搜索结果：Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention

Children of parents with diagnosed mental health and addiction conditions have a higher risk of unintentional injuries compared with children of parents without those conditions. This study quantifies and compares the risk of unintentional injury among children whose parents are diagnosed with mood and anxiety disorders compared with children of parents without these conditions in Alberta, Canada. This retrospective case-control study used administrative health data to identify cases of children aged 0-9 with an unintentional injury and matched controls without an unintentional injury. Children were identified as 'infant', 'preschool' or 'school-age' based on age at injury and were linked to their parents' health records. Conditional logistic regression estimated unadjusted and adjusted odds ratios (ORs) of unintentional injury given parental anxiety or mood disorder compared with unintentional injury given no parental mental health and addiction conditions. The crude unadjusted risk of unintentional injury was elevated among children with parents diagnosed with anxiety (infant OR=1.24; preschool OR=1.25; school-age OR=1.18) and mood (infant OR=1.32; preschool OR=1.15; school-age OR=1.22) disorders compared with children of parents without those disorders. Following propensity score adjustment and adjustment for presence of other mental health and addiction conditions, all ORs remained positive. Consistent with international findings, parental diagnosis of mood and anxiety disorders was associated with an increased risk of unintentional injury in children in Alberta, even when adjusting for presence of other disorders. Childhood unintentional injury may impact development and perpetuate a cycle of mental health and addiction conditions, warranting further investigation.

This commentary synthesises insights from the 15th World Conference on Injury Prevention and Safety Promotion (Safety 2024) to propose an actionable agenda for researchers, practitioners and policymakers in injury prevention and violence reduction. Building on established injury prevention science, it translates emerging global challenges-climate disruption, precarious funding and commercial pressures-into concrete strategic priorities for the field.The Delhi Safety 2024 Conference highlighted that injuries are deeply rooted in societal, commercial and environmental factors, disproportionately affecting marginalised communities. Key themes were as follows: (1) Social Determinants and Community-Driven Solutions, (2) Climate Change as a Threat Multiplier: Integrating Safety into Planetary Health, (3) Sustainable Funding and Strategic Partnerships: Navigating the Current Landscape, and (4) Evidence, Advocacy, and Innovation: Driving Lasting Change.Planetary health-a framework recognising the interdependence of human health and natural systems-provides a critical lens for understanding how environmental degradation and climate change amplify injury risks. Equitable and sustainable implementation requires identifying evidence-based solutions for marginalised groups, aligning with planetary health agendas, developing strategic partnerships and driving policy change.This forward-looking synthesis bridges current practice with emerging priorities, providing stakeholders with a roadmap for action. By centring equity, embracing intersectoral collaboration and confronting commercial and environmental determinants, the injury prevention field can build more resilient and just systems that protect all communities.

Robust, unbiased injury data are essential for guiding effective prevention strategies, but Ghana lacks this. Religious-based organisations (RBOs) have played a significant role in addressing health needs; however, they have not been explored as a platform for injury data collection. This study explores the acceptability of using RBOs for such a purpose. A survey was conducted among RBOs in the Kumasi Metropolitan area, Ghana. Respondents over 18 years, who had participated in an injury survey, took part in this sub-study on acceptability. The theoretical framework of acceptability was used to examine the acceptance of injury data collection in RBOs. Analysis was conducted descriptively, and ANOVA/t-test was used to assess the differences in acceptability by demographics. A total of 304 members and 29 leaders of RBOs participated in the study. The average age of members was 41.25 years and leaders 48.80 years. A higher percentage of members were women, and all leaders were men. RBO members and leaders rated the theoretical framework of acceptability questions positively. The estimated standardised mean acceptability score (mean=75.60) was high. Acceptability did not differ between members and leaders. There was no significant difference in the mean acceptability score by sex or type of RBO. Leaders and members were concerned about interference with data collection in RBOs, particularly regarding their priorities. This study demonstrates an acceptance of using RBOs as a platform for injury data collection. The high acceptance makes this a viable alternative for routine injury data collection, which could help address the injury data gaps. A qualitative inquiry is needed to provide an in-depth understanding of acceptance.

