|
|
February 16, 2001
General Topics
- Childhood injuries in the European Union: can epidemiology contribute to their control? Petridou E. Acta Paediatr 2000; 89(10):1244-9.
ABSTRACT: An average of 6000 children (0-14-y-old) died every year from injuries in the European Union during the last decade. Although the trends are overall favorable, injuries continue to represent the leading cause of death in this age group. The aim of this paper is to present childhood-injury-related public health issues and consider possible remedies of contemporary epidemiologic methods as applied to injury epidemiology and prevention. It has been estimated that half of the lives lost to childhood injuries could have been saved if all European Union countries matched the accomplishments of the country with the lowest mortality rate in each injury category. There is no specific pattern of association between Gross Domestic Product and incidence of motor-vehicle accidents by category of road user, whereas fatality from motor-vehicle accidents seems to be inversely, strongly and significantly related to Gross Domestic Product. CONCLUSION: The ongoing development of large injury databases in the European Union is a prerequisite for understanding the complex interactions that lead to a childhood injury. Moreover, possible remedies for overcoming the genuine problems associated with the application of traditional epidemiologic methods to the investigation of the frequently transient in nature causes of injuries should be considered.
- How well do socio-demographic characteristics explain variation in childhood safety practices? Hapgood R; Kendrick D; Marsh P. J Public Health Med 2000; 22(3):307-11.
ABSTRACT: BACKGROUND: Unintentional injury is the leading cause of death in children older than 1 year. Deaths from accidents have a steeper class gradient than any other fatal condition and this inequality is widening. There are few published data on the relationship between safety practices and sociodemographic characteristics, hence this study has been undertaken to examine this relationship. METHODS: The study population comprised all parents and guardians of children aged 3-12 months in 36 practices throughout Nottingham (n = 2,152). A postal questionnaire was used to survey current childcare safety practices (from which safe practices scores were derived), together with socio-demographic variables and known risk factors for childhood unintentional injury. RESULTS: Unsafe childcare practices were common. Socioeconomically disadvantaged families had more unsafe practices than more affluent families, but few parents undertook safe practices all the time. The child's age (p <0.01), ethnicity (p <0.01) and living in non-owner-occupied accommodation (p <0.01) were independently associated with the safe practices score. Multivariate regression modelling showed that these risk factors explained only 11 per cent of the variation in the safety practices score. Socio-economic factors explained more of the variation in possession and use of items of safety equipment (13 per cent) than the variation in safety behaviors with no cost implications (3 per cent). CONCLUSIONS: Most of the variation in the number of safety practices is not explained by socio-demographic characteristics and further work is required to examine other possible determinants of safe practice.
- Annual summary of vital statistics: trends in the health of Americans during the 20th century. Guyer B; Freedman MA; Strobino DM; Sondik EJ. Pediatrics 2000; 106(6):1307-17.
ABSTRACT: The overall improvement in the health of Americans over the 20th century is best exemplified by dramatic changes in 2 trends: 1) the age-adjusted death rate declined by about 74%, while 2) life expectancy increased 56%. Leading causes of death shifted from infectious to chronic diseases. In 1900, infectious respiratory diseases accounted for nearly a quarter of all deaths. In 1998, the 10 leading causes of death in the United States were, respectively, heart disease and cancer followed by stroke, chronic obstructive pulmonary disease, accidents (unintentional injuries), pneumonia and influenza, diabetes, suicide, kidney diseases, and chronic liver disease and cirrhosis. Together these leading causes accounted for 84% of all deaths. The size and composition of the American population is fundamentally affected by the fertility rate and the number of births. From the beginning of the century there was a steady decline in the fertility rate to a low point in 1936. The postwar baby boom peaked in 1957, when 123 of every 1000 women aged 15 to 44 years gave birth. Thereafter, fertility rates began a steady decline. Trends in the number of births parallel the trends in the fertility rate. Beginning in 1936 and continuing to 1956, there was precipitous decline in maternal mortality from 582 deaths per 100 000 live births in 1935 to 40 in 1956. Since 1950 the maternal mortality ratio dropped by 90% to 7.1 in 1998. The infant mortality rate has shown an exponential decline during the 20th century. In 1915, approximately 100 white infants per 1000 live births died in the first year of life; the rate for black infants was almost twice as high. In 1998, the infant mortality rate was 7.2 overall, 6.0 for white infants, and 14.3 for black infants. For children older than 1 year of age, the overall decline in mortality during the 20th century has been spectacular. In 1900, >3 in 100 children died between their first and 20th birthday; today, <2 in 1000 die. At the beginning of the 20th century, the leading causes of child mortality were infectious diseases, including diarrheal diseases, diphtheria, measles, pneumonia and influenza, scarlet fever, tuberculosis, typhoid and paratyphoid fevers, and whooping cough. Between 1900 and 1998, the percentage of child deaths attributable to infectious diseases declined from 61.6% to 2%. Accidents accounted for 6.3% of child deaths in 1900, but 43.9% in 1998. Between 1900 and 1998, the death rate from accidents, now usually called unintentional injuries, declined two-thirds, from 47. 5 to 15.9 deaths per 100 000. The child dependency ratio far exceeded the elderly dependency ratio during most of the 20th century, particularly during the first 70 years. The elderly ratio has gained incrementally since then and the large increase expected beginning in 2010 indicates that the difference in the 2 ratios will become considerably less by 2030. The challenge for the 21st century is how to balance the needs of children with the growing demands for a large aging population of elderly persons.
