Aim: The purpose of this qualitative study was to investigate the effects experienced by users of a novel psychoactive substance, the benzodiazepine flubromazolam, by analysing users' own accounts on the Swedish forum Flashback.org. Method: A thematic analysis of anonymous self-reports published on the forum was performed and generated five general themes describing effects and experiences by flubromazolam users. Results: The themes which emerged were: Onset and duration, Desired effects, Adverse effects and addiction, Loss of control, General estimations and evaluations. The main reported characteristics of flubromazolam were heavy hypnotic and sedative effects, long-lasting amnesiac effects and the rapid development of tolerance. Flubromazolam was also anxiolytic and acted as a muscle relaxant for many users. Some users experienced euphoria or intense wellbeing. Other prominent characteristics were loss of control (leading to poor choices and actions, with unpleasant consequences) and long-lasting, often severe withdrawals. There were also serious incidents where users had been admitted to hospital, acute psychiatric treatment or taken into custody by the police. Conclusion: Flubromazolam appears to be a highly addictive and precarious benzodiazepine with many, possibly severe, side effects. The substance is generally described as very potent and with long-lasting effects. Memory loss and loss of control are common adverse effects, and withdrawals appear to be severe for many users

Med sina färre än 2.6 dödade/100,000 invånare är Sverige världsledande inom vägtrafiksäkerhet. Sverige har, genom riksdagens antagande av Nollvisionen år 1997, tydligt bundit sig för ett ambitiöst och framåtsträvande inriktat trafiksäkerhetsarbete (Trafikanalys 2015). Nollvisionen är inte bara ett långsiktigt mål som innebär att antalet dödade och allvarligt skadade till följd av trafikolyckor på sikt ska elimineras, utan även ett förhållningssätt angående hur trafiksäkerheten ska ökas. Nollvisionen skiljer sig i förhållande till ett mer traditionell trafiksäkerhetsarbete bland annat i sin holistiska systemsyn på trafiksäkerhetsproblemet, där samhället, industrin och akademin i samverkan spelar en väsentlig roll i möjligheten att åstadkomma långsiktigt hållbara förbättringar.

Injuries have emerged as one of the biggest public health issues of the 21th century. Yet, the causal effects of injury control strategies are often questioned due to a lack of randomized experiments. In this thesis, a set of quasi-experimental methods are applied and discussed in the light of causal inference theory and the type of data commonly available in injury surveillance systems. I begin by defining the interrupted time series design as a special case of the regression-discontinuity design, and the method is applied to two empirical cases. The first is a ban on the sale and production of non-reduced ignition propensity (RIP) cigarettes, and the second is a tightening of the licensing rules for mopeds. A two-way fixed effects model is then applied to a case with time-varying starting dates, attempting to identify the causal effects of municipality-provided home help services for the elderly. Lastly, the effect of the Swedish bicycle helmet law is evaluated using the comparative interrupted time series and synthetic control methods. The results from the empirical studies suggest that the stricter licensing rules and the bicycle helmet law were effective in reducing injury rates, while the home help services and RIP cigarette interventions have had limited or no impact on safety as measured by fatalities and hospital admissions. I conclude that identification of the impact of injury control interventions is possible using low cost means. However, the ability to infer causality varies greatly by empirical case and method, which highlights the important role of causal inference theory in applied intervention research. While existing methods can be used with data from injury surveillance systems, additional improvements and development of new estimators specifically tailored for injury data will likely further enhance the ability to draw causal conclusions in natural settings. Implications for future research and recommendations for practice are also discussed.

Introduction This paper discusses the application of the synthetic control method to injury-related interventions using aggregate data from public information systems. The method selects and determines the optimal control unit in the data by minimising the difference between the pre-intervention outcomes in one treated unit (eg, a state) and a weighted combination of potential control units. Method I demonstrate the synthetic control method by an application to Florida's post-2010 policy and law enforcement initiatives aimed at bringing down opioid overdose deaths. Using opioid-related mortality data for a panel of 46 states observed from 1999 to 2015, the analysis suggests that a weighted combination of Maine (46.1%), Pennsylvania (34.4%), Nevada (5.4%), Washington (5.3%), West Virginia (4.3%) and Oklahoma (3.4%) best predicts the preintervention trajectory of opioid-related deaths in Florida between 1999 and 2009. Model specification and placebo tests, as well as an iterative leave-k-out sensitivity analysis are used as falsification tests. Results The results indicate that the policies have decreased the incidence of opioid-related deaths in Florida by roughly 40% (or -6.19 deaths per 100.000 person-years) by 2015 compared with the evolution projected by the synthetic control unit. Sensitivity analyses yield an average estimate of -4.55 deaths per 100.000 person-years (2.5th percentile: -1.24, 97.5th percentile: -7.92). The estimated cumulative effect in terms of deaths prevented in the postperiod is 3705 (2.5th percentile: 1302, 97.5th percentile: 6412). Discussion Recommendations for practice, future research and potential pitfalls, especially concerning low-count data, are discussed. Replication codes for Stata are provided.

