Publications by authors named "Suliman Alghnam"

33 Publications

Predictors of Seatbelt Use Among Saudi Adults: Results From the National Biobank Project.

Front Public Health 2020 26;8:579071. Epub 2020 Oct 26.

Saudi Centre for Disease Control and Prevention, Riyadh, Saudi Arabia.

Road traffic crashes (RTCs) are a leading cause of death and disabilities and impose a significant burden on the healthcare system and economy of Saudi Arabia. Around 20% of all hospital beds are occupied by victims of RTCs, which represent approximately 80% of trauma deaths occurring in these facilities. Using a seatbelt is an effective method to reduce traffic deaths and minimize the extent of associated injuries. However, little is currently known about the prevalence and predictors of seatbelt use in Saudi Arabia. More studies are needed to determine the trends of seatbelt use and study the relationship between individual factors and compliance with seatbelt use laws. The aim of the present study is to examine the prevalence and predictors of seatbelt use using the National Saudi Biobank dataset. This cross-sectional study was conducted using an in-person survey from the Saudi National Biobank (SNB). The participants were adults affiliated with the Ministry of National Guard Health Affairs in Riyadh who were examined between 2017 and 2019. Chi-squared and Wald tests were used to assess the association between the respondents' characteristics and their seatbelt use. In addition, logistic regression models were constructed to assess the univariate and multivariate associations between seatbelt use and potential predictors. All statistical tests were two-sided, and the findings were considered significant at < 0.05. A total of 5,790 adults participated in the survey. The majority of the participants (52.44%) were between 18 and 25 years old, half were males, and 58.80% were single. About 42.83% of the participants reported consistent seatbelt use as drivers or passengers. In the multivariable analysis, females were 86% less likely to wear seatbelts than males (OR = 0.136, 95%CI = 0.107-0.173). Individuals who rated their mental health as "weak" were 26% less likely to wear seatbelts than those who reported "excellent" mental health status. Seatbelt use remains low in the country and substantially lower than in developed countries. Young adults, females, and individuals reporting suboptimal mental health were less likely to fasten their seatbelts. These findings are valuable for public health programs to target specific groups and raise awareness about the need to increase seatbelt compliance and reduce traffic injuries.
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http://dx.doi.org/10.3389/fpubh.2020.579071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649265PMC
October 2020

A Mental Health Surveillance System for the General Population During the COVID-19 Pandemic: Protocol for a Multiwave Cross-sectional Survey Study.

JMIR Res Protoc 2020 Nov 26;9(11):e23748. Epub 2020 Nov 26.

Ministry of Health, Riyadh, Saudi Arabia.

Background: The COVID-19 outbreak can potentially be categorized as a traumatic event. Public health surveillance is one of the cornerstones of public health practice, and it empowers decision makers to lead and manage public health crises and programs more effectively by providing timely and useful evidence.

Objective: This paper presents the protocol for a study that aims to identify, track, and monitor trends in the population in Saudi Arabia at risk of major depressive disorders and anxiety during the COVID-19 pandemic.

Methods: This study utilizes continuous, cross-sectional, national-level mental health screening via computer-assisted phone interviews, conducted in four waves on a monthly basis (between May and August 2020). Arabic-speaking adults, aged ≥18 years, and living in Saudi Arabia were recruited via a random phone list. This surveillance system used the proportional quota sampling technique to achieve an equal distribution of participants, stratified by age and gender, and region, within and across the 13 administrative regions of Saudi Arabia. A sample size of 4056 participants per wave was calculated to achieve enough power to detect changes in mental health status. The questionnaire includes the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms and the General Anxiety Disorder-7 (GAD-7) to measure anxiety. In addition, it will collect data on sociodemographic variables and potential risk factors.

Results: Study recruitment began in May 2020. The data analysis was completed in October 2020, and the final report is expected to be published by the end of December 2020.

Conclusions: Monitoring the population's mental health status during the COVID-19 pandemic will inform decision makers of any potential deterioration in mental health on a national level and among subgroups, including across regions, age groups, and gender groups. It will allow decision makers to recognize issues and intervene sooner. It will also provide valuable scientific data to help understand the effects of epidemics and pandemics on mental health. As far as we know, this is the only study that attempts to monitor the mental health status of the general population on a monthly basis.

International Registered Report Identifier (irrid): DERR1-10.2196/23748.
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http://dx.doi.org/10.2196/23748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695540PMC
November 2020

The prevalence of head and facial injuries among children in Saudi Arabia following road traffic crashes.

Ann Saudi Med 2020 Sep-Oct;40(5):417-424. Epub 2020 Oct 1.

From the National Road Safety Center, Ministry of Transport, Riyadh, Saudi Arabia.

Background: Motor vehicle crashes (MVCs) are the leading cause of death among children in Saudi Arabia. Childhood injuries can be prevented or minimized if safety measures, such as car seats, are implemented. The literature on the epidemiology of head and facial injury among children is limited, which affects the ability to understand the extent of the burden and hinders investment in public health prevention.

Objective: Describe the epidemiology of head and facial injuries among children admitted to the hospital following MVCs.

Design: Retrospective chart review.

Setting: Five hospitals in several regions.

Patients And Methods: We collected data on all patients ≤16 years old, who were admitted to the hospital following MVCs between 2016-2019. Differences in various characteristics like head injury status and age groups were compared.

Main Outcome Measures: Head and facial injuries.

Sample Size: 253 patients.

Results: Of the injured population, 97 (38.3%) sustained a head injury, and 88 (34.8%) had a facial injury. Thirteen (9.1%) children were driving the car at the time of the crash. About half of the children were seated in the back (53.8%) without a seatbelt or safety seat.

Conclusion: The prevalence of head and facial injuries is striking. In addition, the study revealed that driving among children is not uncommon, which warrants monitoring and implementing interventions. Improved documentation of restraint use and police enforcement of safety laws can play a significant role in reducing associated injuries. The study findings highlight the importance of combination or rear seating as well as age-appropriate restraint in order to reduce the likelihood of head or facial injuries among children.

Limitations: Retrospective study using the electronic search system to identify patients, but may have missed cases that were not coded correctly. Large amount of missing data for some variables. Additionally, the analysis was limited to those admitted to the hospital.

Conflict Of Interest: None.
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http://dx.doi.org/10.5144/0256-4947.2020.417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532055PMC
October 2020

Fighting pandemics with digital epidemiology.

EClinicalMedicine 2020 Sep 25;26:100512. Epub 2020 Aug 25.

Google Health, Palo Alto, CA, USA.

