economic limitations to travel to hospitals or seek treatment. CONCLUSION: Results imply the burden of non-fatal injury may be underestimated by hospital-based surveillance systems such as that used in China.© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. Language: en

Objective To assess reporting change for unintentional injury mortality data for Americans aged 65+from 1999 to 2016 and quantify its contribution to reported underlying cause of death (UCD)-based mortality. Methods Using data from the US. Center for Disease Control and Prevention WONDER online databases, we developed a simple model to estimate injury mortality attributed to data reporting changes in cause specificity and selection of UCD from multiple cause of death (MCD) during 1999–2016. Findings From 1999 through 2016, the proportion of MCD-based cause-specific unintentional injury mortality increased from 74% to 85%; proportions of UCD/MCD mortality for overall and cause-specific unintentional injury rose substantially in all specific causes except motor vehicle crashes. Age-adjusted UCD-based mortality attributed to data reporting changes increased gradually and distinctly between 1999 and 2016; the increase for overall unintentional injury, falls, motor vehicle crashes, suffocation, poisoning, and fire/burn was 24.2, 13.5, 2.1, 2.3, 1.6 and 0.4 per 1 00 000 persons, respectively. Percent change in mortality between 1999 and 2016 differed greatly between reported and adjusted UCD-based mortality – overall unintentional injury, 18% vs −10%; falls, 113% vs 63%; motor vehicle crashes, −35% vs −44%; suffocation, −18% vs −48%; poisoning, 134% vs 64%; fire/burn, −32% vs −42%. Conclusion Data reporting changes have affected reported UCD-based overall and cause-specific unintentional injury mortality for older Americans and altered their trends from 1999 to 2016. Data reporting changes should be considered in interpreting change in overall and specific unintentional injury mortality over time for older Americans.