Traffic-related injuries represent a global public health problem, and contribute largely to mortality and years lived with disability worldwide. Over the course of the last decades, improvements to road traffic safety and injury surveillance systems have resulted in a shift in focus from the prevention of motor vehicle accidents to the control of injury events involving vulnerable road users (VRUs), such as cyclists and moped riders. There have been calls for improvements to the evaluation of safety interventions due to methodological problems associated with the most commonly used study designs. The purpose of this licentiate thesis was to assess the strengths and limitations of the interrupted time series (ITS) design, which has gained some attention for its ability to provide valid effect estimates. Two national road safety interventions involving VRUs were selected as cases: the Swedish bicycle helmet law for children under the age 15, and the tightening of licensing rules for Class 1 mopeds. The empirical results suggest that both interventions were effective in improving the safety of VRUs. Unless other concurrent events affect the treatment population at the exact time of intervention, the effect estimates should be internally valid. One of the main limitations of the study design is the inability to identify why the interventions were successful, especially if they are complex and multifaceted. A lack of reliable exposure data can also pose a further threat to studies of interventions involving VRUs if the intervention can affect the exposure itself. It may also be difficult to generalize the exact effect estimates to other regions and populations. Future studies should consider the use of the ITS design to enhance the internal validity of before-after measurements.

This study aimed to evaluate and quantify the effect of the introduction of the AM driving license on non-fatal moped-related injuries in Sweden. With the introduction of the new license category in October 2009, prospective moped drivers are now required to pass a mandatory theory test following a practical and theoretical course. In addition, obtaining a license to operate a moped is now considerably more costly.

METHODS:Time series intervention analysis on monthly aggregated injury data (1st Jan 2007-31st Dec 2013) was performed using generalized additive models for location, shape and scale (GAMLSS) to quantify the effect size on injury events involving teenage (15-17 years) moped drivers, while controlling for trend and seasonality. Exposure was adjusted for by using the number of registered mopeds in traffic as a proxy.

RESULTS:The introduction of AM license was associated with a 41% reduction in the rate of injury events involving 15-year-old moped drivers (IRR 0.59 [95% CI: 0.48-0.72]), and a 39% and 36% decrease in those involving 16-year-old (IRR 0.61 [95% CI: 0.48-0.79]) and 17-year-old drivers (IRR 0.64 [95% CI: 0.46-0.90]), respectively. The effect in the 15-year-old stratum was decreased roughly by half after adjusting for exposure, but remained significant, and the corresponding estimates in the other age groups did not change noticeably.

CONCLUSIONS:This study provides quasi-experimental evidence of an effect on non-fatal moped-related injuries as a result of stricter licensing rules. Only part of the effect could be explained by a reduction in the number of mopeds in traffic, indicating that other mechanisms must be studied to fully understand the cause of the reduction in injuries.

Cyklismen får en allt viktigare roll i det hållbara transportsystemet. Att cykla förespråkas av hälso-, miljö- och framkomlighetsskäl, men är samtidigt ett av de farligaste färdsätten utifrån ett personskadeperspektiv. Lokala strävanden mot ökat cyklande måste ta säkerhetsaspekten i beaktande om dessa satsningar ska bli lyckade. Enligt målet för trafiksäkerhet i regeringens proposition "Mål för framtida transporter" (prop.2008/09:93) ska antalet döda halveras och allvarligt skadade i trafiken minskas 25 procent fram till år 2020. För att kunna uppnå detta behövs satsningar både nationellt som lokalt. På nationell nivå finns möjlighet att arbeta med övergripande och generaliserbara trafiksäkerhetsproblem, medan det på lokal nivå finns unika möjligheter att identifiera och åtgärda olycksdrabbade platser.

I SKL:s trafiksäkerhetshandbok "Trafiksäkra staden

" (Sveriges Kommuner och Landsting 2013), presenteras ett systematiskt sätt att arbeta med trafikskadedata på kommunnivå. Utgångspunkten i handboken är att analysera den lokala skadebilden och sätta igång en systematisk process med verksamhetsövergripande samarbete och kontinuerlig förbättring. Den nu föreliggande vägledningen är tänkt att fungera som ett komplement till SKL:s metodhandbok, med fokus på identifiering och analys av särskilt skadedrabbade platser i lokalsamhället.

Denna vägledning är tänkt att utgöra ett stöd för det lokala cykelsäkerhetsarbetet mot bakgrund av i lokala förutsättningar och problem. Utgångspunkten är att ta tillvara faktaunderlag som ofta finns tillgängliga lokalt, i kombination med annan lokal kunskap. Dessa underlag kan sedan nyttiggöras vid beslut om utformning av trafikmiljöer. Genom att systematiskt studera och sammanställa uppgifter om olyckor finns möjlighet att hitta typiska olycksmönster eller farliga platser inom en avgränsad befolkning eller geografiskt område. Denna kunskap kan sedan användas vid planering av nya trafikmiljöer, som underlag för löpande trafiksäkerhetsarbete i befintliga miljöer, samt vid utvärdering av satsningar syftande till ökad säkerhet.

Background Fall-related injuries are a global public health problem, especially in elderly populations. In this study, the effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention, which involves home hazards reduction by providing a minor home help service, is provided in the majority of Swedish municipalities.

