The Gambia is the smallest country in mainland Africa. Along with the rapid urbanization rate, motorization has increased rapidly as well, contributing to an increased number of road traffic crashes. Road traffic crashes are the 4th leading cause of in-patient deaths in adults in the Gambia and currently are a significant public health problem. This study utilized the Gambia Traffic Force’s data registry to become the first epidemiological study on road traffic injuries in the Gambia as well as the first to analyze the Gambia’s traffic data registry on a national level. Reported crashes from October 1st, 2014 to June 30, 2015 were converted from the paper-based data registry into an electronic database and analyzed statistically, and the location data were geocoded and plotted on the Gambian map. The results of this study showed that crashes involving pedestrian victims and crashes that occurred on unpaved roads were more likely to be associated with outcomes that were fatal or serious. When multiple vehicles were involved in a crash, the involvement of motorcycles and bicycles were more likely to lead to a fatal or serious injury. The mapped data showed that towards the center of each district, the number of crashes increased as pedestrian and vehicle density increased, but that injury severity outcomes were generally minor or none. In contrast, as pedestrian and vehicle density decreased, crash frequency decreased as well, but injury outcomes were more likely to be severe or fatal. The findings of the study also helped in identifying areas in policy and education that need improvement.

The Child Pedestrian Injury Prevention Project (CPIPP) is a rigorous school- and community-based intervention trial delivered to 2,500 children in their second, third and fourth year of schooling in three communities in Perth, Western Australia, from 1995 to 1997. The CPIPP was designed to improve children's pedestrian safety knowledge, their road related behaviors - crossing and playing, and to reduce their risk in, and exposure to, traffic. This thesis addresses the process evaluation of the CPIPP school-based intervention. The Curtin University Human Research Ethics Committee provided ethics approval for this project.Evaluation of previous school-based pedestrian safety programs has focused mainly on assessing outcomes with little or no process evaluation. An absence of process evaluation increases the likelihood of Type III error, that is, incorrectly attributing null or weak outcomes to a program that has not been adequately implemented.In each of the three study years, following a teacher training, teachers were asked to implement the school-based intervention. Each year this comprised nine 40-minute pedestrian safety lessons and home activities. Lessons included road crossing practise on real and simulated roads.Data were collected from the student cohort (n=1049) and their Grade 2, 3 and 4 teachers. Four process evaluation instruments were developed and administered in each of the three study years. These included one student instrument (work samples) and three teacher instruments (lesson log, teacher post-implementation questionnaire and classroom observation). Student outcome data including their pedestrian-related knowledge and road crossing and playing behaviours were assessed using a pre- and post-test self report questionnaire.The majority of teachers (70-97%) and students (72-84%) responded positively to questions about their satisfaction with the ++ / CPIPP Grades 2, 3 and 4 curricular. Evidence in student work samples demonstrated that teachers taught 76% (seven of nine lessons) of the Grades 2 and 3 curricular, and 68% (six of the nine lessons) of the Grade 4 curricular. Teacher self-reported implementation rates using a 'lesson log' were 88%, 81% and 60% respectively for the three curricular. Teachers reported practising road crossing on a real road in 21% (one lesson) of six designated crossing practise lessons in 1996 and 36% (two lessons) in 1997.Multivariate analyses revealed students pedestrian safety knowledge was significantly associated with teacher implementation of the classroom curriculum. This relationship was one of dose-response. It demonstrated students who, each year, received at least 7 lessons (81% or more) of the three CPIPP curricular showed a greater improvement in pedestrian safety knowledge than those students who received a lower dose of the curriculum. Significant effects on pedestrian safety knowledge were also observed for students who, each year, practised crossing a real road in at least one lesson (17%) of the curriculum. The relationship between implementation and student road crossing and road playing behaviours was not one of dose-response.Student work samples, teacher lesson logs and to a lesser extent teacher self-report questionnaires, were found to be valid measures of curriculum implementation. This study also found that implementation of the CPIPP curriculum achieved a modest improvement in student pedestrian safety knowledge and possibly arrested the decline of safe road crossing behaviour. It also demonstrated that classroom pedestrian safety education alone, while necessary, is not sufficient to positively modify children's road crossing behaviours.The findings of this study demonstrate the importance of measuring teacher implementation. A process evaluation is ++ / essential to determine if an intervention has been implemented and to help explain the impact this level of implementation had on program outcomes. However, more research needs to explore the link between other factors in the process of curriculum delivery and program effects. Further research also needs to determine how to develop and measure an intervention that includes the key procedures and content that theoretically promote the desired behaviour, but also allows teachers to make adjustments to the program to suit their teaching style and the needs of their students.Child pedestrian injury is a complex problem that requires a multifaceted intervention, of which a classroom curriculum can form part.