Drowning is the third leading cause of unintentional injury deaths worldwide. While multiple factors contribute to the risk of drowning, drowning settings, patterns and rates vary by age. Drowning prevention efforts should be tailored based on age; however, most drowning prevention interventions focus on children and do not address the injury burden in older adults that disproportionately affects ageing societies. A formal rapid review of drowning prevention studies of adults aged 50 years and older published between 1 January 2008 and 30 November 2025 was conducted. Results were analysed using Haddon's matrix, a tool that organises interventions by different phases of injury and injury components. Eight studies were eligible for data extraction. Most interventions targeted the general population, reporting differing age ranges of older adults. Most studies used a predrowning behavioural intervention for both young and older populations in high-income countries. Drowning prevention research in older adults was limited, lacking common definitions of what age groups constitute older adults and lacking diversity in levels of prevention, target injury components and settings unique to older adults. Recent studies indicate that drowning risk factors for older adults differ from those of other age groups and underscore the importance of focusing drowning prevention efforts on this growing high-risk group. Future drowning prevention efforts for older adults need to address the unique risk factors of the older age group and a wider array of types of prevention.

Relatively little research has examined the correlates of suicidal ideation (SI) and non-suicidal self-injury (NSSI) in children. To address this gap, we sought to identify demographic, psychological and parent-related factors associated with increased SI and NSSI in this population. Participants were 697 children (ages 7-11; 62.6% Non-Hispanic White; 51.9% boys) and their mothers recruited from the community. Information was collected regarding children's histories of SI and NSSI, demographics, children's and mothers' psychopathology, mothers' prior suicide attempt and parenting styles. SI and NSSI were relatively common in this age range, with lifetime rates of 12.6% and 6.3%, respectively. Rates of both outcomes were higher in boys, Hispanic youth, children with histories of major depression or post-traumatic stress disorder, children with higher levels of internalising and externalising symptoms and children of mothers with histories of agoraphobia. Additional relations were specific to SI (child history of generalised anxiety disorder, mother's prior suicide attempt and maternal warmth) or NSSI (minority race, mother history of panic disorder and maternal authoritarianism). Results provide evidence for correlates of SI and NSSI in children spanning demographic, psychopathology-related and parenting variables, which may further our understanding of which children are at greatest risk for self-injurious thoughts and behaviours.