- Fatal and near-fatal asthma in children exposed to fireworks. Becker JM; Iskandrian S; Conkling J. Ann Allergy Asthma Immunol 2000; 85(6):512-3.
ABSTRACT: BACKGROUND: Fireworks accounted for an estimated 8,300 emergency department visits during 1997 in the United States. Firecrackers, bottle rockets, Roman candles, and sparklers contribute to the most hospitalizations. Burns account for the majority of these injuries Fireworks are manufactured from a variety of chemicals, which include the known irritant, sulfur dioxide, as one of the products of combustion. We are reporting one fatal and one near fatal asthma exacerbation after use of fireworks. OBJECTIVE: We are reporting two patients who had severe asthma exacerbation shortly after having exposure to different types of fireworks. METHODS: Patient data were collected from patients that presented the week of July 4, 1998 to our institution. Information was also obtained from the Consumer Product Safety Commission and the National Weather Service. RESULT: The patients presented to our institution within hours of their exposure from the fireworks. One patient had a respiratory arrest and was resuscitated, but subsequently expire. The second patient was able to treated aggressively and avoided intubation. CONCLUSIONS: These cases demonstrate risks that fireworks may present to the asthmatic child and that patient's with asthma should exercise caution when observing or participating in fireworks demonstrations.
- Distribution of accidents, injuries, and illnesses by family type. O'Connor TG; Davies L; Dunn J; Golding J. Pediatrics 2000; 106(5):E68.
ABSTRACT: Objective. To investigate whether family type and psychosocial risks indexed by family type were systematically associated with differences in health outcomes in children. Design and Subjects. The study is based on a longitudinal, prospective study of a large (n = approximately 10 000) community sample of families, the Avon Longitudinal Study of Pregnancy and Childhood. Main Outcome Measures. Frequency of accidents, illnesses, and medical interventions. Results. At 2 years of age, children in single-parent and step-families were disproportionately likely to experience accidents and receive medical treatment for physical illnesses. In addition, children in single-parent families and step-families were more likely to be hospitalized or receive attention from a hospital doctor for an injury or illness. Exposure to psychosocial risks also were elevated in single-parent families and step-families, compared with intact or nonstepfamilies, and these factors primarily accounted for the connection between family type and children's physical health. Conclusions. The consequences of family transitions on children's health extend beyond traditional mental health and behavioral outcomes and include accident proneness, illness, and receipt of medical attention. The mediating processes are not entirely attributable to social class differences connected to family type and may instead be associated with a range of psychosocial risks that are more frequently found in single-parent families and step-families, compared with intact or nonstepfamilies. Prevention and intervention efforts directed toward children at risk for poor behavioral and mental health adjustment secondary to family disruption should consider children's physical health and health-related behaviors.
- Paralysis from Sport and Diving Accidents. Schmitt H; Gerner HJ. Clin J Sport Med. 2001; 11(1):17-22.
ABSTRACT: OBJECTIVE: To examine the causes of sport-related spinal cord injuries that developed into paraplegia or tetraplegia, and to compare data from different sports with previous studies in the same geographical region. DESIGN: A retrospective epidemiological study and comparison with previous studies. SETTING: The Orthopedic Department, specializing in the treatment and rehabilitation of paralyzed patients, at the University of Heidelberg, Germany. PARTICIPANTS: Between 1985 and 1997, 1,016 cases of traumatic spinal cord injury presented at the Orthopedic Department at the University of Heidelberg: 6.8% were caused by sport and 7.7% by diving accidents. MAIN OUTCOME MEASURES: Sport-related spinal cord injuries with paralysis. RESULTS: A total of 1,016 cases of traumatic spinal cord injury were reviewed. Of these, 14.5% were caused by sport accidents (n = 69) or diving accidents (n = 78). Age of patients ranged from 9 to 52 years. 83% were male. 77% of the patients developed tetraplegia, and 23%, paraplegia. 16 of the sport accidents resulted from downhill skiing, 9 resulted from horseback riding, 7 from modern air sports, 6 from gymnastics, 5 from trampolining, and 26 from other sports. Previous analyses had revealed that paraplegia had mainly occurred from gymnastics, trampolining, or high diving accidents. More recently, however, the number of serious spinal injuries caused by risk-filled sports such as hang gliding and paragliding has significantly increased (p = 0.095), as it has for horseback riding and skiing. Examinations have shown that all patients who were involved in diving accidents developed tetraplegia. An analysis of injury from specific sports is still under way. CONCLUSIONS: Analysis of accidents resulting in damage to the spinal cord in respect to different sports shows that sports that have become popular during the last 10 years show an increasing risk of injury. Modern air sports hold the most injuries. Injury-preventing strategies also are presented.
