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Literature Update for the Week of
April 23, 2001
General:
Physical and psychological effects of injury. Data from the 1958 British birth cohort study.
Li L, Roberts I, Power C. Eur J Public Health 2001; 11(1):81-3.
Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
BACKGROUND: There is only scant evidence for the long-term health effects of road traffic injuries. We therefore assessed the extent to which motor vehicle driver injuries influence limiting long-standing illness and psychological distress using data from a nationwide study (the 1958 British birth cohort) in early adulthood. METHODS: Information was obtained on driver injuries occurring between ages 23 and 33 years and limiting illnesses and psychological distress at age 33 years. The risks of injury-related adverse consequences were derived using logistic regression and expressed as odds ratios (ORs) and 95% confidence intervals. RESULTS: A single injury was associated with limiting illness (OR = 2.01 and 95% CI: 1.38-2.94). The association between a single injury and psychological distress was strong for a recent injury occurring between ages 30 and 33 years (OR = 1.86 and 95% CI: 1.24-2.81), but not for injuries occurring earlier on. The population attributable fraction for limiting illness with one injury was 3.8% (range 1.7-5.3%) and with two or more injuries was 1.0% (range 0.5-1.3%). After controlling for potential confounding factors the corresponding figures were 4.2% (range 2.2-5.6%) and 1.1% (range 0.5-1.3%) respectively. CONCLUSIONS: Driver injuries are associated with a substantial increase in disability and, also in the short term, with increases in psychological distress. These results highlight the need for identifying effective strategies for the prevention of road traffic injuries as well as more effective approaches for rehabilitation of the injured.
Proposed explanations for excess injury among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers.
Bell NS, Amoroso PJ, Wegman DH, Senier L. Inj Prev 2001; 7(1):4-9.
Social Sectors Development Strategies, Inc, Natick, Massachusetts 01760-1041, USA. BellSSDS@aol.com
INTRODUCTION: Death rates among US veterans of the Persian Gulf War were lower than rates among non-deployed veterans and the US population at large, with the exception of injury deaths; returning veterans were at significantly greater risk of injury mortality. Similar patterns of excess injury mortality were documented among US and Australian veterans returning from Vietnam. In spite of these consistent findings little has been done to explain these associations and in particular to determine whether or not, and how, war related exposures influence injury risk among veterans returning home after deployments. HYPOTHESIZED PATHWAYS: Several potential pathways are proposed through which injury might be related to deployment. First, increases in injury mortality may be a consequence of depression, post-traumatic stress disorder, and symptoms of other psychiatric conditions developed after the war. Second, physical and psychological traumas experienced during the war may result in the postwar adoption of "coping" behaviors that also increase injury risk (for example, heavy drinking). Third, greater injury risk may be the indirect consequence of increased experiences of ill defined diseases and symptoms reported by many returning veterans. Fourth, veterans may experience poorer survivability for a given injury event resulting in greater mortality but not morbidity. Finally, the process that selects certain individuals for deployment may lead to a spurious association between deployment status and injury mortality by preferentially selecting individuals who are risk takers and/or exposed to greater hazards. CONCLUSIONS: More research and attention from policymakers is needed to clarify the link between deployment and postwar increased risk of injury.
Do self reported safety behaviours predict childhood unintentional injuries?
Hapgood R, Kendrick D, Marsh P. Inj Prev 2001; 7(1):14-7.
Department of General Practice, University of Nottingham, UK. rhydian.hapgood@nottingham.ac.uk
OBJECTIVE: The aim of this study was to investigate the validity of self reported safety behaviours as a proxy for injuries in unintentional injuries research. SETTING: The study population comprised parents and guardians of children aged 3-12 months in 18 general practices throughout Nottingham (n = 764) who responded to a questionnaire on safety practices. METHOD: Injury data were collected by searching the primary and secondary care records of each child in the study. Safety behaviour was measured by computing a safety practices score from self reported safety practices for each respondent to a postal baseline questionnaire survey of safety behaviours. The score was used to classify families into low, medium, and high risk of injury occurrence. Two further scores were calculated, firstly for those safety practices which required obtaining an item of safety equipment, and secondly those safety practices requiring behavioural change without cost implications. RESULTS: High risk families were no more likely than low risk families to sustain an injury (odds ratio (OR) 1.08; 95% confidence interval 0.65 to 1.79). Medium risk families were also no more likely than low risk families to have a medically attended injury (OR 1.09; 0.73 to 1.61) suggesting no association between safety score and future medically attended injury. Similarly, compared to low risk families, medium risk (OR 0.93; 0.33 to 2.61) and high risk (OR 0.46; 0.08 to 2.43) families were no more likely to have a child admitted to hospital with an injury. There was no correlation between the total number of injuries sustained during the study period and the baseline safety practices score (Spearman's rho = 0.004; p = 0.917). Subgroup analyses for safety behaviours requiring passive and active safety measures did not reveal significant associations with injury outcomes. CONCLUSION: Self reported safety behaviours do not appear to be good predictors of childhood unintentional injuries. Further research is required to ascertain valid proxy outcome measures for injury research.