Methods Intention-to-treat effect estimates were derived using quasi-experimental time series intervention (ITS) analysis for immediate effects and a difference-in-discontinuity (RD) design for long term effects, and community-level estimates were pooled using meta-analysis. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).

Results We found no statistically significant reductions in injury incidence in the ITS (IRR 1.01 [95% CI: 0.98–1.05]) or RD (IRR 1.00 [95% CI: 0.97–1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.

Conclusions It is unclear whether absence of an effect is due to a low efficacy of the home hazards modifications provided, or a result of low utilisation. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help services

Background

Fall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities.   

Methods

A quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression-discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).

Results

We found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 [95% CI: 0.98-1.05]) or RD (IRR 1.00 [95% CI: 0.97-1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.

Conclusions

It is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programs.

We study the effects of a studded footwear subsidy program in Gothenburg, Sweden, where a free pair of anti-slip devices was distributed to all residents aged over 65 years as a pedestrian falls prevention measure. Using a difference-in-differences approach with internal age-based controls, we find evidence of a short-term effect on emergency department visits due to slips on snow and ice during the first year of the intervention ( -45% [95% CI: - 54, - 9] in 2013), which equates to 21.8 injuries prevented (95% CI: 3.34, 39.4). A cost-benefit analysis based on this result suggests that the short-term benefits outweigh the total costs of the intervention (benefit-cost ratio: 6.9 [95% CI: 1.05-12.46]), indicating that this type of subsidy program may be an important tool for the prevention of pedestrian falls among older adults during icy weather conditions. However, replication at other sites is recommended before drawing any strong and general conclusions.

Background: Slipping on snow or ice poses a significant health risk among older adults in Sweden. To combat this problem, about 80 Swedish municipalities have distributed ice cleats to older citizens (65+ years old) over the last decade. This paper details a cost-benefit analysis of such programmes. Materials and methods: We developed a decision-analytical model to estimate the costs and benefits of ice cleat programmes in Swedish municipalities compared with a business-as-usual scenario. The modelled benefits of the programme were based on effect estimates from previous research, data from population and healthcare registers and a survey of attitudes to and actual ice cleat use. The modelled costs of the programme were based on resource use data collected from 34 municipalities with existing ice cleat programmes. We assessed heterogeneity in the potential impact and benefit-to-cost ratios across all Swedish municipalities as a function of the average number of days with snow cover per year. Uncertainty in the cost-benefit results was assessed using deterministic and probabilistic sensitivity analyses. Results: The average benefit-to-cost ratio was 87, ranging from about 40 in low-risk municipalities to 140 in high-risk municipalities, implying that the potential benefits of ice cleat programmes greatly outweigh their costs. Probabilistic and deterministic sensitivity analyses support the robustness of this conclusion to parameter uncertainty and large changes in assumptions about the magnitude of the impact on ice cleat use and injuries. Conclusion: The benefits of distributing ice cleats to older adults appear to outweigh the costs from a Swedish societal perspective.

OBJECTIVE: To estimate the effects of fire safe cigarette laws on fire mortality and cigarette-related fires in the USA.

METHODS: We examined the gradual implementation of the laws to identify their average effects, using difference-in-differences analysis to account for common year effects, time-invariant state effects, state-specific trends and observable time-varying state-level covariates.

RESULTS: We found no statistically significant effects on all-cause fire mortality, residential fire mortality or cigarette-caused fire rates. The estimates for cigarette-caused fire deaths were significant under some specifications, but were not robust to the inclusion of state-specific trends or comparisons to effects on other cause-determined fires.

CONCLUSIONS: Given the mixed state of our results, we conclude that previous claims regarding the effects of fire safe cigarette laws may be premature.

BACKGROUND:Annually, 100 people die as a result of residential fires in Sweden and almost a third of the fatal fires are known to be caused by smoking. In an attempt to reduce the occurrence of these events, reduced ignition propensity (RIP) cigarettes have been developed. They are designed to reduce the risk of fire by preventing the cigarette from burning through the full length when left unattended. In November 2011, a ban was introduced, forbidding the production and sale of all non-RIP cigarettes in all member states of the European Union, including Sweden.

METHODS:Monthly data on all recorded residential fires and associated fatalities in Sweden from January 2000 to December 2013 were analyzed using an interrupted time series design. The effect of the intervention [in relative risk (RR)] was quantified using generalised additive models for location, shape and scale.

RESULTS:There were no statistically significant intervention effects on residential fires (RR 0.95 [95% CI: 0.89-1.01]), fatal residential fires (RR 0.99 [95% CI: 0.80-1.23]), residential fires where smoking was a known cause (RR 1.10 [95% CI: 0.95-1.28]) or fatal residential fires where smoking was a known cause (RR 0.92 [95% CI: 0.63-1.35]).

CONCLUSION:No evidence of an effect of the ban on all non-RIP cigarettes on the risk of residential fires in Sweden was found. The results may not be generalisable to other countries.