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http://dx.doi.org/10.1016/j.eclinm.2020.100512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446704PMC
September 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Authors:
Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Nicholas L S Roberts Dillon O Sylte Gregory J Bertolacci Matthew Cunningham Nathaniel J Henry Kate E LeGrand Ahmed Abdelalim Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Aidin Abedi Kedir Hussein Abegaz Akine Eshete Abosetugn Abdelrahman I Abushouk Oladimeji M Adebayo Jose C Adsuar Shailesh M Advani Marcela Agudelo-Botero Tauseef Ahmad Muktar Beshir Ahmed Rushdia Ahmed Miloud Taki Eddine Aichour Fares Alahdab Fahad Mashhour Alanezi Niguse Meles Alema Biresaw Wassihun Alemu Suliman A Alghnam Beriwan Abdulqadir Ali Saqib Ali Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Amir Almasi-Hashiani Nihad A Almasri Khalid Altirkawi Yasser Sami Abdeldayem Amer Catalina Liliana Andrei Alireza Ansari-Moghaddam Carl Abelardo T Antonio Davood Anvari Seth Christopher Yaw Appiah Jalal Arabloo Morteza Arab-Zozani Zohreh Arefi Olatunde Aremu Filippo Ariani Amit Arora Malke Asaad Beatriz Paulina Ayala Quintanilla Getinet Ayano Martin Amogre Ayanore Ghasem Azarian Alaa Badawi Ashish D Badiye Atif Amin Baig Mohan Bairwa Ahad Bakhtiari Arun Balachandran Maciej Banach Srikanta K Banerjee Palash Chandra Banik Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Akbar Barzegar Mohsen Bayati Shahrzad Bazargan-Hejazi Neeraj Bedi Masoud Behzadifar Habte Belete Derrick A Bennett Isabela M Bensenor Kidanemaryam Berhe Akshaya Srikanth Bhagavathula Pankaj Bhardwaj Anusha Ganapati Bhat Krittika Bhattacharyya Zulfiqar A Bhutta Sadia Bibi Ali Bijani Archith Boloor Guilherme Borges Rohan Borschmann Antonio Maria Borzì Soufiane Boufous Dejana Braithwaite Nikolay Ivanovich Briko Traolach Brugha Shyam S Budhathoki Josip Car Rosario Cárdenas Félix Carvalho João Mauricio Castaldelli-Maia Carlos A Castañeda-Orjuela Giulio Castelpietra Ferrán Catalá-López Ester Cerin Joht S Chandan Jens Robert Chapman Vijay Kumar Chattu Soosanna Kumary Chattu Irini Chatziralli Neha Chaudhary Daniel Youngwhan Cho Jee-Young J Choi Mohiuddin Ahsanul Kabir Chowdhury Devasahayam J Christopher Dinh-Toi Chu Flavia M Cicuttini João M Coelho Vera M Costa Saad M A Dahlawi Ahmad Daryani Claudio Alberto Dávila-Cervantes Diego De Leo Feleke Mekonnen Demeke Gebre Teklemariam Demoz Desalegn Getnet Demsie Kebede Deribe Rupak Desai Mostafa Dianati Nasab Diana Dias da Silva Zahra Sadat Dibaji Forooshani Hoa Thi Do Kerrie E Doyle Tim Robert Driscoll Eleonora Dubljanin Bereket Duko Adema Arielle Wilder Eagan Demelash Abewa Elemineh Shaimaa I El-Jaafary Ziad El-Khatib Christian Lycke Ellingsen Maysaa El Sayed Zaki Sharareh Eskandarieh Oghenowede Eyawo Pawan Sirwan Faris Andre Faro Farshad Farzadfar Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Pietro Ferrara Florian Fischer Morenike Oluwatoyin Folayan Artem Alekseevich Fomenkov Masoud Foroutan Joel Msafiri Francis Richard Charles Franklin Takeshi Fukumoto Biniyam Sahiledengle Geberemariyam Hadush Gebremariam Ketema Bizuwork Gebremedhin Leake G Gebremeskel Gebreamlak Gebremedhn Gebremeskel Berhe Gebremichael Getnet Azeze Gedefaw Birhanu Geta Agegnehu Bante Getenet Mansour Ghafourifard Farhad Ghamari Reza Ghanei Gheshlagh Asadollah Gholamian Syed Amir Gilani Tiffany K Gill Amir Hossein Goudarzian Alessandra C Goulart Ayman Grada Michal Grivna Rafael Alves Guimarães Yuming Guo Gaurav Gupta Juanita A Haagsma Brian James Hall Randah R Hamadeh Samer Hamidi Demelash Woldeyohannes Handiso Josep Maria Haro Amir Hasanzadeh Shoaib Hassan Soheil Hassanipour Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Delia Hendrie Fatemeh Heydarpour Martha Híjar Hung Chak Ho Chi Linh Hoang Michael K Hole Ramesh Holla Naznin Hossain Mehdi Hosseinzadeh Sorin Hostiuc Guoqing Hu Segun Emmanuel Ibitoye Olayinka Stephen Ilesanmi Leeberk Raja Inbaraj Seyed Sina Naghibi Irvani M Mofizul Islam Sheikh Mohammed Shariful Islam Rebecca Q Ivers Mohammad Ali Jahani Mihajlo Jakovljevic Farzad Jalilian Sudha Jayaraman Achala Upendra Jayatilleke Ravi Prakash Jha Yetunde O John-Akinola Jost B Jonas Kelly M Jones Nitin Joseph Farahnaz Joukar Jacek Jerzy Jozwiak Suresh Banayya Jungari Mikk Jürisson Ali Kabir Amaha Kahsay Leila R Kalankesh Rohollah Kalhor Teshome Abegaz Kamil Tanuj Kanchan Neeti Kapoor Manoochehr Karami Amir Kasaeian Hagazi Gebremedhin Kassaye Taras Kavetskyy Gbenga A Kayode Peter Njenga Keiyoro Abraham Getachew Kelbore Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ibrahim A Khalil Rovshan Khalilov Maseer Khan Ejaz Ahmad Khan Junaid Khan Tripti Khanna Salman Khazaei Habibolah Khazaie Roba Khundkar Daniel N Kiirithio Young-Eun Kim Yun Jin Kim Daniel Kim Sezer Kisa Adnan Kisa Hamidreza Komaki Shivakumar K M Kondlahalli Ali Koolivand Vladimir Andreevich Korshunov Ai Koyanagi Moritz U G Kraemer Kewal Krishan Barthelemy Kuate Defo Burcu Kucuk Bicer Nuworza Kugbey Nithin Kumar Manasi Kumar Vivek Kumar Narinder Kumar Girikumar Kumaresh Faris Hasan Lami Van C Lansingh Savita Lasrado Arman Latifi Paolo Lauriola Carlo La Vecchia Janet L Leasher Shaun Wen Huey Lee Shanshan Li Xuefeng Liu Alan D Lopez Paulo A Lotufo Ronan A Lyons Daiane Borges Machado Mohammed Madadin Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Venkatesh Maled Deborah Carvalho Malta Navid Manafi Amir Manafi Ana-Laura Manda Narayana Manjunatha Fariborz Mansour-Ghanaei Mohammad Ali Mansournia Joemer C Maravilla Amanda J Mason-Jones Seyedeh Zahra Masoumi Benjamin Ballard Massenburg Pallab K Maulik Man Mohan Mehndiratta Zeleke Aschalew Melketsedik Peter T N Memiah Walter Mendoza Ritesh G Menezes Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Hayimro Edemealem Merie Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Ted R Miller G K Mini Andreea Mirica Erkin M Mirrakhimov Mehdi Mirzaei-Alavijeh Prasanna Mithra Babak Moazen Masoud Moghadaszadeh Efat Mohamadi Yousef Mohammad Aso Mohammad Darwesh Abdollah Mohammadian-Hafshejani Reza Mohammadpourhodki Shafiu Mohammed Jemal Abdu Mohammed Farnam Mohebi Mohammad A Mohseni Bandpei Mariam Molokhia Lorenzo Monasta Yoshan Moodley Masoud Moradi Ghobad Moradi Maziar Moradi-Lakeh Rahmatollah Moradzadeh Lidia Morawska Ilais Moreno Velásquez Shane Douglas Morrison Tilahun Belete Mossie Atalay Goshu Muluneh Kamarul Imran Musa Ghulam Mustafa Mehdi Naderi Ahamarshan Jayaraman Nagarajan Gurudatta Naik Mukhammad David Naimzada Farid Najafi Vinay Nangia Bruno Ramos Nascimento Morteza Naserbakht Vinod Nayak Javad Nazari Duduzile Edith Ndwandwe Ionut Negoi Josephine W Ngunjiri Trang Huyen Nguyen Cuong Tat Nguyen Diep Ngoc Nguyen Huong Lan Thi Nguyen Rajan Nikbakhsh Dina Nur Anggraini Ningrum Chukwudi A Nnaji Richard Ofori-Asenso Felix Akpojene Ogbo Onome Bright Oghenetega In-Hwan Oh Andrew T Olagunju Tinuke O Olagunju Ahmed Omar Bali Obinna E Onwujekwe Heather M Orpana Erika Ota Nikita Otstavnov Stanislav S Otstavnov Mahesh P A Jagadish Rao Padubidri Smita Pakhale Keyvan Pakshir Songhomitra Panda-Jonas Eun-Kee Park Sangram Kishor Patel Ashish Pathak Sanghamitra Pati Kebreab Paulos Amy E Peden Veincent Christian Filipino Pepito Jeevan Pereira Michael R Phillips Roman V Polibin Suzanne Polinder Farshad Pourmalek Akram Pourshams Hossein Poustchi Swayam Prakash Dimas Ria Angga Pribadi Parul Puri Zahiruddin Quazi Syed Navid Rabiee Mohammad Rabiee Amir Radfar Anwar Rafay Ata Rafiee Alireza Rafiei Fakher Rahim Siavash Rahimi Muhammad Aziz Rahman Ali Rajabpour-Sanati Fatemeh Rajati Ivo Rakovac Sowmya J Rao Vahid Rashedi Prateek Rastogi Priya Rathi Salman Rawaf Lal Rawal Reza Rawassizadeh Vishnu Renjith Serge Resnikoff Aziz Rezapour Ana Isabel Ribeiro Jennifer Rickard Carlos Miguel Rios González Leonardo Roever Luca Ronfani Gholamreza Roshandel Basema Saddik Hamid Safarpour Mahdi Safdarian S Mohammad Sajadi Payman Salamati Marwa R Rashad Salem Hosni Salem Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Abdur Razzaque Sarker Arash Sarveazad Brijesh Sathian Monika Sawhney Mehdi Sayyah David C Schwebel Soraya Seedat Subramanian Senthilkumaran Seyedmojtaba Seyedmousavi Feng Sha Faramarz Shaahmadi Saeed Shahabi Masood Ali Shaikh Mehran Shams-Beyranvand Aziz Sheikh Mika Shigematsu Jae Il Shin Rahman Shiri Soraya Siabani Inga Dora Sigfusdottir Jasvinder A Singh Pankaj Kumar Singh Dhirendra Narain Sinha Amin Soheili Joan B Soriano Muluken Bekele Sorrie Ireneous N Soyiri Mark A Stokes Mu'awiyyah Babale Sufiyan Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Biruk Wogayehu Taddele Yonatal Mesfin Tefera Arash Tehrani-Banihashemi Gebretsadkan Hintsa Tekulu Ayenew Kassie Tesema Tesema Berhe Etsay Tesfay Rekha Thapar Mariya Vladimirovna Titova Kenean Getaneh Tlaye Hamid Reza Tohidinik Roman Topor-Madry Khanh Bao Tran Bach Xuan Tran Jaya Prasad Tripathy Alexander C Tsai Aristidis Tsatsakis Lorainne Tudor Car Irfan Ullah Saif Ullah Bhaskaran Unnikrishnan Era Upadhyay Olalekan A Uthman Pascual R Valdez Tommi Juhani Vasankari Yousef Veisani Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Yuan-Pang Wang Taweewat Wiangkham Haileab Fekadu Wolde Dawit Habte Woldeyes Temesgen Gebeyehu Wondmeneh Adam Belay Wondmieneh Ai-Min Wu Grant M A Wyper Rajaram Yadav Ali Yadollahpour Yuichiro Yano Sanni Yaya Vahid Yazdi-Feyzabadi Pengpeng Ye Paul Yip Engida Yisma Naohiro Yonemoto Seok-Jun Yoon Yoosik Youm Mustafa Z Younis Zabihollah Yousefi Chuanhua Yu Yong Yu Telma Zahirian Moghadam Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Hamed Zandian Fatemeh Zarei Zhi-Jiang Zhang Yunquan Zhang Arash Ziapour Sanjay Zodpey Rakhi Dandona Samath Dhamminda Dharmaratne Simon I Hay Ali H Mokdad David M Pigott Robert C Reiner Theo Vos

Inj Prev 2020 Oct 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Epidemiological characteristics of fall injuries and their related outcome in Riyadh, Saudi Arabia: A descriptive study from a Level-I trauma center.

J Family Community Med 2020 May-Aug;27(2):114-119. Epub 2020 Jun 3.

Department of Surgery, NGHA Hosptial, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background: Falls are the leading cause of admissions for trauma emergency in Saudi Arabia. However, the scarcity of evidence of what the burden of falls is locally limits the understanding of the underlying risk factors and hinders planning of effective prevention. The objective of this study was to describe patients' characteristics and health outcomes after hospital admissions as a result of a fall injury.

Materials And Methods: A retrospective analysis was conducted using a trauma registry from a level-I trauma center in Riyadh. All patients admitted as a result of a fall between 2001 and 2018 were included ( = 4825). Variables included were demographics, mechanism of fall, length of hospital stay, surgery, intensive care unit admission, intubation rate, and severity of the injury. For continuous variables, means and standard deviations were calculated, whereas, frequencies and proportions were used to describe categorical.

Results: Majority of the patients (63.6%) were male and about 39% of the sample were children. The most common mechanism of falls was standing (52.6%) followed by slipping (23.0%). Overall, limb fractures were the most common injury (73.3%). While upper limb fractures were more common in children (44.5%; < 0.01), lower limb fractures were more prevalent among the older patients (70.2%; < 0.01). Fall injuries in the elderly were significantly associated with higher mortality (3.5%; < 0.01).

Conclusion: This study highlights the significant burden fall injuries impose on population health. Prevention programs may use these findings to guide and tailor interventions for specific age groups. Furthermore, this study underlines the need for a national recording system for injuries to guide policymakers in evidence-based decisions.
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http://dx.doi.org/10.4103/jfcm.JFCM_245_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415265PMC
June 2020

The association between family cohesion and disability following blunt trauma: findings from a level-I trauma center in Saudi Arabia.

Inj Epidemiol 2020 Aug 10;7(1):40. Epub 2020 Aug 10.

Population Health Section- King Abdullah International Medical Research Centre (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, 11426, Saudi Arabia.

Background: Injuries pose a significant burden on population health of Saudi Arabia. Even in nonfatal injuries, the burden varies from temporary to permanent disabilities. Health outcomes following injuries can vary, and predictors of recovery from disability are not well understood. In the Kingdom, family values and cohesion can differ from other countries due to several factors, including religious beliefs and cultural traditions. Learning about predictors of injury recovery can improve prevention as well as planning for rehabilitation programs. Therefore, the study aims to evaluate the association between family cohesion and recovery following blunt injuries.

Methods: This prospective study included 249 patients who were hospitalized for at least 1 day following blunt trauma in King Abdulaziz Medical City, Riyadh. Adult patients were interviewed twice: initially during admission, and a second interview via the phone 3 months after discharge. Baseline information included: demographics, injury characteristics, the five dimensions EQ-5D and family support scale. The follow-up interview captured only EQ-5D. Suboptimal family cohesion was defined as any issue with the relationship with parents, spouse, or siblings. Any disability was defined as a reported limitation in one or more domains of the EQ-5D scale. Logistic regression was used to assess the association between family cohesion and recovery at 3 months.

