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BACKGROUND: Balance testing is an important part of the initial concussion assessment. There is no research on the differences in Modified Balance Error Scoring System (M-BESS) scores when tested in real world as compared to control conditions. OBJECTIVE: To assess the difference in M-BESS scores in athletes wearing their protective equipment and cleats on different surfaces as compared to control conditions. METHODS: This cross-sectional study examined university North American football and soccer athletes. Three observers independently rated athletes performing the M-BESS test in three different conditions: (1) wearing shorts and T-shirt in bare feet on firm surface (control); (2) wearing athletic equipment with cleats on FieldTurf; and (3) wearing athletic equipment with cleats on firm surface. Mean M-BESS scores were compared between conditions. RESULTS: 60 participants were recruited: 39 from football (all males) and 21 from soccer (11 males and 10 females). Average age was 21.1 years (SD=1.8). Mean M-BESS scores were significantly lower (p<0.001) for cleats on FieldTurf (mean=26.3; SD=2.0) and for cleats on firm surface (mean=26.6; SD=2.1) as compared to the control condition (mean=28.4; SD=1.5). Females had lower scores than males for cleats on FieldTurf condition (24.9 (SD=1.9) vs 27.3 (SD=1.6), p=0.005). Players who had taping or bracing on their ankles/feet had lower scores when tested with cleats on firm surface condition (24.6 (SD=1.7) vs 26.9 (SD=2.0), p=0.002). CONCLUSIONS: Total M-BESS scores for athletes wearing protective equipment and cleats standing on FieldTurf or a firm surface are around two points lower than M-BESS scores performed on the same athletes under control conditions.

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BACKGROUND: Professional drivers play a pivotal role in transporting people and goods in Cameroon. Alcohol misuse is frequent in Cameroon, but its impact on professional drivers has never been studied. This study assessed driving under the influence of alcohol and its correlates in professional drivers in Cameroon. METHODS: A cross-sectional study was conducted at 4 sites on the Yaoundé-Douala highway during a 10-day period in 2014. At each site, professional drivers were randomly stopped during a 24-h window and their breath was sampled for alcohol use. The prevalence of driving under the influence (the equivalent of blood alcohol level ≥ 1 mg/100 mL) and impaired driving (blood alcohol level ≥ 40 mg/100 mL) was computed for all drivers. The correlates of driving under the influence were assessed using logistic regression analysis. RESULTS: Of the 807 professional drivers stopped, complete data for 783 were available. Almost all were men (n = 781). The mean age of drivers was 38.3 years (SD = 8.9). About one in 10 drivers (n = 77, 9.8%) tested positive for driving under the influence. About 2.8% (n = 22) had blood alcohol levels ≥ 40 mg/100 mL (legal limit in the United States) and 1.4% (n = 11) had blood alcohol levels ≥ 80 mg/100 mL. The likelihood of driving under the influence increased in drivers scoring 8 or more on Alcohol Use Disorder Identification Test (adjusted odds ratio [aOR] = 3.60; 95% confidence interval [CI], 2.14-6.07) and in those having a nighttime driving schedule (aOR = 4.43; 95% CI, 1.33-14.77). CONCLUSION: These findings suggest that increasing enforcement to counter impaired driving in professional drivers in Cameroon is needed. Interventions might include screening for alcohol misuse and hazardous occupational practices.

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OBJECTIVES: To compare the crash reporting system of National Highways & Motorways Police (NH&MP), Pakistan, with the World Health Organization (WHO) injury surveillance guidelines. METHODS: Based on information collected from field observations, key informant interviews, and review of official documents, this note firstly describes the reporting system according to the components of a surveillance system. Then the reporting is compared with WHO criteria for designing and building an injury surveillance system and attributes of such a system. RESULTS: After a crash, a patrol officer communicates the information to the higher police authorities by wireless, fax, and on paper in the first 24 hours. Microcomputer Accident Analysis Package (MAAP) Performa filed by the officers are collected at a central location in the following 4 days, and reports are published biannually. Notable deficiencies in the reporting were nonidentification of stakeholders for data utilization and limited prospects of data recording process modification and its monitoring. Moreover, crash and injury definitions do not conform to international standards practiced elsewhere. CONCLUSION: NH&MP crash reporting needs to be simplified and standardized, and steps should be taken to improve its utilization for prevention purposes.