The importance of natural disturbances for biodiversity is well-documented in the disturbance ecology literature. Natural disturbances such as fire, wind, and flooding strongly influence ecosystems by creating short and long-term ecological processes. Conservation management of protected areas should consider the importance of natural disturbances since natural shifts in ecosystems are, in a long-term perspective, necessary to maintain high biodiversity. The purpose of this study is to explore how and if natural disturbances are incorporated in the management of Swedish national parks and to identify possible examples of barriers for this incorporation. The design of the study is a multiple comparative case study based on a document study and completed with qualitative interviews. The cases consist of propositions and management plans for 15 Swedish national parks established between 1962 and 2018. The document analysis generated four main categories: historic/future and positive/negative perceptions of natural disturbances. The results indicate that there are positive perceptions concerning the inclusion of disturbance ecology in the management of national parks. However, there are also obstacles and challenges around natural disturbances within Swedish national parks. These obstacles are, in some cases, explained by practical implications such as the closeness to surrounding societies and in others explained by paradoxes such as visitors’ perceptions of national parks and the wilderness. 

En sammanställning och granskning av uppgifter från dödsorsaksregistret. Studien, som omfattar 3 860 drunkningsfall, är utförd av Centrum för personsäkerhet vid Karlstads Universitet.

Fall injuries pose a global and national public health problem. Whilst all elderly are at risk of fall injuries, the risk of injury is 10 times as high amongst elderly living in nursing homes compared to elderly living at home.

An injury occurs when body tissue is subjected to external kinetic energy exceeding the tissue's tolerance. Reducing this energy in order to prevent injuries has been successfully applied in many injury prevention fields though less so within fall injury prevention. However, the idea of ​​a shock-absorbing floor as an energy reducing measure to prevent fall injuries has been suggested in scientific literature since the early 1990s and since then, different floors have been developed and tested. The aim of this licentiate thesis is to investigate the potential fall injury reducing effects of a shock-absorbing flooring in a nursing home, as well as the staff's experience of working in premises with shock-absorbing flooring.

The results show that for women the risk of injury following a fall on the shock-absorbing flooring was 59% less compared to falls on ordinary floors, after adjustment for age, BMI, vision impairments, and cognitive impairment. BMI was the only covariate to influence the results, with a lower BMI increasing the risk of injury. With regards to the staff’s experience of the shock-absorbing flooring, the nurses felt that the floor defused the falls and in that way reduced the risk of injury. They were also positively surprised by the change in acoustics. There were also some challenges associated with the floor, for example, adapting to walking on the floor and manoeuvring equipment (eg hoists).

The results suggest, that for an elderly and frail population, shock-absorbing flooring seems to be an effective injury prevention measure. The intervention was generally perceived as positive by the staff, even though some negative aspects were observed. These aspects need to be studied further.

Background (1): In the wake of COVID-19, elderly people have been labelled a risk group.As the pandemic is a new crisis in Sweden, we have no knowledge on how this group perceives theinformation and recommendations being provided. Complying with these recommendations entailsphysical distancing and, for some, isolation at home. Methods (2): From 16 April to 15 May 2020, weconducted an online survey targeting people aged 70 and older in Sweden (n = 1854). Results (3):A vast majority of the participants find the information and recommendations clear and reliable.Half of the participants report staying at home all the time, and up to half report decreased mentalhealth in terms of, e.g., feeling depressed, having sleeping problems and that isolation makes them feelbad. However, elderly people are not a homogenous group, and there are gender and demographicdierences. (4) Conclusion: At this point, we do not know the full extent of the ongoing pandemic,either in terms of duration or in terms of losses. The Swedish model for action on COVID-19 has notincluded a lock down. However, elderly people seem to comply with recommendations and practicesocial distancing to a high degree. This might lead to decreased mental health and long-term eects.

Sammanfattning

Att cykla är hälsosamt och miljövänligt, men tyvärr också ganska farligt. Även om forskning tyder på att hälsovinsterna överstiger skaderiskerna, krävs åtgärder för att minska de cykelrelaterade skadorna i samhället.

Genom att studera och sammanställa uppgifter om olyckor som hänt finns möjlighet att hitta utsatta grupper, typiska olycksmönster eller farliga platser inom en avgränsad befolkning eller geografiskt område. Denna statistikrapport använder sig av data som insamlats av hälso- och sjukvården och polisen i Värmland inom datasystemet STRADA (Swedish Traffic Accident Data Acquisition) kring cykelskadade i Karlstads kommun mellan 2007 och 2011. Mellan dessa år skadade sig 857 cyklister så pass allvarlig att de var tvungna att uppsöka akutmottagningen på Centralsjukhuset i Karlstad.

Cykelskador inträffar oftare under sommarhalvåret, mellan klockan 14.00 och 21.00 samt på fredagar. Män är något mer representerade i hela skadebilden och åldrarna 10-14 och 40-65 år är överrepresenterade.

Trots lagliga krav var det en stor andel av 10-14 åringarna som inte bar hjälm vid skadetillfället (flickor; 60 procent och pojkar; 45 procent).