Results: Of the overall sample, 169 (67.8%) responded to the second interview, and three patients passed away. About 95.2% of patients reported disabilities at baseline, while 88.1% continued to report disabilities after 3 months. Forty patients (16.1%) reported suboptimal family cohesion. Of these patients, 37(94.87%) were in pain, 33(82.5%) reported problems with usual activities, 32(80%) faced problems with self-care, 32 (80%) patients had difficulty in mobility, and 23(57.5%) were depressed. Multivariable regression suggested that patients with suboptimal family cohesion were less likely to recover from disabilities.

Conclusion: The prevalence of any disability 3 months after discharge is striking. This study suggests that health outcomes after blunt trauma are affected by the strength of the patient's family cohesion. More research is needed to identify effective ways through which the provision of social support can reduce short term disability after trauma.
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http://dx.doi.org/10.1186/s40621-020-00271-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416389PMC
August 2020

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Authors:
Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Nicholas L S Roberts Dillon O Sylte Nathaniel J Henry Kate E LeGrand Ahmed Abdelalim Amir Abdoli Ibrahim Abdollahpour Rizwan Suliankatchi Abdulkader Aidin Abedi Akine Eshete Abosetugn Abdelrahman I Abushouk Oladimeji M Adebayo Marcela Agudelo-Botero Tauseef Ahmad Rushdia Ahmed Muktar Beshir Ahmed Miloud Taki Eddine Aichour Fares Alahdab Genet Melak Alamene Fahad Mashhour Alanezi Animut Alebel Niguse Meles Alema Suliman A Alghnam Samar Al-Hajj Beriwan Abdulqadir Ali Saqib Ali Mahtab Alikhani Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Amir Almasi-Hashiani Nihad A Almasri Khalid Altirkawi Yasser Sami Abdeldayem Amer Saeed Amini Arianna Maever Loreche Amit Catalina Liliana Andrei Alireza Ansari-Moghaddam Carl Abelardo T Antonio Seth Christopher Yaw Appiah Jalal Arabloo Morteza Arab-Zozani Zohreh Arefi Olatunde Aremu Filippo Ariani Amit Arora Malke Asaad Babak Asghari Nefsu Awoke Beatriz Paulina Ayala Quintanilla Getinet Ayano Martin Amogre Ayanore Samad Azari Ghasem Azarian Alaa Badawi Ashish D Badiye Eleni Bagli Atif Amin Baig Mohan Bairwa Ahad Bakhtiari Arun Balachandran Maciej Banach Srikanta K Banerjee Palash Chandra Banik Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Lope H Barrero Akbar Barzegar Mohsen Bayati Bayisa Abdissa Baye Neeraj Bedi Masoud Behzadifar Tariku Tesfaye Bekuma Habte Belete Corina Benjet Derrick A Bennett Isabela M Bensenor Kidanemaryam Berhe Pankaj Bhardwaj Anusha Ganapati Bhat Krittika Bhattacharyya Sadia Bibi Ali Bijani Muhammad Shahdaat Bin Sayeed Guilherme Borges Antonio Maria Borzì Soufiane Boufous Alexandra Brazinova Nikolay Ivanovich Briko Shyam S Budhathoki Josip Car Rosario Cárdenas Félix Carvalho João Mauricio Castaldelli-Maia Carlos A Castañeda-Orjuela Giulio Castelpietra Ferrán Catalá-López Ester Cerin Joht S Chandan Wagaye Fentahun Chanie Soosanna Kumary Chattu Vijay Kumar Chattu Irini Chatziralli Neha Chaudhary Daniel Youngwhan Cho Mohiuddin Ahsanul Kabir Chowdhury Dinh-Toi Chu Samantha M Colquhoun Maria-Magdalena Constantin Vera M Costa Giovanni Damiani Ahmad Daryani Claudio Alberto Dávila-Cervantes Feleke Mekonnen Demeke Asmamaw Bizuneh Demis Gebre Teklemariam Demoz Desalegn Getnet Demsie Afshin Derakhshani Kebede Deribe Rupak Desai Mostafa Dianati Nasab Diana Dias da Silva Zahra Sadat Dibaji Forooshani Kerrie E Doyle Tim Robert Driscoll Eleonora Dubljanin Bereket Duko Adema Arielle Wilder Eagan Aziz Eftekhari Elham Ehsani-Chimeh Maysaa El Sayed Zaki Demelash Abewa Elemineh Shaimaa I El-Jaafary Ziad El-Khatib Christian Lycke Ellingsen Mohammad Hassan Emamian Daniel Adane Endalew Sharareh Eskandarieh Pawan Sirwan Faris Andre Faro Farshad Farzadfar Yousef Fatahi Wubalem Fekadu Tomas Y Ferede Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Pietro Ferrara Garumma Tolu Feyissa Irina Filip Florian Fischer Morenike Oluwatoyin Folayan Masoud Foroutan Joel Msafiri Francis Richard Charles Franklin Takeshi Fukumoto Biniyam Sahiledengle Geberemariyam Abadi Kahsu Gebre Ketema Bizuwork Gebremedhin Gebreamlak Gebremedhn Gebremeskel Berhe Gebremichael Getnet Azeze Gedefaw Birhanu Geta Mansour Ghafourifard Farhad Ghamari Ahmad Ghashghaee Asadollah Gholamian Tiffany K Gill Alessandra C Goulart Ayman Grada Michal Grivna Mohammed Ibrahim Mohialdeen Gubari Rafael Alves Guimarães Yuming Guo Gaurav Gupta Juanita A Haagsma Nima Hafezi-Nejad Hassan Haghparast Bidgoli Brian James Hall Randah R Hamadeh Samer Hamidi Josep Maria Haro Md Mehedi Hasan Amir Hasanzadeh Soheil Hassanipour Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Khezar Hayat Delia Hendrie Fatemeh Heydarpour Martha Híjar Hung Chak Ho Chi Linh Hoang Michael K Hole Ramesh Holla Naznin Hossain Mehdi Hosseinzadeh Sorin Hostiuc Guoqing Hu Segun Emmanuel Ibitoye Olayinka Stephen Ilesanmi Irena Ilic Milena D Ilic Leeberk Raja Inbaraj Endang Indriasih Seyed Sina Naghibi Irvani Sheikh Mohammed Shariful Islam M Mofizul Islam Rebecca Q Ivers Kathryn H Jacobsen Mohammad Ali Jahani Nader Jahanmehr Mihajlo Jakovljevic Farzad Jalilian Sudha Jayaraman Achala Upendra Jayatilleke Ravi Prakash Jha Yetunde O John-Akinola Jost B Jonas Nitin Joseph Farahnaz Joukar Jacek Jerzy Jozwiak Suresh Banayya Jungari Mikk Jürisson Ali Kabir Rajendra Kadel Amaha Kahsay Leila R Kalankesh Rohollah Kalhor Teshome Abegaz Kamil Tanuj Kanchan Neeti Kapoor Manoochehr Karami Amir Kasaeian Hagazi Gebremedhin Kassaye Taras Kavetskyy Hafte Kahsay Kebede Peter Njenga Keiyoro Abraham Getachew Kelbore Bayew Kelkay Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ibrahim A Khalil Rovshan Khalilov Mohammad Khammarnia Ejaz Ahmad Khan Maseer Khan Tripti Khanna Habibolah Khazaie Fatemeh Khosravi Shadmani Roba Khundkar Daniel N Kiirithio Young-Eun Kim Daniel Kim Yun Jin Kim Adnan Kisa Sezer Kisa Hamidreza Komaki Shivakumar K M Kondlahalli Vladimir Andreevich Korshunov Ai Koyanagi Moritz U G Kraemer Kewal Krishan Burcu Kucuk Bicer Nuworza Kugbey Vivek Kumar Nithin Kumar G Anil Kumar Manasi Kumar Girikumar Kumaresh Om P Kurmi Oluwatosin Kuti Carlo La Vecchia Faris Hasan Lami Prabhat Lamichhane Justin J Lang Van C Lansingh Dennis Odai Laryea Savita Lasrado Arman Latifi Paolo Lauriola Janet L Leasher Shaun Wen Huey Lee Tsegaye Lolaso Lenjebo Miriam Levi Shanshan Li Shai Linn Xuefeng Liu Alan D Lopez Paulo A Lotufo Raimundas Lunevicius Ronan A Lyons Mohammed Madadin Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Jeadran N Malagon-Rojas Venkatesh Maled Reza Malekzadeh Deborah Carvalho Malta Navid Manafi Amir Manafi Ana-Laura Manda Narayana Manjunatha Fariborz Mansour-Ghanaei Borhan Mansouri Mohammad Ali Mansournia Joemer C Maravilla Lyn M March Amanda J Mason-Jones Seyedeh Zahra Masoumi Benjamin Ballard Massenburg Pallab K Maulik Gebrekiros Gebremichael Meles Addisu Melese Zeleke Aschalew Melketsedik Peter T N Memiah Walter Mendoza Ritesh G Menezes Meresa Berwo Mengesha Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Hayimro Edemealem Merie Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Ted R Miller G K Mini Andreea Mirica Erkin M Mirrakhimov Mehdi Mirzaei-Alavijeh Prasanna Mithra Babak Moazen Masoud Moghadaszadeh Efat Mohamadi Yousef Mohammad Karzan Abdulmuhsin Mohammad Aso Mohammad Darwesh Naser Mohammad Gholi Mezerji Abdollah Mohammadian-Hafshejani Milad Mohammadoo-Khorasani Reza Mohammadpourhodki Shafiu Mohammed Jemal Abdu Mohammed Farnam Mohebi Mariam Molokhia Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Masoud Moradi Ghobad Moradi Maziar Moradi-Lakeh Farhad Moradpour Lidia Morawska Ilais Moreno Velásquez Naho Morisaki Shane Douglas Morrison Tilahun Belete Mossie Atalay Goshu Muluneh Srinivas Murthy Kamarul Imran Musa Ghulam Mustafa Ashraf F Nabhan Ahamarshan Jayaraman Nagarajan Gurudatta Naik Mukhammad David Naimzada Farid Najafi Vinay Nangia Bruno Ramos Nascimento Morteza Naserbakht Vinod Nayak Duduzile Edith Ndwandwe Ionut Negoi Josephine W Ngunjiri Cuong Tat Nguyen Huong Lan Thi Nguyen Rajan Nikbakhsh Dina Nur Anggraini Ningrum Chukwudi A Nnaji Peter S Nyasulu Felix Akpojene Ogbo Onome Bright Oghenetega In-Hwan Oh Emmanuel Wandera Okunga Andrew T Olagunju Tinuke O Olagunju Ahmed Omar Bali Obinna E Onwujekwe Kwaku Oppong Asante Heather M Orpana Erika Ota Nikita Otstavnov Stanislav S Otstavnov Mahesh P A Jagadish Rao Padubidri Smita Pakhale Keyvan Pakshir Songhomitra Panda-Jonas Eun-Kee Park Sangram Kishor Patel Ashish Pathak Sanghamitra Pati George C Patton Kebreab Paulos Amy E Peden Veincent Christian Filipino Pepito Jeevan Pereira Hai Quang Pham Michael R Phillips Marina Pinheiro Roman V Polibin Suzanne Polinder Hossein Poustchi Swayam Prakash Dimas Ria Angga Pribadi Parul Puri Zahiruddin Quazi Syed Mohammad Rabiee Navid Rabiee Amir Radfar Anwar Rafay Ata Rafiee Alireza Rafiei Fakher Rahim Siavash Rahimi Vafa Rahimi-Movaghar Muhammad Aziz Rahman Ali Rajabpour-Sanati Fatemeh Rajati Ivo Rakovac Kavitha Ranganathan Sowmya J Rao Vahid Rashedi Prateek Rastogi Priya Rathi Salman Rawaf Lal Rawal Reza Rawassizadeh Vishnu Renjith Andre M N Renzaho Serge Resnikoff Aziz Rezapour Ana Isabel Ribeiro Jennifer Rickard Carlos Miguel Rios González Luca Ronfani Gholamreza Roshandel Anas M Saad Yogesh Damodar Sabde Siamak Sabour Basema Saddik Saeed Safari Roya Safari-Faramani Hamid Safarpour Mahdi Safdarian S Mohammad Sajadi Payman Salamati Farkhonde Salehi Saleh Salehi Zahabi Marwa R Rashad Salem Hosni Salem Omar Salman Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Abdur Razzaque Sarker Arash Sarveazad Brijesh Sathian Monika Sawhney Susan M Sawyer Sonia Saxena Mehdi Sayyah David C Schwebel Soraya Seedat Subramanian Senthilkumaran Sadaf G Sepanlou Seyedmojtaba Seyedmousavi Feng Sha Faramarz Shaahmadi Saeed Shahabi Masood Ali Shaikh Mehran Shams-Beyranvand Morteza Shamsizadeh Mahdi Sharif-Alhoseini Hamid Sharifi Aziz Sheikh Mika Shigematsu Jae Il Shin Rahman Shiri Soraya Siabani Inga Dora Sigfusdottir Pankaj Kumar Singh Jasvinder A Singh Dhirendra Narain Sinha Catalin-Gabriel Smarandache Emma U R Smith Amin Soheili Bija Soleymani Ali Reza Soltanian Joan B Soriano Muluken Bekele Sorrie Ireneous N Soyiri Dan J Stein Mark A Stokes Mu'awiyyah Babale Sufiyan Hafiz Ansar Rasul Suleria Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Biruk Wogayehu Taddele Degena Bahrey Tadesse Animut Tagele Tamiru Ingan Ukur Tarigan Yonatal Mesfin Tefera Arash Tehrani-Banihashemi Merhawi Gebremedhin Tekle Gebretsadkan Hintsa Tekulu Ayenew Kassie Tesema Berhe Etsay Tesfay Rekha Thapar Asres Bedaso Tilahune Kenean Getaneh Tlaye Hamid Reza Tohidinik Roman Topor-Madry Bach Xuan Tran Khanh Bao Tran Jaya Prasad Tripathy Alexander C Tsai Lorainne Tudor Car Saif Ullah Irfan Ullah Maida Umar Bhaskaran Unnikrishnan Era Upadhyay Olalekan A Uthman Pascual R Valdez Tommi Juhani Vasankari Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Girmay Teklay Weldesamuel Andrea Werdecker Taweewat Wiangkham Haileab Fekadu Wolde Dawit Habte Woldeyes Dawit Zewdu Wondafrash Temesgen Gebeyehu Wondmeneh Adam Belay Wondmieneh Ai-Min Wu Rajaram Yadav Ali Yadollahpour Yuichiro Yano Sanni Yaya Vahid Yazdi-Feyzabadi Paul Yip Engida Yisma Naohiro Yonemoto Seok-Jun Yoon Yoosik Youm Mustafa Z Younis Zabihollah Yousefi Yong Yu Chuanhua Yu Hasan Yusefzadeh Telma Zahirian Moghadam Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Maryam Zamanian Hamed Zandian Ahmad Zarei Fatemeh Zare Zhi-Jiang Zhang Yunquan Zhang Sanjay Zodpey Lalit Dandona Rakhi Dandona Louisa Degenhardt Samath Dhamminda Dharmaratne Simon I Hay Ali H Mokdad Robert C Reiner Benn Sartorius Theo Vos