- Fatal accidents following changes in daylight savings time: the American experience. Varughese J; Allen RP. Sleep Med. 2001; 2(1):31-36.
ABSTRACT: Objective: This study examines specific hypotheses that both sleep loss and behavioral changes occurring with the time shifts for Daylight Savings Time (DST) significantly effect the number of fatal traffic accidents in the United States of America. Background: It has been reported that there is a significant increase in the number of automobile accidents in the spring shift to DST due to the loss of 1 h of sleep. But the extra hour gained at night with the shift from DST in the fall has been variably reported to be associated with increases and decreases in the number of automobile accidents which may reflect either behavioral anticipation with an extended late night prior to the change or the benefit of extra sleep after the change. Methods: Data from 21 years of United States' fatal automobile accidents were gathered. The mean number of accidents on the days at the time of the shifts (Saturday, Sunday and Monday) was compared to the average of the corresponding mean number of accidents on the matching day of the weeks preceding and following the shift. This was repeated for each DST shift. The number of accidents for a particular shift was also correlated with the year of the accidents. Results: There was a significant increase in accidents for the Monday immediately following the spring shift to DST (t=1.92, P=0.034). There was also a significant increase in number of accidents on the Sunday of the fall shift from DST (P <0.002). No significant changes were observed for the other days. A significant negative correlation with the year was found between the number of accidents on the Saturdays and Sundays but not Mondays. Conclusions: The sleep deprivation on the Monday following shift to DST in the spring results in a small increase in fatal accidents. The behavioral adaptation anticipating the longer day on Sunday of the shift from DST in the fall leads to an increased number of accidents suggesting an increase in late night (early Sunday morning) driving when traffic related fatalities are high possibly related to alcohol consumption and driving while sleepy. Public health educators should probably consider issuing warnings both about the effects of sleep loss in the spring shift and possible behaviors such as staying out later, particularly when consuming alcohol in the fall shift. Sleep clinicians should be aware that health consequences from forced changes in the circadian patterns resulting from DST come not only from physiological adjustments but also from behavioral responses to forced circadian changes.
- Developing a model law restricting the transporting of passengers in the cargo areas of pickup trucks.
Christoffel T; Agran P; Winn D; Anderson C; Del Valle C. J Public Health Policy 2000; 21(1):61-81.
ABSTRACT: Pickup trucks have become increasingly popular in the United States, accounting for about one in five vehicles involved in fatal motor-vehicle crashes. A critical factor in these deaths is the practice of carrying passengers in truck cargo areas, which are not designed for this purpose. Each year approximately 200 deaths occur to occupants riding in the back of pickup trucks. Over half the states have laws dealing with preventable injury problem, but these laws vary widely and most are too limited to be effective. We have reviewed existing laws, as well as crash injury data, and we have developed and recommend a model bill. The bill focuses on intended use, restricting passengers to only those portions of a vehicle designed for human transport. We have also conducted and report on a survey of legislative sponsors of pickup truck legislation.
- Further evidence of associations of type A personality scores and driving-related attitudes and behaviors. Perry AR; Baldwin DA. Percept Mot Skills 2000 Aug;91(1):147-54.
ABSTRACT: The present study examined the effects of Type A personality on specific self-reported driving attitudes and behaviors when operating a motor vehicle. 102 undergraduate students completed the student version of the Jenkins Activity Survey (Form T) and several questionnaires asking participants about their driving history, driving attitudes, and driving behaviors. When the full range of Type A scores were examined, Type A personality was significantly related to more traffic accidents, greater frequency of breaking traffic laws, higher impatience when driving, more displays of aggression on the road, and engaging in more risky driving behaviors. When extreme Type A and Type B scores were compared, Type A drivers reported being involved in significantly more motor vehicle accidents and reported displaying more aggression on the road. Further research should examine actual behavioral data using more diverse samples to validate the results.
Back to "New This Week" Menu
|
|