Geografiskt följer cykelolyckorna i Karlstads kommun befolkningstätheten i stora drag, men särskilda kluster kan identifieras på vissa platser och sträckor som därmed framstår som särskilt olycksdrabbade. Bland annat syns anhopningar av olyckshändelser kring ett antal broar och tunnlar och på dessa platser behöver djupare olycksanalyser genomföras. Rapporten ger också exempel på hur statistiken kan användas för att utvärdera gjorda trafiksäkerhetsförbättringar.

BACKGROUND:Fall-related injuries affect the lives of elderly to a substantial degree. This quasi-experimental study investigates the fall-injury reducing effect of impact absorbing flooring among female nursing home residents.

METHODS:The intervention site is a nursing home in Sweden where impact absorbing flooring was installed in parts of one of six wards (six out of 10 apartments (excluding bathrooms), the communal dining-room and parts of the corridor). The impact absorbing flooring is a 12 mm thick closed cell flexible polyurethane/polyurea composite tile (500×500 mm) with an exterior surface of polyurethane/polyurea. A generalised linear model (log-binomial) was used to calculate the RR of injury from falls on impact absorbing flooring compared to falls on regular flooring, adjusted for age, body mass index, visual and cognitive impairments.

RESULTS:During the study period (1 October 2011 to 31 March 2014), 254 falls occurred on regular flooring and 77 falls on impact absorbing flooring. The injury/fall rate was 30.3% for falls on regular flooring and 16.9% for falls on impact absorbing flooring. Adjusted for covariates, the impact absorbing flooring significantly reduced the RR of injury in the event of a fall by 59% (RR 0.41 (95% Cl 0.20 to 0.80)).

CONCLUSIONS:This is, to our knowledge, the first study evaluating the injury-reducing effect of impact absorbing flooring in a nursing home showing statistically significant effect. The results from this study are promising, indicating the considerable potential of impact absorbing flooring as a fall-related injury intervention among frail elderly.

Background

Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting.

Methods

The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring.

Results

The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46–1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25–0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50–0.80).

Conclusion

The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.

Background. Falls are the most common cause of injury in all ages and are especiallydifficult to prevent among residential care residents. Compliant flooring has beenproposed as a measure to prevent fall-injury, however little is known regarding theimplementation aspects in clinical settings. The aim of this study was to explore thefrail elderly person's view on falls, the risk of fall-injury, prevention in general andspecifically compliant flooring as an injury preventative measure. Methods. In this qualitative study, we used the grounded theory method and conductedin depths interviews with eight elderly people in residential care.Results. The identified categories were Falling as a part of life, Fearing theconsequences and A wish to prevent falls and injuries. Through the results is was clearthat There is more to life than risk avoidance, permeated the interviews, thereforeforming the grounded theory. The interviewees viewed falls as something common andnormal, and were uninterested in focusing on the risk of falls. Although they wanted toprevent falls, it was often difficult to integrate preventative measures into their everydaylife. They embraced the idea of an injury reducing compliant flooring, but their maininterests lie elsewhere.Conclusions. The results in this paper propose explanations on the obstacles ofimplementing fall prevention measures in an elderly frail population. The findings cangive us insights as to why interest, compliance for active fall prevention measures arelow, and on various factors that have to be taken under consideration in the process ofconstructing prevention. Compliant flooring is a passive fall injury prevention measurethat does not require the target group to make active decisions, adapt or activelyparticipate in the program. Therefore, we conclude that complaint flooring, from theperspective of the residents, can work well in residential care.

Introduction

Walking as a means of transportation can enforce a more active lifestyle and constitutes an environmentally friendly option to motor vehicles. However, in Northern countries, ice and snow tend to increase the risk of fall injuries among pedestrians during the winter. Therefore, the use of anti-slip devices, such as ice cleats or “studded footwear”, has been suggested as a viable intervention in promoting an active lifestyle whilst reducing injury risk. We investigate the usage of anti-slip devices, focusing on people 50 years and above living in Sweden.

Method

We used nationally representative survey data for men and women aged 18–79 years and residing in Sweden (n = 23,168), focusing primarily on middle-aged to older adults (50+ years). We used logistic regression to identify predictors of use.

Results

Overall, our estimates suggest that 28.5 (95% CI: 27.0, 29.2) percent of the Swedish population use anti-slip devices during snowy and slippery road conditions, with usage rates increasing strongly with age (from roughly 10 percent at 20 years to 60 percent at 79 years). In addition, the results show that being female, experiencing a fear of falling, living in a municipality with a high number of snow days, and using other types of personal safety equipment increases the probability of being an anti-slip device user.

Conclusions

Our results imply that people at risk for outdoor fall injuries are high users. Even so, the number of pedestrian injuries due to slipping on snow and ice are still substantial and there are a several potential target groups for future intervention. More research is needed to determine if the devices are used correctly, and to determine the barriers to anti-slip device use in low-use populations.