BACKGROUND: Child sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school-based education programmes. Although programmes have been taught in schools since the 1980s, their effectiveness requires ongoing scrutiny. OBJECTIVES: To systematically assess evidence of the effectiveness of school-based education programmes for the prevention of child sexual abuse. Specifically, to assess whether: programmes are effective in improving students' protective behaviours and knowledge about sexual abuse prevention; behaviours and skills are retained over time; and participation results in disclosures of sexual abuse, produces harms, or both. SEARCH METHODS: In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE and 11 other databases. We also searched two trials registers and screened the reference lists of previous reviews for additional trials. SELECTION CRITERIA: We selected randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of school-based education interventions for the prevention of child sexual abuse compared with another intervention or no intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of trials for inclusion, extracted data, and assessed risk of bias. We summarised data for six outcomes: protective behaviours; knowledge of sexual abuse or sexual abuse prevention concepts; retention of protective behaviours over time; retention of knowledge over time; harm; and disclosures of sexual abuse. MAIN RESULTS: This is an update of a Cochrane Review that included 15 trials (up to August 2006). We identified 10 additional trials for the period to September 2014. We excluded one trial from the original review. Therefore, this update includes a total of 24 trials (5802 participants). We conducted several meta-analyses. More than half of the trials in each meta-analysis contained unit of analysis errors.1. Meta-analysis of two trials (n = 102) evaluating protective behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval (CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi² = 1.37, df = 1, P value = 0.24, I² = 27%, Tau² = 0.16). The results did not change when we made adjustments using intraclass correlation coefficients (ICCs) to correct errors made in studies where data were analysed without accounting for the clustering of students in classes or schools.2. Meta-analysis of 18 trials (n = 4657) evaluating questionnaire-based knowledge favoured intervention (standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was substantial heterogeneity (Chi² = 104.76, df = 17, P value < 0.00001, I² = 84%, Tau² = 0.10). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.66, 95% CI 0.51 to 0.81; ICC: 0.2 SMD 0.63, 95% CI 0.50 to 0.77).3. Meta-analysis of 11 trials (n =1688) evaluating vignette-based knowledge favoured intervention (SMD 0.45, 95% CI 0.24 to 0.65), but there was substantial heterogeneity (Chi² = 34.25, df = 10, P value < 0.0002, I² = 71%, Tau² = 0.08). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.53, 95% CI 0.32 to 0.74; ICC: 0.2 SMD 0.60, 95% CI 0.31 to 0.89).4. We included four trials in the meta-analysis for retention of knowledge over time. The effect of intervention seemed to persist beyond the immediate assessment (SMD 0.78, 95% CI 0.38 to 1.17; I² = 84%, Tau² = 0.13, P value = 0.0003; n = 956) to six months (SMD 0.69, 95% CI 0.51 to 0.87; I² = 25%; Tau² = 0.01, P value = 0.26; n = 929). The results did not change when adjustments were made using ICCs.5. We included three studies in the meta-analysis for adverse effects (harm) manifesting as child anxiety or fear. The results showed no increase or decrease in anxiety or fear in intervention participants (SMD -0.08, 95% CI -0.22 to 0.07; n = 795) and there was no heterogeneity (I² = 0%, P value = 0.79; n=795). The results did not change when adjustments were made using ICCs.6. We included three studies (n = 1788) in the meta-analysis for disclosure of previous or current sexual abuse. The results favoured intervention (OR 3.56, 95% CI 1.13 to 11.24), with no heterogeneity (I² = 0%, P value = 0.84). However, adjusting for the effect of clustering had the effect of widening the confidence intervals around the OR (ICC: 0.1 OR 3.04, 95% CI 0.75 to 12.33; ICC: 0.2 OR 2.95, 95% CI 0.69 to 12.61).Insufficient information was provided in the included studies to conduct planned subgroup analyses and there were insufficient studies to conduct meaningful analyses.The quality of evidence for all outcomes included in the meta-analyses was moderate owing to unclear risk of selection bias across most studies, high or unclear risk of detection bias across over half of included studies, and high or unclear risk of attrition bias across most studies. The results should be interpreted cautiously. AUTHORS' CONCLUSIONS: The studies included in this review show evidence of improvements in protective behaviours and knowledge among children exposed to school-based programmes, regardless of the type of programme. The results might have differed had the true ICCs or cluster-adjusted results been available. There is evidence that children's knowledge does not deteriorate over time, although this requires further research with longer-term follow-up. Programme participation does not generate increased or decreased child anxiety or fear, however there is a need for ongoing monitoring of both positive and negative short- and long-term effects. The results show that programme participation may increase the odds of disclosure, however there is a need for more programme evaluations to routinely collect such data. Further investigation of the moderators of programme effects is required along with longitudinal or data linkage studies that can assess actual prevention of child sexual abuse.

Preventable unintentional injuries are a leading cause of death, disability and hospitalisation for children worldwide. Researchers work with parents to understand their perspectives on children's safety and to mitigate the likelihood of children being injured. While recent evidence suggests that exposure to injuries can heighten parents' awareness for child safety threats, little is known on how occupational exposure to severe injuries and death, such as those witnessed in emergency departments by physicians and nurses, may shape parents' emotional well-being and child safety perspectives. To address this gap in knowledge, we conducted semi-structured interviews with physicians (n=40) and nurses (n=16) across Canada with emergency room experience. Our approach was informed by tenets of narrative inquiry and we conducted a thematic narrative analysis. We identified two themes: (1) 'Moments you carry with you forever': Exposure to severe child injuries and death results in declines in emotional well-being; and (2) 'Where was the supervising parent?': Exposure heightens awareness for preventable injuries. Exposure can result in physicians and nurses exercising more caution towards activities and environments that could result in their children experiencing similar injuries to their patients. As a result of witnessing injuries and death, physicians and nurses can have declines in well-being, more awareness for safety threats, and they can feel frustration towards children experiencing injuries they perceive as preventable.

