Violence%20

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Violence Injury Prevention(VIP)

• Nurah M Alamro, MD. MPH.
• Lecturer Community Medicine
• College of Medicine
• King Saud University
• nmalamro_at_ksu.edu.sa

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DefinitionsInjury

• Acute exposure to physical agents such as
  mechanical energy, heat, electricity, chemicals,
  and ionising radiation interacting with the body
  in amounts or at rates that exceed the threshold
  of human tolerance. In some cases, injuries
  result from the sudden lack of essential agents
  such as oxygen or heat.
• (Source Gibson, 1961 Haddon, 1963)

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DefinitionsViolence

• The intentional use of physical force or power,
  threatened or actual, against oneself, another
  person, or against a group or community, that
  either results in or has a high likelihood of
  resulting in injury, death, psychological harm,
  maldevelopment or deprivation.
• (Source WHO, 1996)

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The Global Injury Problem

• 5 million deaths worldwide 9 of all deaths
  (2000)
• 12 of global burden of disease
• Road traffic incidents are the leading cause of
  injury deaths worldwide
• 90 of injury deaths occur in low- and
  middle-income countries
• Highest number of deaths in S.E. Asia Western
  Pacific regions

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Principles!
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The Epidemiological Model
Host
Environment
Vector
Agent
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The Ecological Model
Society
Individual
Community
Relationship
Complex Linkages
Source Krug E et al., eds., 2002.
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VIP Public Health Approach

• Defining Characteristics

• Population-based
• Multidisciplinary
• Evidence-based
• Collective action
• Prevention

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The Public Health Approach
(1) Surveillance What is the problem?
(2) Risk factor identification What are the
causes?
(3) Develop and evaluate interventions What
works?
(4) Implementation How is it done?
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Public Health Approach in Action
DESEPAZ in Colombia
(2) Risk factors Alcohol Handguns Attitudes/value
s
(1) Surveillance High rate of violent crime
Reduction in homicides
Public demand for more prevention
(4) Implementation Special budgets for police,
judiciary etc. Television advertising Cultural/ed
ucational Programmes /Restrictions on alcohol
and handguns
(3) Interventions Education Legislation Community
involvement
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Categorizing Injury
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Data Classification Systems

• International Classification of Disease (ICD)
• Occupational Injury and Illness Classification
  System (OIICS)
• Nordic Medico-Statistical Committee (NOMESCO)
• The International Classification of External
  Causes of Injury (ICECI)
• The Abbreviated Injury Severity Scale (AIS)

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Injury Pyramid
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Types of data and potential sources of information
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Source adapted from Krug et al., eds., 2002
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Leading Causes of Mortality and Burden of
Diseaseworld, 2004
Mortality
DALYs

• 
  
• Ischaemic heart disease 12.2
• Cerebrovascular disease 9.7
• Lower respiratory infections 7.1
• COPD 5.1
• Diarrhoeal diseases 3.7
• HIV/AIDS 3.5
• Tuberculosis 2.5
• Trachea, bronchus, lung cancers 2.3
• Road traffic accidents 2.2
• Prematurity, low birth weight 2.0

• 
  
• Lower respiratory infections 6.2
• Diarrhoeal diseases 4.8
• Depression 4.3
• Ischaemic heart disease 4.1
• HIV/AIDS 3.8
• Cerebrovascular disease 3.1
• Prematurity, low birth weight 2.9
• Birth asphyxia, birth trauma 2.7
• Road traffic accidents 2.7
• Neonatal infections and other 2.7

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Adult mortality rates by major cause group and
region, 2004
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Source WHO, 2004
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Ten leading causes of burden of disease, world,
2004 and 2030
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Quiz

• Defining VIP according to target group include
  except
• Universal
• Selective
• Indicated
• Passive

• In epidemiological model of road traffic
  incident, the host is
• Car
• Driver
• Energy transferred
• Wet road

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• Injury can be categorised according
• Severity
• Intent
• Setting
• All of the above

• The apex of the injury pyramid represents
• Relatively small number of non-fatal injury cases
  
• Relatively small number of fatal injury cases
• More numerous injuries of lesser severity
• More numerous injuries of greater severity

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• According to WHO, RTA as a leading cause of
  burden of disease in 2030 will rank
• 1st
• 3rd
• 20th
• 9th

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Prevention is the Vaccine for the Disease of
Injury