Inj Prev 2020 Oct 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia. Findings from a level-I trauma center.

Saudi Med J 2020 Mar;41(3):247-252

King Abdullah International Medical Research Center, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To investigate the incidence and predictors of traumatic pneumothorax using data from a Level-I trauma center in Riyadh, Saudi Arabia.

Methods: This is a retrospective chart-review study carried out in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Data were extracted from the hospital's trauma registry (2016-2018). A total of 2,109 trauma patients were included. Inclusion criteria were patients ≥16 years  old admitted for a traumatic injury. Variables included patient demographics, transport mode, trauma team activation, mechanism of injury, mortality rate, Glasgow Coma Scale and Injury Severity Scores. A logistic regression analysis was constructed to evaluate potential predictors of pneumothorax. Results: Of 2,109 patients included from the trauma registry, 236 (11.2%) were diagnosed with pneumothorax. The majority of the study population was young (19-49 years) (60.7%) and male (79.4%.) Injury mechanism was significantly associated with the presence of pneumothorax (p greater than 0.001). Regression analysis indicated that the odds of having pneumothorax among intentional injury victims was 15 times higher than fall injury victims (OR=15.3, 95% CI= 7.2-32.9). Participants who sustained motor vehicle collision injuries had 3 times higher odds of developing pneumothorax than those who suffered fall injuries (OR=3.1, 95% CI= 1.5-6.1). Conclusion: The incidence of traumatic pneumothorax is sizable and highly associated with the mechanism of injury. Efforts to reduce motor vehicle collision burden should be directly associated with decreasing the burden of traumatic pneumothorax.
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http://dx.doi.org/10.15537/smj.2020.3.24917DOI Listing
March 2020

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017.

Authors:
Spencer L James Lydia R Lucchesi Catherine Bisignano Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Darrah McCracken Molly R Nixon Dillon O Sylte Nicholas L S Roberts Oladimeji M Adebayo Teamur Aghamolaei Suliman A Alghnam Syed Mohamed Aljunid Amir Almasi-Hashiani Alaa Badawi Masoud Behzadifar Meysam Behzadifar Eyasu Tamru Bekru Derrick A Bennett Jens Robert Chapman Kebede Deribe Bereket Duko Adema Yousef Fatahi Belayneh K Gelaw Eskezyiaw Agedew Getahun Delia Hendrie Andualem Henok Hagos de Hidru Mehdi Hosseinzadeh Guoqing Hu Mohammad Ali Jahani Mihajlo Jakovljevic Farzad Jalilian Nitin Joseph Manoochehr Karami Abraham Getachew Kelbore Md Nuruzzaman Khan Yun Jin Kim Parvaiz A Koul Carlo La Vecchia Shai Linn Reza Majdzadeh Man Mohan Mehndiratta Peter T N Memiah Melkamu Merid Mengesha Hayimro Edemealem Merie Ted R Miller Mehdi Mirzaei-Alavijeh Aso Mohammad Darwesh Naser Mohammad Gholi Mezerji Roghayeh Mohammadibakhsh Yoshan Moodley Maziar Moradi-Lakeh Kamarul Imran Musa Bruno Ramos Nascimento Rajan Nikbakhsh Peter S Nyasulu Ahmed Omar Bali Obinna E Onwujekwe Sanghamitra Pati Reza Pourmirza Kalhori Farkhonde Salehi Saeed Shahabi Seifadin Ahmed Shallo Morteza Shamsizadeh Zeinab Sharafi Sharvari Rahul Shukla Mohammad Reza Sobhiyeh Joan B Soriano Bryan L Sykes Rafael Tabarés-Seisdedos Degena Bahray Bahrey Tadesse Yonatal Mesfin Tefera Arash Tehrani-Banihashemi Boikhutso Tlou Roman Topor-Madry Taweewat Wiangkham Mehdi Yaseri Sanni Yaya Muluken Azage Yenesew Mustafa Z Younis Arash Ziapour Sanjay Zodpey David M Pigott Robert C Reiner Simon I Hay Alan D Lopez Ali H Mokdad

Inj Prev 2020 Oct 8;26(Supp 1):i46-i56. Epub 2020 Jan 8.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.

Background: The global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years.

Methods: We used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury.

Results: Globally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change.

Conclusions: While road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented.
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http://dx.doi.org/10.1136/injuryprev-2019-043302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571357PMC
October 2020