I samband med införandet av nuvarande lag (2003:778) om skydd mot olyckor (LSO) instiftades samtidigt kravet på en skriftlig redogörelse av brandskydd (Regeringens proposition, 2002/03:119). Kravet gäller för verksamheter där konsekvenser av en brand kan bli särskilt stora. Lagstiftarens intention var att den skriftliga redogörelsen skulle fungera som ett underlag för kommunens tillsyn över den enskildes (ägare och nyttjanderättshavare) brandskydd. Redogörelsen var även tänkt att tydliggöra den enskildes ansvar för brandskyddet. LSO har genom åren följts upp och det har kommit indikationer på att redogörelsen inte till fullo fyller den funktion som lagstiftaren avsåg. I denna studie undersöks hur redogörelsen används idag i förhållande till dess intention. Studien inkluderar även hur det systematiska brandskyddsarbetet (SBA) bedrivs i praktiken, med förskolor som exempel, samt vilken inverkan redogörelsen haft på SBA.För att besvara syftet har en enkät skickats ut till landets samtliga räddningstjänster och den enskildes synpunkter har fångats med hjälp av intervjuer med två fastighetsägare och 12 förskolechefer.Resultatet visar att två tredjedelar av landets räddningstjänster använder redogörelsen. Trots det, finns delade meningar om redogörelsens funktion för tillsynsverksamheten och många menar att nyttan är högst begränsad. Det beror främst på att räddningstjänsten upplever att informationen i redogörelsen inte är av det slag som behövs eller att den inte är tillförlitlig. Redogörelsen är svårbegriplig för den enskilde att fylla i vilket leder till att den enskilde antingen inte skickar in redogörelsen eller att inkommande redogörelser inte är tillförlitliga. Problematiken förstärks ytterligare av att räddningstjänsterna ofta upplever att den arbetsinsats som krävs för att hantera och bearbeta inkomna redogörelser är allt för betungande.I Regeringens proposition (2002/03:119) var tanken att redogörelsen inte skulle bli onödigt betungande. De innehållsmässiga kraven på dokumentationen skulle begränsas till de för brandskyddet mest väsentliga och den enskilde skulle få praktiska verktyg till stöd för att förstå brandskyddet. Dessa delar har inte genomförts, vilket innebär ett problem då de anses viktiga för att redogörelsen ska fungera likt dess intention. Däremot skulle en systematisk återkoppling kunna tydliggöra ansvaret. Det är en viktig pusselbit i den enskildes SBA och oavsett nivå. Problemet idag är att återkopplingen sker sporadiskt vid tillsyn, vilket är ett betungande och delvis ineffektivt arbetssätt.Den enskilde behöver ökade kunskaper samt förståelse för varför SBA ska bedrivas. Den måste förstå vikten och innebörden med SBA, annars är sannolikheten stor att de visserligen uppfyller lagen men att arbetet inte blir gjort i praktiken. Räddningstjänsten tycker att MSB bör peka ut vilka delar för SBA som ska betraktas som kritiska, dvs. hur brandskyddet ska prioriteras. De menar även att tydligare krav bör riktas mot SBA i sin helhet och inte enbart mot det tekniska systemet.

Genom en litteraturstudie identifierades ett flertal olika metoder som kan användas för att uppskatta, mäta och modellera oskyddade trafikanters rörelsemönster. En utvärdering och jämförelse av metodernas pålitlighet och lämplighet för framtida implementering i Sverige är dock svår i dagsläget på grund av stora skillnader i studiernas ansatser. Framtida metoder kommer med stor sannolikhet förlita sig på individers mobila rörelsedata, insamlade med smart teknologi genom applikationer, platsbaserade tjänster och spårning genom rumsliga nätverk såsom telekommunikationsnätverk, globala navigationssystem eller Bluetooth.Syftet med denna studie var att genom en litteraturstudie kartlägga olika tekniker och metoder som kan användas för uppskattning av oskyddade trafikanters exponering och rörelsemönster för användning vid riskkartering och andra spatiala riskanalyser. Vi genomförde två delstudier: (i) en internationell kartläggning av hur tidigare forskning som använt sig av geografiska analyser har kvantifierat exponering och rörelsemönster bland fotgängare och cyklister, och (ii) en litteraturgranskning av nya metoder för att mäta exponering.Den internationella litteraturgranskningen visade att man enbart i ett fåtal studier använt sig av faktiska exponeringsdata i studier av geografiska skademönster bland oskyddade trafikanter. De flesta metoder som bygger på direkt uppskattning av trafikanter i rörelse (t.ex. genom att räkna cyklister) kan vara svåra att generalisera eftersom detta vanligtvis görs på specifika platser eller under vissa tider och på ett icke-heltäckande sätt över vägnätet. Att använda sig av resedatamodeller för att uppskatta exponering på vägsegmentnivå kan vara ett genomförbart tillvägagångssätt, vilket framgår av flera studier som analyserats. De vanligaste uppskattningsmetoderna som används i Sverige idag är flödesmätningar och resvaneundersökningar. Internationellt har flera studier utförts med flera andra metoder som kan vara intressanta även för implementering i Sverige. Främst bland dem är analyser på data från lånecyklar och GPS-data från crowdsourcing med mobilapplikationer. Betydligt fler studier kunde identifieras som rör uppskattning av cyklister än fotgängare. Resvaneundersökningar är ett bra alternativ för att undersöka generella trender över tid. Dock saknas rumslig noggrannhet och det är svårt att kartlägga resandet i en stad endast baserat på resvaneundersökningar. Genom att kombinera data från resvaneundersökningar med befolkningsstatistik kan enkla sketchplaneringar genomföras. Ofta görs dessa modeller med enkla och lättåtkomliga data vilket gör att metoderna är lätta att genomföra och billiga. Det finns en mängd olika tekniker för att implementera flödesmätningar på oskyddade trafikanter i praktiken. Tekniskt sett är det genomförbart att applicera stickprovsmodeller på liknande vis vad som görs i vägnätet för fordonstrafik. En bra uppskattning för resmönstret hos trafikanterna kräver dock många mätningar, detta medför kostnader i form av både utrustning och arbetstid. I nuläget sker förmodligen för få flödesmätningar i de flesta svenska städer, speciellt mätningar av gångtrafikanter för att kunna applicera en sådan metod med ett acceptabelt resultat. Flödesmätningar kan dock användas i kombination med andra metoder för att bekräfta deras resultat. Flödesmätningar är förmodligen den effektivaste metoden för att kontrollera resmönster på små geografiska områden. En känslig fråga som begränsar användning av spårningsteknik idag genom nätverkstriangulering, Bluetooth eller mobila applikationer är personlig integritet. Utöver detta är det en högre risk att sårbara delar av befolkningen (t.ex. barn och äldre) exkluderas av automatisk spårning då dessa individer med större sannolikhet inte medför smart teknisk utrustning. Ändå anses denna teknik mycket framtidsorienterad, effektiv, billig och pålitlig, speciellt när lokaliseringsenheter börjar prata med varandra, när mängden insamlade data och dess tillgänglighet ökar och om dagens begränsningar gällande personlig integritet och lagstiftning förändras.