Project ARM: alcohol risk management to prevent sales to underage and intoxicated patrons.
Toomey TL, Wagenaar AC, Gehan JP, Kilian G, Murray DM, Perry CL. Health Educ Behav 2001; 28(2):186-99.
Division of Epidemiology, University of Minnesota, Minneapolis 55454-1015, USA. toomey@epi.umn.edu
Clear policies and expectations are key to increasing responsible service of alcohol in licensed establishments. Few training programs focus exclusively on owners and managers of alcohol establishments to reduce the risk of alcohol service. Project ARM: Alcohol Risk Management is a one-on-one consultation program for owners and managers. Participants received information on risk level, policies to prevent illegal sales, legal issues, and staff communication. This nonrandomized demonstration project was implemented in five diverse bars. Two waves of underage and pseudo-intoxicated purchase attempts were conducted pre- and postintervention in the five intervention bars and nine matched control bars. Underage sales decreased by 11.5%, and sales to pseudo-intoxicated buyers decreased by 46%. Results were in the hypothesized direction but not statistically significant. A one-on-one, outlet-specific training program for owners and managers is a promising way to reduce illegal alcohol sales, particularly to obviously intoxicated individuals.
- Work related spinal cord injury, Australia 1986-97.
O'Connor P. Inj Prev 2001; 7(1):29-34.
Australian Spinal Cord Injury Register, AIHW National Injury, Surveillance Unit, Flinders University Research Centre for Injury Studies, Bedford Park, South Australia. peter.oconnor@nisu.flinders.edu.au
OBJECTIVES: Little has been published before on the epidemiology and prevention of work related spinal cord injury (SCI). This study is the first national population based epidemiological analysis of this type of injury. It presents that largest case series ever reported. SETTING: The study utilises information from the Australian Spinal Cord Injury Register, which has full coverage of the population. METHODS: All newly incident cases of SCI from 1986 to 1997 were considered. RESULTS: Work related SCI accounted for about 13% of all traumatic cases of SCI over the period 1986-97. The labour force based incidence rate in Australia averaged four cases per million of population per annum over the period. The rate was highest among those aged 25-34 years (4.9/million) and among farmers (17.0/ million). Nearly half of the cases studied received their injury due to a fall. Motor vehicle crashes were also common and vehicle rollover was the predominant crash type. A high proportion of cases did not receive any compensation for their SCI. CONCLUSIONS: Although rare, SCI is one of the most severe and debilitating injuries that can be suffered in the workplace. As there is no cure for SCI, and the level of impairment does not improve substantially for the vast majority of cases even after rehabilitation, it is arguable that primary prevention should receive substantially greater emphasis.
Comparison of work related fatal injuries in the United States, Australia, and New Zealand: method and overall findings.
Feyer AM, Williamson AM, Stout N, Driscoll T, Usher H, Langley JD. Inj Prev 2001; 7(1):22-8.
New Zealand Environmental and Occupational Health Research Centre, University of Otago, Dunedin. afeyer@gandalf.otago.ac.nz
OBJECTIVES: To compare the extent, distribution, and nature of fatal occupational injury in New Zealand, Australia, and the United States. SETTING: Workplaces in New Zealand, Australia, and the United States. METHODS: Data collections based on vital records were used to compare overall rates and distribution of fatal injuries covering the period 1989-92 in Australia and the United States, and 1985-94 in New Zealand. Household labour force data (Australia and the United States) and census data (New Zealand) provided denominator data for calculation of rates. Case definition, case inclusion criteria, and classification of occupation and industry were harmonised across the three datasets. RESULTS: New Zealand had the highest average annual rate (4.9/100,000), Australia an intermediate rate (3.8/100,000), and the United States the lowest rate (3.2/ 100,000) of fatal occupational injury. Much of the difference between countries was accounted for by differences in industry distribution. In each country, male workers, older workers, and those working in agriculture, forestry and fishing, in mining and in construction, were consistently at higher risk. Intentional fatal injury was more common in the United States, being rare in both Australia and New Zealand. This difference is likely to be reflected in the more common incidence of work related fatal injuries for sales workers in the United States compared with Australia and New Zealand. CONCLUSIONS: The present results contrasted with those obtained by a recent study that used published omnibus statistics, both in terms of absolute rates and relative ranking of the three countries. Such differences underscore the importance of using like datasets for international comparisons. The consistency of high risk areas across comparable data from comparable nations provides clear targets for further attention. At this stage, however, it is unclear whether the same specific occupations and/or hazards are contributing to the aggregated industry and occupation group rates reported here.