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

Authors:
Juanita A Haagsma Spencer L James Chris D Castle Zachary V Dingels Jack T Fox Erin B Hamilton Zichen Liu Lydia R Lucchesi Nicholas L S Roberts Dillon O Sylte Oladimeji M Adebayo Alireza Ahmadi Muktar Beshir Ahmed Miloud Taki Eddine Aichour Fares Alahdab Suliman A Alghnam Syed Mohamed Aljunid Rajaa M Al-Raddadi Ubai Alsharif Khalid Altirkawi Mina Anjomshoa Carl Abelardo T Antonio Seth Christopher Yaw Appiah Olatunde Aremu Amit Arora Hamid Asayesh Reza Assadi Ashish Awasthi Beatriz Paulina Ayala Quintanilla Shivanthi Balalla Amrit Banstola Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Shahrzad Bazargan-Hejazi Neeraj Bedi Masoud Behzadifar Meysam Behzadifar Corina Benjet Derrick A Bennett Isabela M Bensenor Soumyadeep Bhaumik Zulfiqar A Bhutta Ali Bijani Guilherme Borges Rohan Borschmann Dipan Bose Soufiane Boufous Alexandra Brazinova Julio Cesar Campuzano Rincon Rosario Cárdenas Juan J Carrero Félix Carvalho Carlos A Castañeda-Orjuela Ferrán Catalá-López Jee-Young J Choi Devasahayam J Christopher Christopher Stephen Crowe Koustuv Dalal Ahmad Daryani Dragos Virgil Davitoiu Louisa Degenhardt Diego De Leo Jan-Walter De Neve Kebede Deribe Getenet Ayalew Dessie Gabrielle Aline deVeber Samath Dhamminda Dharmaratne Linh Phuong Doan Kate A Dolan Tim Robert Driscoll Manisha Dubey Ziad El-Khatib Christian Lycke Ellingsen Maysaa El Sayed Zaki Aman Yesuf Endries Sharareh Eskandarieh Andre Faro Seyed-Mohammad Fereshtehnejad Eduarda Fernandes Irina Filip Florian Fischer Richard Charles Franklin Takeshi Fukumoto Kebede Embaye Gezae Tiffany K Gill Alessandra C Goulart Ayman Grada Yuming Guo Rahul Gupta Hassan Haghparast Bidgoli Arvin Haj-Mirzaian Arya Haj-Mirzaian Randah R Hamadeh Samer Hamidi Josep Maria Haro Hadi Hassankhani Hamid Yimam Hassen Rasmus Havmoeller Delia Hendrie Andualem Henok Martha Híjar Michael K Hole Enayatollah Homaie Rad Naznin Hossain Sorin Hostiuc Guoqing Hu Ehimario U Igumbor Olayinka Stephen Ilesanmi Seyed Sina Naghibi Irvani Sheikh Mohammed Shariful Islam Rebecca Q Ivers Kathryn H Jacobsen Nader Jahanmehr Mihajlo Jakovljevic Achala Upendra Jayatilleke Ravi Prakash Jha Jost B Jonas Zahra Jorjoran Shushtari Jacek Jerzy Jozwiak Mikk Jürisson Ali Kabir Rizwan Kalani Amir Kasaeian Abraham Getachew Kelbore Andre Pascal Kengne Yousef Saleh Khader Morteza Abdullatif Khafaie Nauman Khalid Ejaz Ahmad Khan Abdullah T Khoja Aliasghar A Kiadaliri Young-Eun Kim Daniel Kim Adnan Kisa Ai Koyanagi Barthelemy Kuate Defo Burcu Kucuk Bicer Manasi Kumar Ratilal Lalloo Hilton Lam Faris Hasan Lami Van C Lansingh Janet L Leasher Shanshan Li Shai Linn Raimundas Lunevicius Flavia R Machado Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Narayan Bahadur Mahotra Marek Majdan Azeem Majeed Reza Malekzadeh Manzoor Ahmad Malik Deborah Carvalho Malta Ana-Laura Manda Mohammad Ali Mansournia Benjamin Ballard Massenburg Pallab K Maulik Hailemariam Abiy Alemu Meheretu Man Mohan Mehndiratta Addisu Melese Walter Mendoza Melkamu Merid Mengesha Tuomo J Meretoja Atte Meretoja Tomislav Mestrovic Tomasz Miazgowski Ted R Miller G K Mini Erkin M Mirrakhimov Babak Moazen Naser Mohammad Gholi Mezerji Roghayeh Mohammadibakhsh Shafiu Mohammed Mariam Molokhia Lorenzo Monasta Stefania Mondello Pablo A Montero-Zamora Yoshan Moodley Mahmood Moosazadeh Ghobad Moradi Maziar Moradi-Lakeh Lidia Morawska Ilais Moreno Velásquez Shane Douglas Morrison Marilita M Moschos Seyyed Meysam Mousavi Srinivas Murthy Kamarul Imran Musa Gurudatta Naik Farid Najafi Vinay Nangia Bruno Ramos Nascimento Duduzile Edith Ndwandwe Ionut Negoi Trang Huyen Nguyen Son Hoang Nguyen Long Hoang Nguyen Huong Lan Thi Nguyen Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Richard Ofori-Asenso Felix Akpojene Ogbo In-Hwan Oh Olanrewaju Oladimeji Andrew T Olagunju Tinuke O Olagunju Pedro R Olivares Heather M Orpana Stanislav S Otstavnov Mahesh P A Smita Pakhale Eun-Kee Park George C Patton Konrad Pesudovs Michael R Phillips Suzanne Polinder Swayam Prakash Amir Radfar Anwar Rafay Alireza Rafiei Siavash Rahimi Vafa Rahimi-Movaghar Muhammad Aziz Rahman Rajesh Kumar Rai Kiana Ramezanzadeh Salman Rawaf David Laith Rawaf Andre M N Renzaho Serge Resnikoff Shahab Rezaeian Leonardo Roever Luca Ronfani Gholamreza Roshandel Yogesh Damodar Sabde Basema Saddik Payman Salamati Yahya Salimi Inbal Salz Abdallah M Samy Juan Sanabria Lidia Sanchez Riera Milena M Santric Milicevic Maheswar Satpathy Monika Sawhney Susan M Sawyer Sonia Saxena Mete Saylan Ione J C Schneider David C Schwebel Soraya Seedat Sadaf G Sepanlou Masood Ali Shaikh Mehran Shams-Beyranvand Morteza Shamsizadeh Mahdi Sharif-Alhoseini Aziz Sheikh Jiabin Shen Mika Shigematsu Rahman Shiri Ivy Shiue João Pedro Silva Jasvinder A Singh Dhirendra Narain Sinha Adauto Martins Soares Filho Joan B Soriano Sergey Soshnikov Ireneous N Soyiri Vladimir I Starodubov Dan J Stein Mark A Stokes Mu'awiyyah Babale Sufiyan Jacob E Sunshine Bryan L Sykes Rafael Tabarés-Seisdedos Karen M Tabb Arash Tehrani-Banihashemi Gizachew Assefa Tessema Jarnail Singh Thakur Khanh Bao Tran Bach Xuan Tran Lorainne Tudor Car Olalekan A Uthman Benjamin S Chudi Uzochukwu Pascual R Valdez Elena Varavikova Ana Maria Nogales Vasconcelos Narayanaswamy Venketasubramanian Francesco S Violante Vasily Vlassov Yasir Waheed Yuan-Pang Wang Tissa Wijeratne Andrea Sylvia Winkler Priyanka Yadav Yuichiro Yano Muluken Azage Yenesew Paul Yip Engida Yisma Naohiro Yonemoto Mustafa Z Younis Chuanhua Yu Shamsa Zafar Zoubida Zaidi Sojib Bin Zaman Mohammad Zamani Yong Zhao Sanjay Zodpey Simon I Hay Alan D Lopez Ali H Mokdad Theo Vos

Inj Prev 2020 Oct 8;26(Supp 1):i12-i26. Epub 2020 Jan 8.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.

Background: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates.

Methods: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate.

Results: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced.

Conclusions: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
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http://dx.doi.org/10.1136/injuryprev-2019-043296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571356PMC
October 2020

The Association between Mobile Phone Use and Severe Traffic Injuries: A Case-Control Study from Saudi Arabia.

Int J Environ Res Public Health 2019 07 29;16(15). Epub 2019 Jul 29.

Department of Surgery, King Abdulaziz Medical City, National Guard Healthcare Affairs, Riyadh 11426, Saudi Arabia.

Road traffic injury (RTI) is the third leading cause of death in Saudi Arabia. Using a mobile phone when driving is associated with distracted driving, which may result in RTIs. Because of limited empirical data, we investigated the association between mobile phone use and RTI in injured patients and community controls in Riyadh. Cases were patients admitted to King Abdulaziz Medical City (KAMC) between October 2016 and March 2018 due to RTIs. During admission, mobile phone use at the time of the accident was investigated. The controls were drivers observed at various locations citywide. A logistic regression model was constructed to estimate the association between mobile phone use while driving and sustaining RTIs. We included 318 cases and 1700 controls. For the cases, using a mobile phone was associated with higher severity and prevalence of disability. In addition, using a mobile phone while driving is associated with 44% higher odds of incurring a severe RTI ( = 0.04). Mobile phone use while driving is prevalent in Riyadh and pose a significant threat of disability. In addition, the low prevalence of seatbelt use is alarming and requires significant improvement. Prevention programs may use these findings to educate the public and policymakers and to advocate for increased visibility of enforcement to reduce RTIs and improve population health.
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http://dx.doi.org/10.3390/ijerph16152706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695828PMC
July 2019

Injuries following motorcycle crashes at a level-1 trauma center in Riyadh.

Ann Saudi Med 2019 May-Jun;39(3):185-191. Epub 2019 May 30.

From the Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background: Motor vehicle crashes are the third leading cause of death in Saudi Arabia. Motorcycle riders, in particular, are considered more vulnerable than occupants, yet there are no previous studies that have examined the epidemiology of their injuries and outcomes in the country. Better understanding is needed to inform policymakers and guide future prevention programs.

Objective: Describe patterns of injury among conscious and unconscious patients injured in motorcycle crashes.

Design: Retrospective chart review.

Settings: Level 1 trauma center in Riyadh.

Patients And Methods: This retrospective study included all patients involved in motorcycle crashes who were admitted between 2001 and 2017. Medical records were reviewed, and data about injury characteristics, outcomes and healthcare utilization were ascertained.

Main Outcome Measures: Injury site and mortality rate.

Sample Size And Characteristics: 572 patients included 488 males (85.3%) and 232 <18 years of age (40.5%), mean (SD) age 21.1 (11.6) years.

Results: About 3% of patients died either before or after admission. Extremity injuries (356, 62.2%) were most common followed by head injuries (229, 40%). Fifty-six (9%) suffered amputation, mostly to a lower limb.

Conclusion: This study underscores the significant burden of motorcycle-related injuries on population health of Saudi Arabia. The number of amputations due to motorcycle injuries is striking. Therefore, we need to increase enforcement of safety measures during recreational use of motorcycles and to raise awareness about the dangers of motorcycle crashes to improve traffic safety and ultimately population health.

Limitations: The study was conducted at a single hospital which may affect the generalizability of the data to the Saudi population.

Conflict Of Interest: None.
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http://dx.doi.org/10.5144/0256-4947.2019.185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832331PMC
December 2019

The associations between injury mechanism and extended hospital stay among pediatric patients: findings from a trauma Center in Saudi Arabia.

BMC Pediatr 2019 06 3;19(1):177. Epub 2019 Jun 3.

General Pediatrics and Complex Care, King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Background: A hospitalized patient's length of stay (LOS) can have a significant impact on the performance and operating costs of a healthcare facility. Among pediatric patients, traumatic injuries are common causes of emergency room visits and hospitalizations. In Saudi Arabia, little is known about the burden of pediatric traumas on population health and the healthcare facilities. Therefore, the aim of this study was to investigate the associations between traumatic pediatric injury mechanisms and extended LOS in a trauma center.

Methods: Data was obtained from the trauma registry. From 2001 to 2018, trauma patients between the ages of 0 and 18 years old with LOSs of > 0 days were analyzed. The independent variable was the injury mechanism, which was classified as follows: falls, burns, drowning, motor vehicle collisions, motorcycle collisions, pedestrian, and intentional injuries. The dependent variable was an extended LOS defined as ≥21 days. A multivariate logistic regression analysis was used to evaluate the associations between the injury mechanisms and an extended LOS.

Results: A total of 5563 pediatric patients were included in this study. Of those, 774 (14%) had extended LOSs. Those patients with extended LOSs suffered more severe injuries than those with short hospital stays as measured by the Injury Severity Score (mean scores: 15.4 vs. 6.8, p < 0.01), the Glasgow Coma Scale score (mean scores: 10.4 vs, 14.0, p < 0.01), and the Revised Trauma Score (mean scores: 9.9 vs. 11.0, p < 0.01). Approximately one half of the patients with extended LOSs were admitted due to motor vehicle injuries. In addition, those patients were almost five times more likely to have extended LOSs than the patients who suffered fall injuries (odds ratio: 4.8, 95% confidence interval: 3.2-7.1).

Conclusions: Based on the study results, motor vehicle injuries were significantly associated with extended hospitalizations. Prevention is instrumental for reducing healthcare utilization; therefore, these findings call for public health professionals and policymakers to plan, design, and implement preventive measures to reduce the traffic injury burden. In addition, increased traffic law enforcement, such as the use of car restraints, is warranted to reduce the preventable injuries and improve the overall population health.
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http://dx.doi.org/10.1186/s12887-019-1559-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545720PMC
June 2019

Neurological disability among adults following traumatic spinal fractures in Saudi Arabia: a retrospective single-center medical record review.

Ann Saudi Med 2019 Jan-Feb;39(1):8-12

Dr. Suhail Saad AlAssiri, Department of Orthopedic Surgery,, National Guard Hospital,, King Abdulaziz Medical City,, Riyadh 11662, Saudi Arabia, T: +9966563456700, suhailasiri@ gmail.com, ORCID: http://orcid. org/0000-0001-7119-1201.

Background: A traumatic spinal fracture (TSF) is a serious condition that has a tremendous impact on patients and their families. Understanding the causes and patterns of TSF is critical in developing prevention programs.

Objectives: Identify causes and patterns of TSF and explore predictors of neurological disability in Saudi Arabia.

Design: A retrospective medical record review.

Setting: Level 1 trauma center in Riyadh.

Patients And Methods: The analysis included all consecutive patients who met the inclusion criteria for any acute TSF in patients 18 years of age and older from January 2001 to January 2016. A multivariate logistic regression model was used to identify predictors of neurological disability following TSF.