The occupation of sheep-shearing is classified as heavy to very-heavy physical work requiring a high level of energy expenditure while performing a repetitive task in a predominantly sustained trunk flexion posture. The task is further complicated by unpredictable animal behaviour. Shearing is considered to carry a high risk of injury particularly to the lumbar spine and epidemiological studies have demonstrated that the prevalence of low back pain (LBP) in shearers is high relative to other occupations. The emergence of a commercial shearing-aid (Warrie Back-Aid TM) that is purported to decrease loading on the spine, reduce injury rate and alleviate symptoms of spinal origin has been welcomed by many sectors of the wool-harvesting industry. However, the precise biomechanical influence of the Warrie Back-Aid TM (WBA) on the sheep-shearing task has not been quantified. The purpose of this study was to investigate the effect of the WBA on three-dimensional kinematics and electromyography of the trunk for 12 experienced shearers during the occupational task of sheep-shearing. Sheep-shearing is a highly patterned process comprised of specific interlinked phases. Nine distinct phases of the shearing-task where the harness was worn during the removal of the sheep�s fleece were investigated. The study used an opto-electronic motion analysis system and rigid body dynamic modelling. The shearer�s trunk and pelvis were considered as a series of three coupled rigid segments; pelvis, lumbar, and thorax with four passive retro-reflective markers defining each segment. The kinematic variables of angular displacement, velocity and acceleration at the thoraco-lumbar and lumbo-pelvic joint centres were calculated for each shearer while shearing with and without the WBA. An eight channel sEMG telemetry system was used to simultaneous record activity in four pairs of trunk muscles. Temporal analysis of the sEMG signal gave information on the duration and relative intensity of trunk muscle activity. The results demonstrated that the task of sheep-shearing required endurance-based muscle activity and the adoption of quasi-static posturing combined with complex asymmetrical trunk motion for extensive periods of the task time. There was considerable variability in the trunk motion of individual shearers despite the pattern-taught and repeatable nature of the shearing task. The introduction of the WBA had no effect on the time taken to shear or trunk kinematics however it resulted in reductions in muscular activity of the trunk extensors. When the complete shearing task was analysed there was a statistically significant reduction in mean intensity of muscle activity for the left multifidus (p = 0.010), right multifidus (p = 0.001), right iliocostalis (p = 0.004) and right longissimus (p = 0.002) when the WBA was used. A reduction in muscular activity of the trunk extensors during the sheep-shearing task may result in a decrease in spinal loading, energy expenditure and muscular fatigue. The clinical recommendation based on the biomechanical results of this and other studies is that the WBA should be incorporated into the practice of sheep-shearing to assist in the reduction of inherent risks associated with the shearing task. Prospective studies into the effect of the harness on LBP are required to endorse this recommendation.