Sport-related injuries account for a significant proportion of injuries in Canadian youth, though their recent epidemiology is unknown. The objective of this study was to investigate the trends in organised sport and recreation-related injuries in the paediatric population (0-17 years) of Southwestern Ontario from January 2017 to June 2023. Data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were used to analyse the patterns of paediatric sport and recreation-related injuries at the London Health Sciences Center Children's Emergency Department (ED). The study period was further divided into prepandemic, peri-pandemic and post-pandemic time frames to better understand the impact of COVID-19 restrictions on the frequency of injuries. Over the 6-year study period, there was a significant decrease in the number of sport and recreation-related injuries. The pre-COVID study period had the most injuries (N=4286), followed by post-COVID (N=1151) and peri-COVID (N=164). Approximately 30% of injuries in each time frame required ED follow-up, referral or admission to hospital. Ice hockey, soccer, basketball, football and physical education were the five sports resulting in highest total number of injuries. The head was the most reported body part injured and 10-year to 14-year olds had the greatest number of injuries in all time periods. Ours is the first study we are aware of that describes the trends in sport and recreation-related injuries in children and how the pandemic impacted their patterns and frequency. The results provide direction for injury prevention and education, though further research is needed.

BACKGROUND: Numerous studies demonstrate associations between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and a variety of common disorders, including musculoskeletal, metabolic, cardiovascular, malignant, autoimmune, and infectious diseases. Although a causal link between serum 25(OH)D concentrations and many disorders has not been clearly established, these associations have led to widespread supplementation with vitamin D and increased laboratory testing for 25(OH)D in the general population. The benefit-risk ratio of this increase in vitamin D use is not clear, and the optimal vitamin D intake and the role of testing for 25(OH)D for disease prevention remain uncertain. OBJECTIVE: To develop clinical guidelines for the use of vitamin D (cholecalciferol [vitamin D3] or ergocalciferol [vitamin D2]) to lower the risk of disease in individuals without established indications for vitamin D treatment or 25(OH)D testing. METHODS: A multidisciplinary panel of clinical experts, along with experts in guideline methodology and systematic literature review, identified and prioritized 14 clinically relevant questions related to the use of vitamin D and 25(OH)D testing to lower the risk of disease. The panel prioritized randomized placebo-controlled trials in general populations (without an established indication for vitamin D treatment or 25[OH]D testing), evaluating the effects of empiric vitamin D administration throughout the lifespan, as well as in select conditions (pregnancy and prediabetes). The panel defined "empiric supplementation" as vitamin D intake that (a) exceeds the Dietary Reference Intakes (DRI) and (b) is implemented without testing for 25(OH)D. Systematic reviews queried electronic databases for publications related to these 14 clinical questions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of evidence and guide recommendations. The approach incorporated perspectives from a patient representative and considered patient values, costs and resources required, acceptability and feasibility, and impact on health equity of the proposed recommendations. The process to develop this clinical guideline did not use a risk assessment framework and was not designed to replace current DRI for vitamin D. RESULTS: The panel suggests empiric vitamin D supplementation for children and adolescents aged 1 to 18 years to prevent nutritional rickets and because of its potential to lower the risk of respiratory tract infections; for those aged 75 years and older because of its potential to lower the risk of mortality; for those who are pregnant because of its potential to lower the risk of preeclampsia, intra-uterine mortality, preterm birth, small-for-gestational-age birth, and neonatal mortality; and for those with high-risk prediabetes because of its potential to reduce progression to diabetes. Because the vitamin D doses in the included clinical trials varied considerably and many trial participants were allowed to continue their own vitamin D-containing supplements, the optimal doses for empiric vitamin D supplementation remain unclear for the populations considered. For nonpregnant people older than 50 years for whom vitamin D is indicated, the panel suggests supplementation via daily administration of vitamin D, rather than intermittent use of high doses. The panel suggests against empiric vitamin D supplementation above the current DRI to lower the risk of disease in healthy adults younger than 75 years. No clinical trial evidence was found to support routine screening for 25(OH)D in the general population, nor in those with obesity or dark complexion, and there was no clear evidence defining the optimal target level of 25(OH)D required for disease prevention in the populations considered; thus, the panel suggests against routine 25(OH)D testing in all populations considered. The panel judged that, in most situations, empiric vitamin D supplementation is inexpensive, feasible, acceptable to both healthy individuals and health care professionals, and has no negative effect on health equity. CONCLUSION: The panel suggests empiric vitamin D for those aged 1 to 18 years and adults over 75 years of age, those who are pregnant, and those with high-risk prediabetes. Due to the scarcity of natural food sources rich in vitamin D, empiric supplementation can be achieved through a combination of fortified foods and supplements that contain vitamin D. Based on the absence of supportive clinical trial evidence, the panel suggests against routine 25(OH)D testing in the absence of established indications. These recommendations are not meant to replace the current DRIs for vitamin D, nor do they apply to people with established indications for vitamin D treatment or 25(OH)D testing. Further research is needed to determine optimal 25(OH)D levels for specific health benefits.