Main Outcome Measures: Neurological disability in patients sustaining TSF.

Sample Size: 1128 patients.

Results: Of 1128 patients, 971 patients (86%) were male with a mean (SD) age 34.4 (16.6) years. The most common mechanism of injury was motor vehicle accidents (88.4%). Cervical spine was the most commonly affected region (48%, n=468) with a mortality rate of 7.6%. Neurological disability occurred in 74 (6.7%) patients, and 41 (8.7%) of those with cervical fractures died in the hospital. The Injury Severity Score was a significant predictor of neurological disability following TSF.

Conclusion: A high proportion of neurological disability following TSF was found. Further studies should attempt to improve the docu.mentation rate of seatbelt status in all traumatic cases including mild injuries. This data will increase our understanding of adult TSF and possibly facilitate injury prevention strategies.

Limitations: Single hospital and may not be generalizable.

Conflict Of Interest: None.
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http://dx.doi.org/10.5144/0256-4947.2019.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464681PMC
May 2019

Global Mortality From Firearms, 1990-2016.

Authors:
Mohsen Naghavi Laurie B Marczak Michael Kutz Katya Anne Shackelford Megha Arora Molly Miller-Petrie Miloud Taki Eddine Aichour Nadia Akseer Rajaa M Al-Raddadi Khurshid Alam Suliman A Alghnam Carl Abelardo T Antonio Olatunde Aremu Amit Arora Mohsen Asadi-Lari Reza Assadi Tesfay Mehari Atey Leticia Avila-Burgos Ashish Awasthi Beatriz Paulina Ayala Quintanilla Suzanne Lyn Barker-Collo Till Winfried Bärnighausen Shahrzad Bazargan-Hejazi Masoud Behzadifar Meysam Behzadifar James R Bennett Ashish Bhalla Zulfiqar A Bhutta Arebu Issa Bilal Guilherme Borges Rohan Borschmann Alexandra Brazinova Julio Cesar Campuzano Rincon Félix Carvalho Carlos A Castañeda-Orjuela Lalit Dandona Rakhi Dandona Paul I Dargan Diego De Leo Samath Dhamminda Dharmaratne Eric L Ding Huyen Phuc Do David Teye Doku Kerrie E Doyle Tim Robert Driscoll Dumessa Edessa Ziad El-Khatib Aman Yesuf Endries Alireza Esteghamati Andre Faro Farshad Farzadfar Valery L Feigin Florian Fischer Kyle J Foreman Richard Charles Franklin Nancy Fullman Neal D Futran Tsegaye Tewelde Gebrehiwot Reyna Alma Gutiérrez Nima Hafezi-Nejad Hassan Haghparast Bidgoli Gessessew Bugssa Hailu Josep Maria Haro Hamid Yimam Hassen Caitlin Hawley Delia Hendrie Martha Híjar Guoqing Hu Olayinka Stephen Ilesanmi Mihajlo Jakovljevic Spencer L James Sudha Jayaraman Jost B Jonas Amaha Kahsay Amir Kasaeian Peter Njenga Keiyoro Yousef Khader Ibrahim A Khalil Young-Ho Khang Jagdish Khubchandani Aliasghar Ahmad Kiadaliri Christian Kieling Yun Jin Kim Soewarta Kosen Kristopher J Krohn G Anil Kumar Faris Hasan Lami Van C Lansingh Heidi Jane Larson Shai Linn Raimundas Lunevicius Hassan Magdy Abd El Razek Muhammed Magdy Abd El Razek Reza Malekzadeh Deborah Carvalho Malta Amanda J Mason-Jones Richard Matzopoulos Peter T N Memiah Walter Mendoza Tuomo J Meretoja Haftay Berhane Mezgebe Ted R Miller Shafiu Mohammed Maziar Moradi-Lakeh Rintaro Mori Devina Nand Cuong Tat Nguyen Quyen Le Nguyen Dina Nur Anggraini Ningrum Felix Akpojene Ogbo Andrew T Olagunju George C Patton Michael R Phillips Suzanne Polinder Farshad Pourmalek Mostafa Qorbani Afarin Rahimi-Movaghar Vafa Rahimi-Movaghar Mahfuzar Rahman Rajesh Kumar Rai Chhabi Lal Ranabhat David Laith Rawaf Salman Rawaf Ali Rowhani-Rahbar Mahdi Safdarian Saeid Safiri Rajesh Sagar Joseph S Salama Juan Sanabria Milena M Santric Milicevic Rodrigo Sarmiento-Suárez Benn Sartorius Maheswar Satpathy David C Schwebel Soraya Seedat Sadaf G Sepanlou Masood Ali Shaikh Nigussie Tadesse Sharew Ivy Shiue Jasvinder A Singh Mekonnen Sisay Vegard Skirbekk Adauto Martins Soares Filho Dan J Stein Mark Andrew Stokes Mu'awiyyah Babale Sufiyan Mamta Swaroop Bryan L Sykes Rafael Tabarés-Seisdedos Fentaw Tadese Bach Xuan Tran Tung Thanh Tran Kingsley Nnanna Ukwaja Tommi Juhani Vasankari Vasily Vlassov Andrea Werdecker Pengpeng Ye Paul Yip Naohiro Yonemoto Mustafa Z Younis Zoubida Zaidi Maysaa El Sayed Zaki Simon I Hay Stephen S Lim Alan D Lopez Ali H Mokdad Theo Vos Christopher J L Murray

JAMA 2018 08;320(8):792-814

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions.

Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories.

Design, Setting, And Participants: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths.

Exposures: Firearm ownership and access.

Main Outcomes And Measures: Cause-specific deaths by age, sex, location, and year.

Results: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35).

Conclusions And Relevance: This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.
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http://dx.doi.org/10.1001/jama.2018.10060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143020PMC
August 2018

The prevalence of seatbelt and mobile phone use among drivers in Riyadh, Saudi Arabia: An observational study.

J Safety Res 2018 09 19;66:33-37. Epub 2018 May 19.

Traffic Safety Technologies Chair, Urban Planning Department, College of Architecture and Planning, King Saud University, Riyadh, Saudi Arabia. Electronic address:

Introduction: Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Numerous factors may increase the likelihood of RTIs. The prevalence of risk factors associated with RTIs may vary due to several reasons. Because little is known about these risk factors locally, we examined the prevalence of mobile phone and seatbelt use and their association with spatial locations.

Methods: This is an observational study conducted at major highways and inner intersections throughout Riyadh, the country's capital. Two observers captured seatbelt and mobile phone use among drivers. Logistic regression models were constructed to examine the association between real estate prices and mobile phone or seatbelt use. Observations were categorized as taken place in an affluent neighborhood if the average price per square meter was above 2500 Saudi Riyal.

Results: A total of 1700 drivers were observed in 13 sites citywide. 13.8% of drivers were seen using mobile while driving and only a third of drivers (34%) were wearing seatbelts. Being at an affluent neighborhood was associated with close to three times higher odds of wearing seatbelts (OR = 2.7, 95% CI = 1.9-3.7) and also associated with 42% lower odds of mobile phone use among drivers (OR = 0.58, 95% CI = 0.36-0.92).

Discussion: This study found a high prevalence of traffic violations among drivers in Riyadh. Based on our estimate, 660,000 drivers are roaming the street during daytime while using their phones and they are less likely to wear seatbelts. Unfortunately, this estimate might contribute to increasing RTIs. Despite existing regulations, seatbelt use among drivers is significantly lower than in developed countries (i.e. USA 94%).

Conclusion: Our study found a high prevalence of traffic violations represented by lack of compliance with seatbelt and mobile phone use laws. These findings provide a basis for their underlying prevalence in SA. Practical applications: Public health prevention programs may use these findings to facilitate support to increasing investment in awareness campaigns and further enforcement by the traffic police to reduce RITs and improve population health.
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http://dx.doi.org/10.1016/j.jsr.2018.05.001DOI Listing
September 2018

The effectiveness of introducing detection cameras on compliance with mobile phone and seatbelt laws: a before-after study among drivers in Riyadh, Saudi Arabia.

Inj Epidemiol 2018 Aug 6;5(1):31. Epub 2018 Aug 6.

Center for Outcomes Research in Surgery, School of Medicine, Indiana University, Bloomington, USA.

Background: Because Saudi Arabia (SA) has struggled with the burden of Road Traffic Injuries (RTIs) for decades, a new automated citations system was implemented in 2018 to improve compliance with seatbelt and mobile phone laws. Therefore, the purpose of this study is to evaluate the impact of the system on the prevalence of seatbelt and mobile phone use among drivers in Riyadh. This is an observational study conducted between 2017 and 2018. A Pre-Post evaluation was employed to determine the impact of a camera detection system on seatbelt and mobile phone use. Two research coordinators collected the observations at several highways and inner intersections around Riyadh (n = 3400). We evaluated differences in the prevalence of seatbelt and mobile phone use across the two time periods using a chi-2 test. In addition, we evaluated the association between the new intervention and traffic violation using a logistic regression model.

Results: The overall seatbelt compliance increased significantly from 33.9% (95% CI = 31.7-36.2) to 75.8% (95% CI = 73.7-77.8; P < 0.01). In addition, mobile phone use declined significantly from 13.8% (95% CI = 12.2-15.5) to 9.8 (95% CI = 8.8-9.1; P < 0.01). We found the detection system to be associated with a significant increase in seatbelt use and also a significant decline in mobile phone use while driving. After implementing the intervention, drivers were 6.1 times (OR = 6.1, 95% CI = 5.2-7.0) more likely to wear seatbelts than before the technology went into effect. Similarly, drivers observed after implementing the cameras were 32% (OR = 0.68, 95% CI = 0.55,0.84) less likely to use mobile phones while driving than those seen prior to the intervention.

Conclusions: This study found a significant reduction in traffic violations following the implementation of a camera detection system in Riyadh. This positive impact is evidence for the role preventative structural strategies play to improve traffic safety and reduce RTI in SA. Therefore, these findings may facilitate further support for policymakers that public health interventions play a significant role to improve traffic safety. Seatbelt and mobile phone use while driving should continue to be monitored, and traffic police may evaluate whether increasing the fine is associated with a significant reduction in traffic violations and associated crashes.
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http://dx.doi.org/10.1186/s40621-018-0161-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081868PMC
August 2018

Association between the mode of transport and in-hospital medical complications in trauma patients: findings from a level-I trauma center in Saudi Arabia.

Ann Saudi Med 2018 Jan-Feb;38(1):8-14

Dr. Suliman Abdulah Alghnam Population Health, King Abdullah International Research Center, PO Box 22490, Riyadh 11426, Saudi Arabia T: +966-539468887, ORCID: http://orcid.org/0000-0001-5817-0481.

Background: In Saudi Arabia, injury is the leading cause of death. Even if nonfatal, the impact of injuries on population health is enormous, as thousands of young patients suffer permanent disabilities every year. Unlike in developed countries, private transportation (PT) is a common means to transport trauma patients. Outcome differences between patients transported via PT relative to emergency medical services (EMS) has not been previously explored.

Objectives: To evaluate the association between transportation mode and in-hospital complications among trauma patients.

Design: Retrospective.

Setting: Tertiary care center.

Patients And Methods: The study included all patients (>=16 years), who were admitted following trauma.