Sudden Death and Other Risks Associated With Dry-Sand Beach Holes.
Maron BA, Maron BJ. JAMA 2001; 285(15):1964.
Brown University School of Medicine, Providence, RI Bradley_Maron@Brown.edu
Risks associated with professional construction excavations in clay, soil, and rock and the consequences of collapse of such holes have long been recognized1 and are the subject of government safety guidelines for industry.2, 3 However, similar serious but largely unrecognized dangers (including sudden death) may be associated with innocent-appearing recreational beach activities. While traditionally there has been a focus on water safety at public beaches, the risks and threats to the recreational safety of children associated with dry-sand holes have to date achieved little attention in the general public and medical community. This research letter describes the problem. - Surface characteristics, equipment height, and the occurrence and severity of playground injuries.
Laforest S, Robitaille Y, Lesage D, Dorval D. Inj Prev 2001; 7(1):35-40.
Montreal Public Health Department, Montreal, Quebec, Canada. lucsofi@hotmail.com
OBJECTIVES: To evaluate whether surface characteristics (absorption level (g-max), material) and the height of play equipment are related to the occurrence and severity of injuries from falls. SETTING AND METHODS: During the summers of 1991 and 1995, conformity of play equipment to Canadian standards was assessed in a random sample (n = 102) of Montreal public playgrounds. Surface absorption (g-max) was tested using a Max Hic instrument and the height of equipment was measured. Concurrently, all injuries presenting at the emergency department of Montreal's two children's hospitals were recorded and parents were interviewed. Inspected equipment was implicated in 185 injuries. The g-max measurements (1995 only) were available for 110 of these playground accidents. RESULTS: One third of falls (35 %) occurred on a surface exceeding 200 g and the risk of injury was three times greater than for g level lower than 150 (95% confidence interval (CI) 1.45 to 6.35). On surfaces having absorption levels between 150 g and 200 g, injuries were 1.8 times more likely (95% CI 0.91 to 3.57). Injuries were 2.56 times more likely to occur on equipment higher than 2 m compared with equipment lower than 1.5 m. Analysis of risk factors by severity of injury failed to show any positive relationships between the g-max or height and severity, whereas surface material was a good predictor of severity. CONCLUSIONS: This study confirms the relationships between risk of injury, surface resilience, and height of equipment, as well as between type of material and severity of injury. Our data suggest that acceptable limits for surface resilience be set at less than 200 g, and perhaps even less than 150 g, and not exceed 2 m for equipment height. These findings reinforce the importance of installing recommended materials, such as sand, beneath play equipment.
An overview of the injury severity score and the new injury severity score.
Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. Inj Prev 2001; 7(1):10-3.
mark@health.curtin.edu.au
OBJECTIVE: The research was undertaken to describe the injury severity score (ISS) and the new injury severity score (NISS) and to illustrate their statistical properties. DESIGN: Descriptive analysis and assessment of the distribution of these scales. METHODS: Three data sources--the National Pediatric Trauma Registry; the Massachusetts Uniform Hospital Discharge Data Set; and a trauma registry from an urban level I trauma center in Massachusetts--were used to describe the distribution of the ISS and NISS among injured patients. RESULTS: The ISS/NISS was found to have a positively skewed distribution and transformation did not improve their skewness. CONCLUSION: The findings suggest that for statistical or analytical purposes the ISS/ NISS should not be considered a continuous variable, particularly if ISS/NISS is treated as a continuous variable for correlation with an outcome measure.
Registration of external causes of death in the Baltic States 1970-1997.
Varnik A, Wasserman D, Palo E, Tooding LM. Eur J Public Health 2001; 11(1):84-8.
Estonian-Swedish Institute of Suicidology, Tallinn, Estonia. airiv@online.ee
BACKGROUND: Trends in external causes of deaths in the Baltic States--Estonia, Latvia and Lithuania--were analysed against the background of turbulent political, social and economic changes. The reliability of mortality statistics concerning external causes of death in these countries is considered to be good. METHOD: This study is based on data published by the statistical offices of the three Baltic States and on data obtained through interviews with personnel employed at the national statistical offices. The study period was divided, by socio-political and economic factors, into a period of stagnation (1970-1984) and a period of reforms (1985-1997). RESULTS: During 1970-1984 a stable slightly upward trend of external causes of death rates was observed. The curve became S-shaped in the reform period: between 1984 and 1988 a marked decrease occurred followed by a rapid increase of rates until 1994, and then by 1997 a fall to the approximate level of 1984. The male to female ratio of external causes of death was between 3.4:1 and 4.2:1. External deaths accounted for 10% to 14% of all deaths before 1984. During the period 1984-1988 the proportion of external deaths was under 10% and peaked in 1994 at 16%. Fluctuations in the trends of external death were more pronounced among males than females in all Baltic countries. CONCLUSION: Trends in external causes of death were similar in Baltic States. High proportions of violent death decreased life-expectancy for both sexes, but markedly for males. Social stresses and alcohol consumption could be considered as factors influencing the mortality rates and specific fluctuations in trends of external death, especially among males.