Paediatric injuries are the leading cause of morbidity and mortality worldwide, with unintentional trauma disproportionately affecting vulnerable populations. Social determinants of health, including socioeconomic status, race and insurance type, significantly influence injury outcomes. Injury pyramids serve as a valuable tool for visualising these disparities and informing targeted prevention strategies. A retrospective cohort analysis was conducted on 6466 paediatric trauma cases recorded at St. Joseph's Children's Hospital (2010-2021) in Tampa, Florida. Incidence rates per 100&#x2009;000 persons were calculated for emergency department visits, hospitalisations and deaths, stratified by sex, age, race, county and insurance type. &#x3c7;&#xb2; analysis assessed statistical significance. The injury pyramid revealed 88.6 emergency visits, 47.6 hospitalisations and 2.4 deaths per 100&#x2009;000 persons. Falls, motor vehicle crashes and sports-related injuries were the leading causes of emergency visits and hospitalisations. Drowning, motor vehicle crashes and gunshot wounds were the primary causes of death. Black children had a higher incidence of firearm-related fatalities, while White children had higher rates of drowning and motor vehicle fatalities. Publicly insured children exhibited greater injury severity compared with those with private insurance. Injury pyramids effectively highlight paediatric trauma disparities, emphasising the need for population-specific prevention strategies. Injury pyramids are effective in intervention development, mitigating health disparities and informing policy development. The integration of conceptual frameworks such as the Haddon Matrix and Injury Equity Framework may enhance understanding of the social and structural contributors to paediatric trauma disparities.

Patients with traumatic brain injury (TBI) are at a greater risk of subsequent violent victimisation, and a prognostic model can assist in identifying those at highest risk who can benefit from targeted interventions. We aimed to develop and internally validate a clinical prediction model to estimate the risk of violent victimisation following TBI in adolescence. We investigated a cohort of adolescents aged 10 to 24 exposed to TBI between 2009 and 2023, using data from a linked register, covering 86% of the population in Wales, the Secure Anonymised Information Linkage (SAIL) Databank. We fitted a multivariable Cox regression model for the association between predictors and time to violent victimisation identified in medical records, with optimism-corrected bootstrapping for internal validation. Key performance measures, including discrimination and calibration, were examined at 1 and 3 years post-TBI. The cohort included 34 092 adolescents, of whom 332 (1.0%) were violently victimised within 1 year and 701 (2.1%) within 3 years of the TBI. The final model included a range of predictors including calendar age, sex at birth, substance misuse, psychiatric conditions, neurological conditions, conduct disorder, learning difficulties and a history of victimisation or self-harm. The clinical prediction model showed good calibration and moderate discrimination at 1 (area under the curve (AUC)=0.72) and 3 years (AUC=0.67) post-TBI. This brief, scalable and evidence-based prediction model showed moderate predictive performance at internal validation. External validation is necessary to test the model's transportability. A large population-based sample was used to identify risk factors for violent victimisation and develop a novel clinical prediction model for use in adolescents with TBI.

Children and adolescents are at an increased risk of unintentional injuries, indicating the importance of recognising the characteristics of high-risk groups. This study aimed to identify the risk profile of unintentional injuries among children and adolescents at elementary and high schools, respectively. A multistage cluster sampling method was used to select the participants. Multivariate logistic regression analyses were conducted to identify the risk profile of unintentional injuries among children and adolescents at elementary and high schools, respectively. For elementary school students, those with higher age (OR: 1.20, 95%&#x2009;CI 1.10 to 1.30) were at an increased risk, while girls (OR: 0.60, 95%&#x2009;CI 0.44 to 0.81), and those accommodated at home (OR: 0.59, 95%&#x2009;CI 0.39 to 0.91), with high educational level for guardians (OR: 0.47, 95%&#x2009;CI 0.30 to 0.71), and with guardian passive (OR: 0.55, 95%&#x2009;CI 0.31 to 0.97) or both sides initiative (OR: 0.43, 95%&#x2009;CI 0.27 to 0.68) communication attitude were at a decreased risk of unintentional injuries. Additionally, for high school students, those accommodated at home (OR: 3.08, 95%&#x2009;CI 1.71 to 5.54) were at an increased risk, while girls (OR: 0.43, 95%&#x2009;CI 0.24 to 0.78), and either father or mother working outside (OR: 0.26, 95%&#x2009;CI 0.08 to 0.83) were at a decreased risk of unintentional injuries. The risk profile of unintentional injuries among children and adolescents at elementary schools differed from that among children and adolescents at high schools in Shenzhen, China, suggesting that different intervention strategies should be implemented to children and adolescents with different educational levels.