Main Outcome Measures: The main outcome in the study was the occurrence of any medical complications including stroke, sepsis, myocardial infarction, pulmonary embolism, pneumonia, renal failure, acute respiratory distress syndrome, and cardiac arrest.

Results: The 493 patients were relatively young (over two-thirds of the sample were 45 years old or younger) and over half the population sustained injuries due traffic crashes. More than half (58%) of patients arrived via private transportation. Regression analyses revealed that in-hospital complications following injuries were significantly lower among those who arrived via PT. However, after incorporating propensity score matching, we found no difference in hospital complications (OR=0.55, 95% CI 0.25-1.17).

Conclusion: Multiple factors may influence this unexpected finding, such as distance to health care set.tings, the belief that PT is faster or lack of knowledge of the EMS contact number. Further efforts are needed to raise awareness of the importance of using EMS to transport trauma patients to hospitals. Prevention programs to reduce traffic crashes may facilitate reduction in traumatic injuries and associated complications.

Limitations: Retrospective and conducted in one center only.
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http://dx.doi.org/10.5144/0256-4947.2018.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074188PMC
September 2018

Long-term disabilities after traumatic head injury (THI): a retrospective analysis from a large level-I trauma center in Saudi Arabia.

Inj Epidemiol 2017 Nov 1;4(1):29. Epub 2017 Nov 1.

Quality Management Section-King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.

Background: Traumatic head injuries (THI) are a critical public health problem worldwide, with more than 10 million individuals affected every year. In Saudi Arabia (SA), the burden of THI is unknown even though injury is the leading cause of death and a major cause of disability. Therefore, we aim to estimate the prevalence of long-term of disabilities among survivors of THI treated at a large level-I trauma center in Riyadh.

Methods: The study included 258 patients, who were hospitalized due to a non-fatal THI between years 2005-2014. Patients (age = 16-60 years) were contacted via the phone and information about their Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) was ascertained. Univariate analyses were performed to examine patients' characteristics and to estimate the prevalence of any disability. Logistic regression was used to evaluate independent predictors of long-term disability.

Results: Respondents were relatively young (mean age = 24.8; SD = 9.8), predominantly males (92.7%) and the majority sustained THI following traffic crashes (91.4%). The average time since the injury was 6.8 years (range = 3-12, SD = 2.6). Close to third of the sample (32.5%) reported at least some limitations in ADL or IADL. Regression analysis suggests that a one-unit increase in Revised Trauma Scale (RTS) was associated with 31% lower odds of disability adjusting for other covariates. While responders with a below high school education were 4.7 times more likely to report a disability than those with at least a college degree (P < 0.05).

Conclusions: THI was associated with significant limitations in various aspects of everyday life. The magnitude and impact of THI in Saudi Arabia requires public health measures to prevent these injuries and to improve their health outcomes. Advocates may use these findings to educate the public about secondary and tertiary prevention and elicit support from policymakers to facilitate interventions toward reducing THI's associated disabilities.
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http://dx.doi.org/10.1186/s40621-017-0126-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663989PMC
November 2017

Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia.

Saudi Med J 2017 Jun;38(6):598-603

Department of Orthopedics, National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. E-mail.

Objectives: To examine the incidence and predictors of blood transfusion following total knee replacement (TKR). Methods: A retrospective study on 462 patients of primary TKR at National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. Descriptive statistics were compared by blood transfusion status and significant variables were further included in the multivariable model. Results: Overall transfusion rate following TKR was 35.3%. Regression analyses identified bilateral surgery, low preoperative hemoglobin (Hb) level, and high amount of blood loss as predictors of blood transfusion.  Conclusion: Correction of Hb level prior to surgery, careful hemostasis, and avoiding bilateral surgery may reduce the rate of blood transfusion following TKR.
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http://dx.doi.org/10.15537/smj.2017.6.17475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541182PMC
June 2017

Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia.

Ann Saudi Med 2017 Jan-Feb;37(1):1-9

Dr. Suliman Abdulah Alghnam, King Abdulah International Research Center (KAIMRC), Population Health, PO Box 22490,, Riyadh, 11426, Saudi Arabia,, T: 0539468887, ORCID: http://orcid.org/0000-0001-5817-0481.

Background: Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Because speed is a major risk factor for severe crash-related injuries, a camera ticketing system was implemented countrywide in mid-2010 by the traffic police in an effort to improve traffic safety. There are no published studies on the effects of the system in Saudi Arabia.

Objective: To examine injury severity and associated mortality at a large trauma center before and after the implementation of the ticketing system.

Design: Retrospective, analytical.

Setting: Trauma center of a tertiary care center in Riyadh.

Patients And Methods: The study included all trauma registry patients seen in the emergency department for a crash-related injury (automobile occupants, pedestrians, or motorcyclists) between January 2005 and December 2014. Associations with outcome measures were assessed by univariate and multivariate methods.

Main Outcome Measure(s): Injury severity score (ISS), Glasgow coma scale (GCS) and mortality.

Results: The study included all trauma registry patients seen in the emergency department for a crash-related injury. All health outcomes improved in the period following implementation of the ticketing system. Following implementation, ISS scores decreased (-3.1, 95% CI -4.6, -1.6) and GCS increased (0.47, 95% CI 0.08, 0.87) after adjusting for other covariates. The odds of death were 46% lower following implementation than before implementation. When the data were log-transformed to account for skewed data distributions, the results remained statistically significant.

Conclusions: This study suggests positive health implications following the implementation of the camera ticketing system. Further investment in public health interventions is warranted to reduce preventable RTIs.

Limitations: The study findings represent a trauma center at a single hospital in Riyadh, which may not generalize to the Saudi population.
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http://dx.doi.org/10.5144/0256-4947.2017.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148978PMC
March 2017

Longitudinal assessment of injury recidivism among adults in the United States: findings from a population-based sample.

Inj Epidemiol 2016 Dec 2;3(1). Epub 2016 Feb 2.

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, HH 598 624 N. Broadway, Baltimore, MD, 21205, USA.

Background: Repeated injuries, as known as injury recidivism, pose a significant burden on population health and healthcare settings. Therefore, identifying those at risk of recidivism can highlight targeted populations for primary prevention in order to improve health and reduce healthcare expenditures. There has been limited research on factors associated with recidivism in the U.S. Using a population-based sample, we aim to: 1) identify the prevalence and risk factors for injury recidivism among non-institutionalized adults; 2) investigate the trend in nationwide recidivism rates over time.

Methods: Using the Medical Expenditure Panel Survey (MEPS), 19,134 adults with at least one reported injury were followed for about 2 years. Reported injuries were those associated with healthcare utilization, disability days or any effects on self-reported health. The independent associations between risk factors for recidivism were evaluated incorporating a weighted logistic regression model.

Results: There were 4,136 recidivists representing over nine million individuals in the U.S. over a 2-year follow-up. About 44 % of recidivists sustained severe injuries requiring a hospitalization, a physician's office visit or an emergency department visit. Compared with those who sustained a single injury, recidivists were more likely to be white, unmarried, reside in metropolitan areas, and report a higher prevalence of chronic conditions. Age, sex, race/ethnicity, marital status, urbanicity, region, diabetes, stroke, asthma and depression symptoms were significant predictors of recidivism. Significant interaction effects between age and gender suggested those in the 18-25 age group, the odds of being a recidivist were 1.45 higher among males than females adjusting for other covariates. While having positive screens for depression in both follow-up years was associated with 1.46 (95 % CI = 1.21-1.77) higher odds of recidivisms than the reference group adjusting for other variables.

Conclusions: We observed a higher recidivism rate among injured individuals in this study than previously reported. Our findings emphasize the pressing need for injury prevention to reduce the burden of repeated injuries. Preventative efforts may benefit from focusing on males between 18 and 25 years of age and those with comorbidities such as diabetes, stroke and depression.
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http://dx.doi.org/10.1186/s40621-016-0071-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737788PMC
December 2016

Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey.

Inj Prev 2017 04 5;23(2):87-92. Epub 2016 Sep 5.

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Background: Although opioid abuse is a rising epidemic in the USA, there are no studies to date on the incidence of persistent opioid use following injuries. Therefore, the aims of this study are: (1) to examine the incidence of persistent opioid use among a nationally representative sample of injured and non-injured populations; (2) to evaluate whether an injury is an independent predictor of persistent opioid use.

Method: Data from the Medical Expenditure Panel Survey were pooled (years 2009-2012). Adults were followed for about 2 years, during which they were surveyed about injury status and opioid use every 4-5 months. To determine whether injuries are associated with persistent opioid use, weighted multiple logistic regressions were constructed.

Results: While 2.3 million injured individuals received any opioid during the follow-up, 371 170 (15.6%) individuals became persistent opioid users (defined as opioid use across multiple time points). In a multiple logistic regression analysis adjusting for sociodemographic characteristics and self-reported health, those who sustained injuries were 1.4 times (95% CI 1.1 to 1.9) more likely to report persistent opioid use than those without injuries.

Conclusions: We found injuries to be significantly associated with persistent opioid use in a nationally representative sample. Further investment in injury prevention may facilitate reduction of persistent opioid use and, thus, improve population health and reduce health expenditures.
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http://dx.doi.org/10.1136/injuryprev-2016-042059DOI Listing
April 2017

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Authors:
Ali H Mokdad Mohammad Hossein Forouzanfar Farah Daoud Charbel El Bcheraoui Maziar Moradi-Lakeh Ibrahim Khalil Ashkan Afshin Marwa Tuffaha Raghid Charara Ryan M Barber Joseph Wagner Kelly Cercy Hannah Kravitz Matthew M Coates Margaret Robinson Kara Estep Caitlyn Steiner Sara Jaber Ali A Mokdad Kevin F O'Rourke Adrienne Chew Pauline Kim Mohamed Magdy Abd El Razek Safa Abdalla Foad Abd-Allah Jerry P Abraham Laith J Abu-Raddad Niveen M E Abu-Rmeileh Abdulwahab A Al-Nehmi Ali S Akanda Hanan Al Ahmadi Mazin J Al Khabouri Faris H Al Lami Zulfa A Al Rayess Deena Alasfoor Fadia S AlBuhairan Saleh F Aldhahri Suliman Alghnam Samia Alhabib Nawal Al-Hamad Raghib Ali Syed Danish Ali Mohammad Alkhateeb Mohammad A AlMazroa Mahmoud A Alomari Rajaa Al-Raddadi Ubai Alsharif Nihaya Al-Sheyab Shirina Alsowaidi Mohamed Al-Thani Khalid A Altirkawi Azmeraw T Amare Heresh Amini Walid Ammar Palwasha Anwari Hamid Asayesh Rana Asghar Ali M Assabri Reza Assadi Umar Bacha Alaa Badawi Talal Bakfalouni Mohammed O Basulaiman Shahrzad Bazargan-Hejazi Neeraj Bedi Amit R Bhakta Zulfiqar A Bhutta Aref A Bin Abdulhak Soufiane Boufous Rupert R A Bourne Hadi Danawi Jai Das Amare Deribew Eric L Ding Adnan M Durrani Yousef Elshrek Mohamed E Ibrahim Babak Eshrati Alireza Esteghamati Imad A D Faghmous Farshad Farzadfar Andrea B Feigl Seyed-Mohammad Fereshtehnejad Irina Filip Florian Fischer Fortuné G Gankpé Ibrahim Ginawi Melkamu Dedefo Gishu Rahul Gupta Rami M Habash Nima Hafezi-Nejad Randah R Hamadeh Hayet Hamdouni Samer Hamidi Hilda L Harb Mohammad Sadegh Hassanvand Mohammad T Hedayati Pouria Heydarpour Mohamed Hsairi Abdullatif Husseini Nader Jahanmehr Vivekanand Jha Jost B Jonas Nadim E Karam Amir Kasaeian Nega Assefa Kassa Anil Kaul Yousef Khader Shams Eldin A Khalifa Ejaz A Khan Gulfaraz Khan Tawfik Khoja Ardeshir Khosravi Yohannes Kinfu Barthelemy Kuate Defo Arjun Lakshmana Balaji Raimundas Lunevicius Carla Makhlouf Obermeyer Reza Malekzadeh Morteza Mansourian Wagner Marcenes Habibolah Masoudi Farid Alem Mehari Abla Mehio-Sibai Ziad A Memish George A Mensah Karzan A Mohammad Ziad Nahas Jamal T Nasher Haseeb Nawaz Chakib Nejjari Muhammad Imran Nisar Saad B Omer Mahboubeh Parsaeian Emmanuel K Peprah Aslam Pervaiz Farshad Pourmalek Dima M Qato Mostafa Qorbani Amir Radfar Anwar Rafay Kazem Rahimi Vafa Rahimi-Movaghar Sajjad Ur Rahman Rajesh K Rai Saleem M Rana Sowmya R Rao Amany H Refaat Serge Resnikoff Gholamreza Roshandel Georges Saade Mohammad Y Saeedi Mohammad Ali Sahraian Shadi Saleh Lidia Sanchez-Riera Maheswar Satpathy Sadaf G Sepanlou Tesfaye Setegn Amira Shaheen Saeid Shahraz Sara Sheikhbahaei Kawkab Shishani Karen Sliwa Mohammad Tavakkoli Abdullah S Terkawi Olalekan A Uthman Ronny Westerman Mustafa Z Younis Maysaa El Sayed Zaki Faiez Zannad Gregory A Roth Haidong Wang Mohsen Naghavi Theo Vos Abdullah A Al Rabeeah Alan D Lopez Christopher J L Murray