Denna rapport, som redovisar del 2 av projektet Social sårbarhet för klimatrelaterade hot, syftar till att ta fram ett generellt sårbarhetsindex för Sverige, men också specifika index för tre olika naturhot: översvämning (älv respektive kust), skogsbrand och ras/skred/erosion. För dessa specifika index har sårbarheten kombinerats med en bedömd exponering för de tre olika hoten. Analysen är gjord på kommun- och RegSO-nivå.

As in most low-income countries, there is a lack of scientific information on the incidence and pattern of child maltreatment (CM) in Bangladesh. However, the role of the media to disclose CM and to develop public awareness in society is noteworthy. The present study assessed newspaper reports about CM by type and socio-demographics of victims and perpetrators in Bangladesh. In total, 790 news articles were collected retrospectively from four Bengali- and two English-language newspapers from October to December 2014. Among all reported incidents, almost half of the CM cases concerned alleged physical abuse (26%) and sexual abuse (22%). Neglect and emotional or psychological abuse received less coverage. Female children were to a high degree (90%) victims of sexual abuse. The main perpetrators were males, and they were often known to the victims. Approximately 32 per cent of the reported abuse cases resulted in death and were related to rape, family violence, administrative negligence, abduction and ransom demand. Some of these deaths were suicides. News stories concerning CM were often reported in an unethical way by identifying the victim and not respecting child rights. Further, the stories seldom discussed the individual or social consequences of CM, or how maltreatment could be prevented. 'The present study assessed newspaper reports about CM by type and socio-demographics of victims and perpetrators in Bangladesh' Key Practitioner Messages The main types of reported cases of CM in Bangladeshi print media are physical abuse and sexual abuse, and there is a high proportion of fatal consequences. The perpetrators are often known to the victims. The identity of the victim is frequently reported, potentially putting the child at risk and violating child rights. Bangladeshi print media seldom discusses individual or societal consequences of CM, or how it could be prevented.

Introduction: Injuries due to accidents are an underlying cause for a large proportion of the number of health care visits in Sweden every year. According to statistics from the National Board of Health and Welfare in Sweden (socialstyrelsen.se) between 1308,25 and 1405,66 health care visits per 100.000 residents are generated each year for the period 2001-2014 due to accidents, and falling is the largest underlying category. Falling can in turn be studied through a number of subcategories, where fall from equipment on playground is one of them, and this is the subcategory studied in this paper. Statistics from the National Board of Health and Welfare show an increase of the number of health care visits per 100.000 residents in Sweden due to this category during the period 2001-2014, despite the fact that since 1999 there are European standards with the purpose of raising the safety of playgrounds. The statistics also show that in Sweden there are large regional differences in injury prevalence for this category of accidents, which is the reason why this became the focus of this study.

One of the reasons this is an important area for injury prevention work is that it’s a shared societal responsibility, another reason is that the studied population has the largest statistical life expectancy left, so injuries that affect their health can also affect the future wellbeing of the society.  The municipalities’ work regarding this area is dictated by European Standards to ensure the safety of playgrounds. Beyond the specifications for the equipment itself, the standards dictate that a series of inspections of varying degrees are preformed throughout the year to ensure the standards are met.

Aim: The aim of this study is to examine if there are any identifiable and differing factors in the way that municipalities work with playgrounds and playground safety, both practically and theoretically, based on if they are located in a region with high injury prevalence or in a region with low injury prevalence of this type of injury.