Substance use can elevate the risk and severity of domestic assault. Using US emergency medical services (EMS) data, this study examined domestic assault severity and associated substance use across the life course. This study used 2019 National Emergency Medical Services Information System (NEMSIS) data to describe patient substance use and injury severity among domestic assault cases (n=176&#x2009;931). Substance use was compared across demographic groups and severity of injury (patient acuity, neurological impairment and transport to trauma centre). Multinomial regression analysed the association between substance use and injury severity indicators. While alcohol was the most frequent substance used, drug use and combined use were more common with severe injuries. Male patients had higher odds of all severe injury indicators with drug use or combined use. Female patients had increased odds of severe injury with any substance use. When stratified by sex, alcohol use significantly contributed to injury differences between male and female patients. Specifically, alcohol use increased the risk of severe injuries for female patients and decreased or had no impact on the risk of severe injuries for male patients. NEMSIS data showed that substance use increased the risk of severe injury from domestic assault across every stage of life, furthering the call for gender-specific interventions in emergency medical care that address these co-occurring issues to prevent severe violence.

BACKGROUND: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS: Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING: Bill & Melinda Gates Foundation.

Many children in Victoria, Australia, undertake swimming lessons to reduce drowning risk; however, benchmark standards are frequently not achieved, implying a disconnect between lesson participation and skill attainment. Existing research often relies on parent/carer perceptions as a proxy for children's swimming ability, despite evidence that such perceptions may misalign with actual ability and potentially contribute to supervisory complacency. Therefore, this study examined parent/carer and child perceptions of swimming distance against children's objectively assessed swim distance and explored demographic variations in swimming distance. This cross-sectional study collected parent/carer and child surveys prior to a school-based swimming programme, capturing demographics and perceived swimming distance relative to national benchmarks. Trained instructors objectively assessed children's ability to swim continuously for up to 50 m. Overall, 365 parent-child dyads from 12 schools participated. 58% of parents/carers and 48% of children accurately assessed the child's swimming distance. Parent/carer perceptions were more accurate for children who could swim 50 m or could not swim at all, but less accurate for moderate swimming distances. Greater swimming distance was associated with higher parent/carer and child perceptions, higher household income, frequent swimming in controlled waterways, private swimming lessons and having a parent/carer born in Australia. Parent/carer perceptions alone are insufficient indicators of children's swimming distance, highlighting the need to actively engage parents/carers in children's swimming development. Misalignment between swimming programmes and national benchmarks may further confuse parent/carer expectations. Demographic variations in swimming distance reinforce the need for accessible, inclusive and regular programmes for all children.

Firearm-related injuries and deaths present a significant public health challenge in the USA, with high rates of firearm ownership, firearm injury and political divisiveness on prevention approaches. Secure firearm storage, especially during times of suicide risk, is an evidence-based, broadly supported approach. Partnerships with firearm businesses (known as 'Gun Shop Projects') can help promote secure storage messages in populations who might not readily interface with medical or public health agencies. To date, these partnerships have generally focused on civilian populations in local regions, yet military populations have high rates of firearm suicide. Here, we describe the development of the Pause to Protect programme, a partnership initiative designed to engage firearm businesses near US military bases with a primary focus on military Service Members and their families. The programme seeks to promote secure firearm storage and injury prevention through education, resources and voluntary storage services. Programme business partners, located near ten bases in 10 US states, received a financial stipend and ongoing technical assistance. The programme website offers business materials and customer education resources usable by any US firearm business, along with an online national map showing businesses willing to store firearms. Ongoing programme evaluation includes quantitative longitudinal surveys and qualitative interviews with businesses and other stakeholders. Programme establishment and ongoing engagement highlight partner and military base enthusiasm for this type of partnership to support education and voluntary action for firearm injury prevention in military and civilian communities. Areas for ongoing consideration include programme growth and sustainability.