Attempting to enhance their productivity or improve working conditions, many businesses have adopted organizational change programs that involve a participatory component. To attain a comprehensive understanding of these change programs we need to investigate the influence of social factors such as power, the impact of local and global contexts, and the role that agency plays in these programs. Further, because organizational programs do not unfold linearly and the contexts in which they are embedded continually evolve, it is crucial to employ an approach that allows studying organizational programs over time. Attending to these considerations enables the production of narratives of organizational change that are congruous with the dynamism of organizational life. This dissertation explores the dynamics of an organizational program in a particular type of occupational health and safety program, which emphasizes employee involvement: participatory ergonomics (PE). Participatory ergonomics, intended to reduce workers’ exposures to work-related musculoskeletal disorders, draws on the input of small groups of labour and management representatives called ergonomic change teams (ECTs) to address exposure to hazards that may lead to musculoskeletal disorders. The dissertation’s examination of an organizational change program consists of an analysis of PE programs in two workplaces: a courier depot and a manufacturing plant. The dissertation’s investigation of the PE programs is based primarily on observations, which were gathered longitudinally as the ECTs endeavoured to make ergonomic changes, and fifty-five semi-structured interviews, which were carried out with ECT members and other key informants who were not members of the ECTs. Data collection occurred during 48 months in the manufacturing setting; in the courier company, collection took place during a 30-month period. The dissertation’s analysis is informed by negotiated order and critical theory lenses. Negotiated order considers social order as an ongoing process and draws attention to the activities of individuals and groups, and the manner in which they influence the dynamics of social life. In regard to organizational programs, it rejects the idea that they unfold independently of actors’ efforts; rather, it considers them as products of individuals’ attempts to establish and maintain the necessary agreements to ensure their operation. Critical theory, as it pertains to occupational health, identifies the constraints that shape working conditions and links these with the uneven distribution of power in the workplace and production imperatives. The dissertation addresses the following general research questions: What actions were undertaken by individuals to ensure the PE programs functioned and continued? How did the organizational and societal context enable or constrain the pursuit of PE program activities? The presentation of the findings begins with an account of the problem-solving processes used in both of the settings, an overview of the types of knowledge that were used, and a description of the actors’ access to knowledge. In each setting, design parameters, production pressures, the nature of the knowledge required to design solutions, and the differential distribution of that knowledge among workplace personnel influenced (a) the effectiveness of the ECTs’ solution building activities, (b) the design process, and (c) the nature and degree of participation by the teams’ worker members. The dissertation then proceeds to an examination of the implementation process. It explores how this process is affected by the organizational context, in particular the ECTs’ limited authority as agents of change, and shows that the minimal authority they possessed prompted the ECTs to select an array of strategies to accomplish their work. These strategies often took the forms of persuasion, persistence, and enlisting the assistance of other personnel. Extending the discussion of implementation, the dissertation then focuses on the division of labour within the ECTs as they carried out their activities. In both settings, implementation activities were unevenly distributed among the ECTs’ membership; they were predominantly carried out by managerial personnel. Both the programs’ functioning and the participation of worker representatives were influenced by the interplay among three main factors: the type of activities that needed to be carried out, workplace hierarchy, and stance, or participants’ views about their ability to act effectively. The discussion of the PE programs then proceeds to an examination of whether the programs were supplied with the resources required to continue over time. The outcomes differed: in Courier Co. the program was discontinued, whereas in Furniture Co. it was maintained. The discussions investigate how PE program continuation was affected by the program supporters’ activities and shaped by conditions both internal and external to the organization. Foremost among these conditions were management’s view of health and safety and the occupational health and safety regulatory framework. The dissertation’s examination of the PE programs over time provides evidence that the functioning and the degree of worker involvement in participatory occupational health programs are conditioned by structural and interactional elements. The programs were shaped by an uneven distribution of power, limits on access to knowledge and scarce resources, and actors’ divergent interests and their capacities to act in accord with these interests. The final chapter of the dissertation reviews the key findings and examines common themes that arose across the workplaces. The dissertation concludes with observations on several topics: the challenges of evaluating program outcomes in settings such as occupational health and safety; the lessons that participatory ergonomics practitioners can take from the study’s findings; and suggestions for possible avenues of future research.