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In this study, we assessed the epidemiological patterns of suicide terrorism in the civilian population of Pakistan. Information about suicide terrorism-related events, deaths and injuries was extracted from the South-Asian Terrorism Portal (SATP) for the period from 2002 to October 2009. Of 198 events, civilians were involved in 194 events. Civilians accounted for 74.1% (N = 2017) of those who died and 93.8% (N = 6129) of those who were injured. In nine districts, mortality rates were more than one death per 100,000 inhabitants per year. The yearly trend showed a shift of attack targets from foreigners and sectarian targets in 2002-2005 to security forces or general public in 2006-2009. Attacks on public installations (mosques) or political gatherings resulted in a significantly greater (P ≤ 0.02) number of deaths (22 vs. 8) and injuries (59 vs. 24) per event compared with security installations. These results show that prevention might focus on political negotiation with armed groups and that appropriate measures should be taken to protect mosques and political gatherings.

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BACKGROUND: The burden of burns is largely underreported due to the lack of a surveillance system in Pakistan. The aim of our study was to determine the incidence of burns and factors associated with their hospitalisation in the city of Rawalpindi, Pakistan. METHODS: A prospective observational study from July 2007 to June 2008 was conducted. All the burn-related injury patients presenting to emergency departments (EDs) of the three public teaching hospitals in Rawalpindi city were included. A standard World Health Organization questionnaire was used to record the information about injury victims. RESULTS: A total of 1498 burned patients presented to EDs. Females accounted for 40% of the patients. The majority of patients were ≤ 46 years. Most of the burns occurred at home (79.2%). The overall incidence of burn-related injuries per 100,000 inhabitants was 76.3 for emergency visits, 17.0 for hospitalisation and 0.3 for ED deaths. Female patients (adjusted odds ratio (aOR)=1.49, 95% confidence interval (95% CI)=1.09, 2.06), intentional burns (aOR=5.25, 95% CI=2.17-12.74) and injuries at work (aOR=3.81, 95% CI=2.40, 6.07) and in a market area (aOR=2.25, 95% CI=1.36-3.74) were more likely to result in hospitalisation. CONCLUSION: Rawalpindi city has a significant burden of burns. These results showed that investigating further factors leading to burns at home and work could be useful for future safety education campaigns. Moreover, continuous surveillance is warranted to decrease burns in Pakistan.

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OBJECTIVE: To assess the burden and factors associated with highway work-zone (HWZ) crashes. DESIGN: Historical cohort. SETTING: Section of the Karachi-Hala Road, Pakistan (196 km). DATA: Police-reported crashes and traffic statistics from January 2006 to December 2008. ANALYSIS: Crash and death risk between the HWZ and other zones for a 50 km section were compared. Crash locations were described for a further 146 km section on which factors associated with HWZ crashes were assessed. RESULTS: HWZ crashes accounted for 15.0% of traffic crashes (N = 180) and 30.8% of road fatalities (N = 91) on the 196 km section. Rates were higher in the HWZ than other zones for crashes (rate ratio (RR) = 2.35, 95% CI = 1.17 to 4.70) and deaths (RR = 4.70, 95% CI = 2.11 to 10.46). Opposite-direction crashes (adjusted OR (aOR) = 10.65, 95% CI = 3.22 to 35.25) and traffic crashes involving pedestrians (aOR = 6.03, 95% CI = 1.39 to 26.20) and on wet surfaces (aOR = 7.26, 95% CI = 4.15 to 48.89) were significantly associated with the HWZ. CONCLUSION: These results support the introduction of prevention measures such as strict traffic enforcement, traffic separation, improving pedestrian visibility, and hazard signage at HWZs in Pakistan. The feasibility and effectiveness of these measures remains to be evaluated.

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OBJECTIVE: Compare concordance between road mortality indicators in high-income (HICs) and low- and middle-income countries (LMICs). STUDY DESIGN: Ecological study. POPULATION: The most recent (from 2001 to 2006) one-year road traffic data were extracted from the World Road Statistics report, 2008. ANALYSES: Three road mortality indicators: per 100,000 inhabitants (M1), per 10,000 vehicles registered (M2), per 100 million vehicle kilometers traveled (M3) were computed. Concordances between indicators were assessed using scatterplots and intraclass correlation coefficient (ICC). RESULTS: Out of 192 countries, M1 was available for 125, M2 for 114, and M3 for 60. Despite significant concordances between indicators in HICs (All ICC > or = 0.42, P < or = 0.002), M1 rates were widely dispersed against M3, whereas M2 rates were relatively more dispersed at higher M3. Scatter of indicators in LMICs was inconclusive. CONCLUSION: Indicators in LMICs were not concordant possibly due to methodological differences in measuring traffic exposition and underreporting of fatalities.

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BACKGROUND: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. METHODS/PRINCIPAL FINDINGS: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1016 intentional injury victims reported to police whereas 3012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46-64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7990, 95% CI: 7322-8565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4-30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101-1516), police reported 0.5% and ED reported 39.9% of them. CONCLUSION: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence.

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