Interpersonal firearm injury (FI) is a leading cause of morbidity and mortality among Americans. Those who experience FI are at increased risk of reinjury. Hospital-based violence intervention programmes (HVIPs) provide case management to interrupt the cycle of violence. The objective of this study was to analyse facilitators and barriers in the implementation of a novel HVIP: the Interrupting Violence in Youth and Young Adults (IVYY) Project. Semistructured interviews were performed with 27 key informants including hospital staff, IVYY team members and violence intervention specialists (VIs) to elicit awareness, facilitators and barriers. Data were analysed with MAXQDA software. Themes were mapped to Consolidated Framework for Implementation Research domains. Domains include: intervention characteristics (programme itself), outer setting (external systems affecting the programme), inner setting (where the programme is implemented), individual characteristics (roles of individuals involved) and the implementation process. Within the intervention characteristics domain, IVYY's knowledgeable leadership was a facilitator. One outer setting facilitator was the local demand for violence prevention, and a barrier was local attitudes about gun violence as a 'poor problem'. The inner setting (the hospital) facilitated implementation by providing space for the programme. In the individual characteristics domain, one strong facilitator was the VIs; hiring credible messengers with lived experiences is integral to programme success. HVIPs are increasingly used as an integral component of treating victims of FI. By highlighting the facilitators and barriers to IVYY implementation, we offer insight and recommendations on best practices for HVIP implementation and replication.

Protecting children aged 1-5 years from drowning in low-income deltaic or riverine regions like the Sundarbans, India, has proven to be challenging due to resource and access constraints. Fencing of water bodies to prevent access is one low-cost intervention proposed for resource-limited settings. We co-developed, implemented a prototype and conducted a process evaluation of a fencing intervention for the first time in a low-income region and assessed its acceptability and feasibility. The study was conducted in the rural region of Sundarbans, India, which faces some of the highest child drowning rates globally. 100 households with children received the intervention where nearby ponds were fenced and monitored over 1 year. The process evaluation was guided by UK Medical Research Council's Guidance for Evaluating Complex Interventions. Quantitative data assessing the fence's safety and use were collected at baseline and four quarterly monitoring visits. Qualitative data was collected from participants, non-participants, self-motivated fence-builders and project team members to understand barriers and enablers to usage and maintenance. Results showed high levels of acceptability by community members, who showed ownership to build and maintain the fencing. However, long-term sustainability may be impacted for those unable to afford materials for maintenance. Community engagement was essential in ensuring continuous use, particularly the involvement of community leaders. Buy-in could be improved by holding engagement sessions in the evening when household decision-makers were available. The fencing intervention was found to be successful and may be considered for larger scale-up to assess its effectiveness against drowning.

The aim of this study was to measure trends in paediatric burn injury in Ontario, Canada, overall and by sociodemographic strata. Population-based, repeated cross-sectional study using linked health and administrative databases, including all individuals 0-17 years old in Ontario, Canada from 2003 to 2022. The outcome was emergency department visits and hospitalisations for burn injury measured as an annual burn injury rate per 100&#x2009;000 population. Burn injury rates were stratified by age, sex and sociodemographic factors. Trends in burn injury were estimated using Quasi-Poisson regression. Between 2003 and 2022,&#x2009;there were 79&#x2009;782 reported paediatric burn injuries. Children with a burn injury had a median age of 4.0 years (IQR 1.0-12.0)&#x2009;and 44&#x2009;191 (55%) were male. The overall paediatric burn injury incidence rate declined 37% (165 to 104&#x2009;burns/100,000 population; rate ratio 0.98, 95% CI 0.98 to 0.98) with similar rates of decline observed among males and females. Among specific sociodemographic groups, large declines in incidence rates were observed in individuals aged 13-17 years old, children of adolescent mothers and rural residents. In contrast, we observed a 91% increase (63 to 120&#x2009;burns/100 000 population; rate ratio 1.04, 95%&#x2009;CI 1.02 to 1.06) in the burn injury incidence rate among refugee immigrants. Paediatric burn incidence in Ontario has declined over twenty years, suggesting burn prevention efforts have been largely successful, with legislative prevention measures serving to equitably reduce burn injury. The rising trends of burn injury incidence rate among refugee immigrants suggest burn prevention efforts must be tailored to this population.