Attempting to enhance their productivity or improve working conditions, many businesses have adopted organizational change programs that involve a participatory component. To attain a comprehensive understanding of these change programs we need to investigate the influence of social factors such as power, the impact of local and global contexts, and the role that agency plays in these programs. Further, because organizational programs do not unfold linearly and the contexts in which they are embedded continually evolve, it is crucial to employ an approach that allows studying organizational programs over time. Attending to these considerations enables the production of narratives of organizational change that are congruous with the dynamism of organizational life. This dissertation explores the dynamics of an organizational program in a particular type of occupational health and safety program, which emphasizes employee involvement: participatory ergonomics (PE). Participatory ergonomics, intended to reduce workers’ exposures to work-related musculoskeletal disorders, draws on the input of small groups of labour and management representatives called ergonomic change teams (ECTs) to address exposure to hazards that may lead to musculoskeletal disorders. The dissertation’s examination of an organizational change program consists of an analysis of PE programs in two workplaces: a courier depot and a manufacturing plant. The dissertation’s investigation of the PE programs is based primarily on observations, which were gathered longitudinally as the ECTs endeavoured to make ergonomic changes, and fifty-five semi-structured interviews, which were carried out with ECT members and other key informants who were not members of the ECTs. Data collection occurred during 48 months in the manufacturing setting; in the courier company, collection took place during a 30-month period. The dissertation’s analysis is informed by negotiated order and critical theory lenses. Negotiated order considers social order as an ongoing process and draws attention to the activities of individuals and groups, and the manner in which they influence the dynamics of social life. In regard to organizational programs, it rejects the idea that they unfold independently of actors’ efforts; rather, it considers them as products of individuals’ attempts to establish and maintain the necessary agreements to ensure their operation. Critical theory, as it pertains to occupational health, identifies the constraints that shape working conditions and links these with the uneven distribution of power in the workplace and production imperatives. The dissertation addresses the following general research questions: What actions were undertaken by individuals to ensure the PE programs functioned and continued? How did the organizational and societal context enable or constrain the pursuit of PE program activities? The presentation of the findings begins with an account of the problem-solving processes used in both of the settings, an overview of the types of knowledge that were used, and a description of the actors’ access to knowledge. In each setting, design parameters, production pressures, the nature of the knowledge required to design solutions, and the differential distribution of that knowledge among workplace personnel influenced (a) the effectiveness of the ECTs’ solution building activities, (b) the design process, and (c) the nature and degree of participation by the teams’ worker members. The dissertation then proceeds to an examination of the implementation process. It explores how this process is affected by the organizational context, in particular the ECTs’ limited authority as agents of change, and shows that the minimal authority they possessed prompted the ECTs to select an array of strategies to accomplish their work. These strategies often took the forms of persuasion, persistence, and enlisting the assistance of other personnel. Extending the discussion of implementation, the dissertation then focuses on the division of labour within the ECTs as they carried out their activities. In both settings, implementation activities were unevenly distributed among the ECTs’ membership; they were predominantly carried out by managerial personnel. Both the programs’ functioning and the participation of worker representatives were influenced by the interplay among three main factors: the type of activities that needed to be carried out, workplace hierarchy, and stance, or participants’ views about their ability to act effectively. The discussion of the PE programs then proceeds to an examination of whether the programs were supplied with the resources required to continue over time. The outcomes differed: in Courier Co. the program was discontinued, whereas in Furniture Co. it was maintained. The discussions investigate how PE program continuation was affected by the program supporters’ activities and shaped by conditions both internal and external to the organization. Foremost among these conditions were management’s view of health and safety and the occupational health and safety regulatory framework. The dissertation’s examination of the PE programs over time provides evidence that the functioning and the degree of worker involvement in participatory occupational health programs are conditioned by structural and interactional elements. The programs were shaped by an uneven distribution of power, limits on access to knowledge and scarce resources, and actors’ divergent interests and their capacities to act in accord with these interests. The final chapter of the dissertation reviews the key findings and examines common themes that arose across the workplaces. The dissertation concludes with observations on several topics: the challenges of evaluating program outcomes in settings such as occupational health and safety; the lessons that participatory ergonomics practitioners can take from the study’s findings; and suggestions for possible avenues of future research.

Each day, approximately 25,000 GSU students, staff, and faculty are exposed to deadly hazards from fast-moving, high-volume traffic. Protecting Pedestrians on the Move (PPM), a collaboration of organizations in downtown Atlanta, has partnered with several groups to implement an action plan to improve pedestrian safety for Georgia State students and others in the downtown campus area. This study utilized the SWOT analysis evaluative tool to understand the team members’ and stakeholders’ perceptions of the project’s programming and implementation. Participants were asked to rate the extent to which the project’s goals were fulfilled, as well as to describe the strengths, weaknesses, opportunities and threats of five aspects of the project: people, program, effectiveness, resources, and growth. Seven participants completed the survey, and gave an overall rating of the completion of project objectives as 6.2 out of 10. Staff expertise and relationships were considered the greatest strengths, and PPM becoming a strong voice for pedestrian safety was viewed to be the primary opportunity of the PPM project. Overly ambitious goals and depleted funding were reported as the greatest weaknesses, and loss of objectives and no succession plan were considered the primary threats. Areas for future improvement included: finding a funding and personnel “home” for the PPM project, having a clear strategic plan, and developing plans for the future/sustainability. The insights gained from this SWOT analysis exercise provides direction for continued research and improved program implementation surrounding pedestrian safety issues.