Factors related to driving difficulty and habits in older drivers.
Lyman JM, McGwin GJ, Simms RV. Accid Anal Prev 2001; 33(3):413-421.
Department of Epidemiology, School of Public Health, 700 S. 18th Street, Suite 609 EFH, University of Alabama at Birmingham, Birmingham, AL, USA. mcgwin@uab.edu
Objectives: To evaluate the association between chronic medical conditions, functional, cognitive, and visual impairments and driving difficulty and habits among older drivers. Design: Cross-sectional study. Setting: Mobile County, Alabama. Participants: A total of 901 residents of Mobile County, Alabama aged 65 or older who possessed a driver's license in 1996. Measurements: Information on demographic characteristics, functional limitations, chronic medical conditions, driving habits, and visual and cognitive function were collected via telephone. The three dependent variables in this study were difficulty with driving, defined as any reported difficulty in 3 driving situations (e.g. at night), low annual estimated mileage, defined as driving less than 3000 miles in 1996, and low number of days (3) driven per week. Results: A history of falls, kidney disease or stroke was associated with difficulty driving. Older drivers with a history of kidney disease were more likely to report a low annual mileage than subjects without kidney disease. Low annual mileage was also associated with cognitive impairment. In general, older drivers with a functional impairment were more likely to drive less than 4 days per week. Older drivers with a history of cataracts or high blood pressure were more likely to report a low number of days driven per week, while subjects with visual impairment were at increased risk of experiencing difficulty driving as well as low number of days driven per week. Conclusions: The results underscore the need to further understand the factors negatively affecting driving independence and mobility in older drivers, as well as the importance of improved communication between older adults and health care professionals regarding driving.
Partners for child passenger safety: a unique child-specific crash surveillance system.
Durbin DR, Bhatia E, Holmes JH, Shaw KN, Werner JV, Sorenson W, Winston FK. Accid Anal Prev 2001; 33(3):407-412.
The Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA ddurbin@cceb.med.upenn.edu
Insurance claims data were combined with telephone survey and on-site crash investigation data to create the first large scale, child-focused motor vehicle crash surveillance system in the US. Novel data management and transfer techniques were used to create a nearly real-time data collection system. In the first year of this on-going project, known as Partners for Child Passenger Safety, over 1200 children 15 years of age per week were identified in crashes reported to State Farm Insurance Co. from 15 states and Washington, D.C. Partners for Child Passenger Safety is similar in its design and overall objectives to National Automotive Sampling System (NASS), the only other population-based crash surveillance system currently operating in the US.
When the perpetrator gets killed: effects of observing the death of a handgun user in a televised public service announcement.
Bernhardt JM, Sorenson JR, Brown JD. Health Educ Behav 2001; 28(1):81-94.
Department of Health Promotion and Behavior, School of Health and Human Performance, University of Georgia, Athens 30602-6522, USA. jaybird@coe.uga.edu
This study evaluates the cognitive effects of an anti-handgun violence public service announcement (PSA) on sixth-, seventh-, and eighth-grade students (N = 294). Participants were randomly assigned to a treatment group, which viewed a PSA depicting the death of an aggressive handgun user, or a comparison group, which viewed identical content except that the PSA showed no negative consequence for the handgun user. Logistic regression analysis, adjusting for race and gender, revealed that the treatment group was more likely to report negative expected outcomes for aggressively using a handgun and lower behavioral intentions to aggressively use a handgun compared with the comparison group. These findings suggest that observing handgun violence on television that depicts death as a negative physical consequence for the perpetrator may produce lower handgun-encouraging beliefs compared with observing no consequence for the perpetrator--the norm for most televised violence today.
Two separate unintentional fatalities with the same revolver.
Lee C, Nolte KB. Ann Emerg Med 2001; 37(3):333-6.
Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, NM 87131-5091, USA.
We report 2 deaths and 1 injury that resulted from 2 separate unintentional discharges of the same Ruger Blackhawk revolver. One discharge was a consequence of careless firearm handling combined with a slip during a decocking procedure unique to certain hammer-action firearms. The second discharge occurred when the firearm was dropped and was the result of a combination of firearm design and a lack of knowledge regarding the safe handling of this type of revolver. The second death may have been prevented by the timely intervention of a health care or law enforcement professional at the time of the first unintentional discharge. Physicians who become knowledgeable about the functioning of different types of firearms and how they can malfunction may help promote the safe and responsible use of firearms among their patients.
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