Lancet Glob Health 2016 10 25;4(10):e704-13. Epub 2016 Aug 25.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.

Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically.

Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred.

Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.

Funding: Bill & Melinda Gates Foundation.
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http://dx.doi.org/10.1016/S2214-109X(16)30168-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660972PMC
October 2016

Work-Related Injuries and Health-Related Quality of Life Among US Workers: A Longitudinal Study of a Population-Based Sample.

J Occup Environ Med 2016 Apr;58(4):385-90

Occupational and Environmental Medicine Training Program (Dr Baragaba); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (Dr Alghnam); and Division of Occupational Medicine, The Johns Hopkins University School of Medicine, The Johns Hopkins Health System and University, Baltimore, Maryland (Dr Bernacki).

Objective: The aim of this study is to examine health-related quality of life (HRQOL) among U.S. injured workers using a longitudinal study of a nationally representative sample.

Methods: Employed adults with and without occupational injuries from the 2000 to 2011 Medical Expenditure Panel Survey (MEPS) were included. Outcomes were the physical and mental components of the SF-12. A within-person change using paired tests and a between-person change using multivariable regression were performed.

Results: We estimate over 1.6 million injured workers per year. Sprains were the most common injury. Relative to noninjured workers, injured workers reported 3.0 and 1.0 points lower physical and mental component scores, respectively.

Conclusions: These results confirm that occupational injuries cause significant deficits in the physical component of HRQOL. This highlights the importance of preventing occupational injuries to reduce associated disabilities in the U.S.
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http://dx.doi.org/10.1097/JOM.0000000000000667DOI Listing
April 2016

Estimating annual medical and out-of-pocket expenditures associated with traumatic injuries in the United States.

J Trauma Acute Care Surg 2016 Feb;80(2):258-64

From the Department of Health Policy and Management (S.A., R.C.), Johns Hopkins Bloomberg School of Public Health; and Health Policy and Management (D.G.), and Health, Behavior and Society (R.T.), Johns Hopkins University, Baltimore, Maryland; and Population Health (D.V.), University of Wisconsin, Madison, Wisconsin.

Background: Every year, as many as 31 million Americans sustain traumatic injuries, leaving survivors with risks of disabilities and health settings with staggering medical costs. Little is known on the societal burden of injuries in terms of medical and out-of-pocket expenditures. Therefore, we used a nationally representative sample to evaluate the association between injuries and health expenditures among a nationally representative US sample.

Methods: This study used years 2006 to 2010 (Panels 11-14; n = 53,065) of the Medical Expenditure Panel Survey. Each panel was followed up for 2 years. Total expenditures included insurance payments and out-of-pocket costs. Two-part models were constructed to examine differences in annual medical expenditures between injured and noninjured populations controlling for confounding effects.

Results: A total of 4,210 individuals (7.9%) reported injuries representing 21.5 million individuals. Injured individuals were more likely to be males, to be white, and to report higher medical expenditures in the second year than the reference population (p < 0.01). Adjusted analyses showed that reporting any injury was associated with $2,577 (95% confidence interval [CI], $2,049-$3,103) and $186 (95% CI, $142-$230) increase in total and out-of-pocket costs, respectively. While a moderate or severe injury was associated with $4,779 (95% CI, $3,947-$5,610) increase in the average of medical expenditures and $256 (95% CI, $190-$322) increase in out-of-pocket costs adjusting for covariates. Our adjusted national medical cost of injuries was estimated at $56 billion and out-of-pocket cost to be approximately $4 billion.

Conclusion: Injuries pose a substantial burden on medical expenditures in the United States. Investment in injury prevention can facilitate reducing medical expenditures and save resources. Prevention programs may use the out-of-pocket findings to highlight injury burden on individual's prosperity and thus facilitate engagement of the public in prevention.

Level Of Evidence: Economic and evaluation study, level III.
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http://dx.doi.org/10.1097/TA.0000000000000910DOI Listing
February 2016

Insurance status and health-related quality-of-life disparities after trauma: results from a nationally representative survey in the US.

Qual Life Res 2016 Apr 4;25(4):987-95. Epub 2015 Sep 4.

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, Hampton House 543, Baltimore, MD, 21205, USA.

Purpose: To determine whether insurance status modifies the association between injuries and health-related quality of life (HRQOL) in a nationally representative sample of US adults.

Methods: This is a longitudinal, observational study using the pooled 2000-2006 Medical Expenditure Panel Survey (MEPS). A total of 50,225 adults (age ≥ 18) with or without injuries were included in the study. HRQOL was evaluated using the EuroQoL Health Index (EQ-5D), visual analog scale (VAS), and the SF-12 physical component score (PCS) and mental component score (MCS). A categorical variable of injury-insurance combinations was created (not injured-privately insured, not injured-publically insured, not injured-uninsured, injured-privately insured, injured-publically insured, or injured-uninsured) and was included in the linear regression models. Adjustment covariates included age, gender, education, race, diabetes, hypertension, and baseline self-reported health. Healthcare utilization was also examined among the study population by injury status and across insurance groups.

Results: Seven hundred and ten individuals reported injuries. Adjusted analyses showed that injured individuals with public insurance had lower EQ-5D (-0.25), VAS (-11.4), PCS (-8.5), and MCS (-4.9) than the privately insured controls, while uninsured had EQ-5D, VAS, PCS and MCS that were, respectively, -0.12, -7.2, -2.6 and -4.1 relative to privately insured controls. With the exception of hospital discharges, healthcare utilization among uninsured individuals was lower than those with public or private insurance.

Conclusions: We found injured individuals to have lower HRQOL than those without injuries, and this effect was exacerbated by insurance status. These findings call for interventions aimed to narrow the outcome disparity among injured in the US.
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http://dx.doi.org/10.1007/s11136-015-1126-0DOI Listing
April 2016

Long-term outcomes of individuals injured in motor vehicle crashes: A population-based study.

Injury 2015 Aug 11;46(8):1503-8. Epub 2015 Jun 11.

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, HH 544 624 N. Broadway, Baltimore, MD 21205, USA.

Background: Despite decline in U.S. traffic fatalities, non-fatal injuries remain a main cause of reduced self-reported health. The authors used a nationally representative survey to examine the long-term (≥1 year) implications of traffic injuries on self-care, depression, mobility, pain and activity domains of a widely used measure assessing Health-Related Quality of Life (HRQOL).

Methods: 30,576 participants from panels (2000-2002) of the Medical Expenditure Panel Survey (MEPS) were followed for about two years. The associations between reporting a traffic injury in the first follow-up year and the five domains of the Euroqol Health index (EQ-5D) were assessed using mixed logistic models with outcome severe/moderate problem in each domain. Models adjustment variables included age, gender, education, income, diabetes, asthma, smoking and insurance status.

Results: 590 participants reported traffic injuries. In the first follow-up analysis, having an injury was associated with deficits in all domains of the EQ-5D. With the exception of self-care, similar findings were reported in the second follow-up (≥1 year) after injuries with strongest associations between traffic injuries and both mobility and activity (both OR=2.9, P<0.01).

Conclusions: Traffic injuries are significantly associated with long-term reduced HRQOL. Injured individuals may benefit from early intervention programs to prevent the development of secondary complications and reduced HRQOL.
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http://dx.doi.org/10.1016/j.injury.2015.06.004DOI Listing
August 2015

Burden of traumatic injuries in Saudi Arabia: lessons from a major trauma registry in Riyadh, Saudi Arabia.

Ann Saudi Med 2014 Jul-Aug;34(4):291-6

Dr. Suliman Alghnam, King Abdullah International Research Center (KAIMRC) Population Health, PO Box 22490 Riyadh 11426 Saudi Arabia, T: 966566639414,

Background And Objectives: In Saudi Arabia (SA), injuries are the second leading cause of death; however, little is known about their frequencies and outcomes. Trauma registries play a major role in measuring the burden on population health. This study aims to describe the population of the only hospital-based trauma registry in the country and highlight challenges and potential opportunities to improve trauma data collection and research in SA.

Design And Settings: Using data between 2001 and 2010, this retrospective study included patients from a large trauma center in Riyadh, SA.

Patients And Methods: A staff nurse utilized a structured checklist to gather information on patients' demographic, physiologic, anatomic, and outcome variables. Basic descriptive statistics by age group ( 14 years) were calculated, and differences were assessed using student t and chi-square tests. In addition, the mechanism of injury and the frequency of missing data were evaluated.

Results: 10 847 patients from the trauma registry were included. Over 9% of all patients died either before or after being treated at the hospital. Patients who were older than 14 years of age (more likely to be male) sustained traffic-related injuries and died in the hospital as compared to patients who were younger than or equal to years of age. Deceased patients were severely injured as measured by injury severity score and Glasgow Coma Scale (P < .001). Overall, the most frequent type of injury was related to traffic (52.0%), followed by falls (23.4%). Missing values were mostly prevalent in traffic-related variables, such as seatbelt use (70.2%).

Conclusion: This registry is a key step toward addressing the burden of injuries in SA. Improved injury classification using the International Classification of Disease-external cause codes may improve the quality of the registry and allow comparison with other populations. Most importantly, injury prevention in SA requires further investment in data collection and research to improve outcomes.
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http://dx.doi.org/10.5144/0256-4947.2014.291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152567PMC
November 2015