This study evaluated the impact of delivery of the Period of PURPLE Crying (PURPLE), in a group of first-time mothers. Frustration with crying is reported as a trigger for abusive head trauma (AHT).The primary objective was to determine whether there was a change in knowledge about crying and shaking after exposure to PURPLE. Factors associated with behavioral responses to crying were studied as was the utility of PURPLE. There was a significant increase in knowledge about infant crying (P = 0.001) after program delivery that was predicted by low baseline knowledge (P < 0.01). There was a non-significant negative change in shaking knowledge (P = 0.5), which may have been the consequence of high baseline knowledge of shaking. The PURPLE program was characterized as informative and useful by participants. Additional to evaluate the impact of program delivery on other caregivers and on the rates of AHT is recommended.

No description available.

Injury to the anterior cruciate ligament (ACL) may have consequences for an athlete in the form of pain, decreased activity levels and early-onset osteoarthritis. Female athletes are at increased risk of injury, perhaps because of differences in neuromuscular function. Methods of identifying risk factors and effective prevention strategies for ACL injury have traditionally involved athletes of high school age or older. However by that age, the opportune time to intervene may have passed. This thesis involves a sequence of studies which measures the neuromuscular function of younger athletes, aged 10-14 years. First, the reliability of measuring strength and power of the lower extremity on an isokinetic dynamometer was explored. Torque and power of the hip flexors and knee extensors were the only measures with acceptable reliability. Conversely, peak velocity of all the tested hip and knee movements demonstrated acceptable reliability. A high amount of variability was found with all test movements, and so alternate tests should be used if measuring an individual athlete’s ability. From the data collected within the reliability study, a sex comparison was undertaken to determine if neuromuscular power differed at this young age. It was determined that girls and boys between 10 and 14 years of age do not differ in terms of knee or hip movement velocity or power. There is evidence to suggest that sex differences exist by adulthood; further research is required to determine when the disparity becomes apparent. The final project was to determine whether strength training would improve the manner in which young female athletes land from a jump; a common ACL injury mechanism. This randomized controlled trial found no difference between the intervention group who trained their legs, and the control group who trained their arms. However those athletes with the poorest landings appeared to improve their movement pattern regardless of training regime. This thesis contributes to the literature by providing evidence for measurement protocols for young athletes, introducing neuromuscular power instead of strength into the investigation of contributing factors to injury, and by furthering the examination of strength training as an effective component of prevention programs.

Inledning: Bandy har en låg skadeincidens med cirka 7 skador per 1000 matchtimmar. Den vanligaste skadelokalisationen är ansiktet som står för ca en tredjedel av rapporterade skador. Eftersom antalet studier inom bandy är begränsat, finns anledning till att öka kunskapen om skadepanoramat, för att på sikt kunna arbeta förebyggande för att minska antalet skador. Syfte: Att med en kvantitativ ansats analysera rapporterade skador i elitseriebandy herrar 2007-2012. Metod: Resultatet av samtliga inrapporterade skador mellan 2007-2012 har analyserats. Materialet bestod av det totala antalet individer från lag som rapporterat skador, totalt 378 spelare. Resultat: Totalt rapporterades 97 skador under 2007-2012. Av dessa klassades 36 % (35/97) som allvarliga, det vill säga spelaren bedömdes avstå träning samt match mer än sju dagar. Ansiktsskador stod för 28 % (29/97) av skadorna. Slutsats: Studien visade i att ansiktsskador var den vanligaste skadelokalisationen, och att andelen allvarliga skador i likhet med tidigare studie inom elitbandy var hög. Nyckelord: ansiktsskada, bandy, retrospektiv, skadeprevention / Introduction: A low injury incidence has been reported from elite bandy (approximately 7 injuries/1000 game hours). The most common location was in the face, which represent about 30% of reported injuries. However, the studies are few and more knowledge is needed to support planning of preventive measures. Objective: To investigate injuries in Elite male bandy the years 2007-2012. Method: All reported injuries from participating teams in the Swedish professional 2007-2012 has been analysed. The participants consisted of 378 players followed between one and four seasons. Result: Totally, 97 injuries were reported during 2007-2012. Of those were 36 % (35/97) classified as severe, meaning that the player could not participate in training or games for at least 7 days. Facial injuries represent 29 % (28/97) of total injuries. Conclusion: Present study show similar results as previous report that face injuries is the most common injury in male elite bandy, and that the share of severe injuries is high. Key words: bandy, facial injury, injury prevention, retrospective