Method: The study was designed as a qualitative interview study where representatives of 11 different municipalities were interviewed with the purpose to map out how they worked with playgrounds and playground safety within their municipality. The data collected was then analysed using thematically/ phenomenological content analysis to see if any differing factors between the two groups could be detected.

Results: No major unambiguous differences were discovered between the two compared groups included in the study, but certain tendencies could be found in the material. Four themes were uncovered, enabling factors for the practical work, hindering factors for the practical work, enabling factors for the theoretical work and hindering factors for the theoretical work. These themes in turn produce a number of categories and subcategories. The results show a wider range of both hindering and enabling factors of both the practical and theoretical work in the municipalities from regions with high injury prevalence, compared to the municipalities from regions with low injury prevalence.

Conclusion: The result indicates that there are differences in how the municipalities from regions with low injury prevalence work regarding playground safety compared to municipalities from regions with high injury prevalence. However, further research will be required to fully uncover and explore which these factors are.

I denna förstudie undersöks förutsättningarna för en möjlig kommande studie kring restvärdesverksamhetens nytta. Verksamheten har kartlagts, definierats och avgränsats på ett sätt som är tänkt att möjliggöra en vetenskaplig operationalisering. Tidigare forskning tycks saknas vilket gör att studier på området startar från en mycket grund nivå.

Ett spektrum av nyttoposter har identifierats. Dessa tillkommer försäkringsbolagen, men även den skadedrabbade ”kunden” (enskilda, företag eller samhället) samt räddningstjänsten och samhället i övrigt. I rapporten redovisas i vilken grad dessa nyttoposter bedöms möjliga att uppskatta i monetära termer, respektive kan värderas på annat sätt.

Tillgång till relevanta data är en nyckelfråga för ett fortsatt genomförande av en huvudstudie. Tekniska och juridiska hinder kring dataåtkomst fördröjde delar av förstudien, samtidigt som det finns ett värde i att dessa identifierats och delvis överbryggats inom förstudiens ram inför beslut om en huvudstudie.

Förstudien bedöms sammantaget uppfylla behovet av att lägga en grund för fortsatt forskning kring restvärdesverksamhetens nytta. Fyra delstudier föreslås som en fortsättning på arbetet med att belysa olika nyttoposter, såväl kvantitativt som kvalitativt. 

Background: Unintentional injuries are the leading cause of death among adolescents. Adolescents with disabilities may be particularly vulnerable with an increased risk of unintentional injuries. Objective: To study the association between a set of disabilities and unintentional injury risks among adolescents, accounting for comorbidity, subjective disability severity and sex. Method: Cross-sectional data from a Swedish national school survey including 4,741 students (15 and 17-year olds) conducted in 2016 was analyzed using log-binomial generalized linear models. Results: We found a 33% increased risk of injury the last 12 months and a 53% increased risk of injury leading to hospitalization for adolescents with any disability compared to their peers with no disability. The differences in injury risk were greater for girls than boys. There was a dose-response relationship between disability severity and injury risk. In analyses adjusted for sociodemographic factors and comorbidity, attention-deficit/hyperactivity disorder (ADHD) and epilepsy were associated with an increased risk of injury the last 12 months, risk ratios [RR] were 1.41 (95% Confidence Interval [CI] 1.08–2.97) and 1.79 (95% CI 1.10–1.81) respectively. Autism spectrum disorder was associated with a decreased injury risk the last 12 months (RR = 0.43, CI 0.2–0.92). ADHD, mobility impairment and visual impairment were associated with hospitalization due to injury during lifetime. Conclusions: There was an increased risk of unintentional injuries for adolescents with disabilities compared to their non-disabled peers, specifically for individuals with ADHD, epilepsy, visual impairment and mobility impairment. Injury prevention strategies may include adapting the physical environment and medical treatment.

In Sweden, more than 100 people die in fires every year and there is a societal goal of decreasing the risk of fire-related deaths. A goal-orientated prevention approach needs to be credibly underpinned with an understanding of the extent of the problem, its causes and risk factors, aspects that have largely been missing in Sweden. Therefore, the purpose of this thesis was to analyze fatal fires and fatalities in Sweden from an epidemiological perspective. The historical trends show that the risk of dying due to fire has decreased by more than 50% over the last 60 years in Sweden, with the largest decline being seen amongst children. In Sweden today, the risk of young children dying in a fire is very low. However, the risk of dying in fires has not declined to the same extent among elderly. In light of the aging Swedish population, older people must therefore be a priority in future fire protection. To investigate fire fatalities, data from three different national registers were combined. By combining the three sources, it was clear that the present routine statistics systematically underestimate the true situation. In-depth analysis regarding residential fires show that men and elderly are particularly at risk, as well as people living alone, as well as those on low income, social security benefits and health-related early-retirement benefits. The most common cause of fire was smoking and the presence of alcohol among the victims was very common. When combined, the extensive material can be simplified and described by well-defined clusters that each can be meet with relevant preventive efforts. Crucially, however, it is clear that mortality in residential fires is essentially a social problem and improving the protection of the most vulnerable people in society needs to be ascertained through sustained and holistic strategies, consisting of both social and technical measures. To establish and facilitate this, a cross-sectoral approach within municipalities and central government is needed.