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Literature Update for the Week of
April 30, 2001
General:
Serious stair injuries can be prevented by improved stair design.
Roys MS. Appl Ergon 2001; 32(2):135-139.
Building Research Establishment Ltd, Garston, Watford, UK. roysm@bre.co.uk
An estimated 2.5 million injuries, and a further 4000 deaths in the UK in 1995 were due to home accidents. About 230,000 of these injuries and 497 deaths resulted from falls on stairs. When exposure is taken into account, stairs are one of the most hazardous locations in buildings. Of these falls, those where the person falls forward are most likely to cause severe injuries. One aspect of stair design, the "going" (the horizontal distance between two consecutive nosings) can be changed to decrease the potential number of serious trip accidents. Builders should therefore be encouraged to build stairs with larger goings.
Injury prevention in people with disabilities: Risks can be minimised without unduly restricting activities.
Forjuoh SN, Guyer B. BMJ 2001; 322:940-941.
Department of Family and Community Medicine, Scott and White Memorial Hospital and Foundation, Texas A&M University System HSC College of Medicine 1402 West Avenue H, Temple, TX 75604, USA
Some risk of injury exists for almost every human activity, and this risk may be increased for people with impairments, disabilities, or other special healthcare needs. The mechanism of injury is insensitive to the presence or type of disability, whether the injury involves transfer of excessive kinetic energy to the body, as in physical trauma, or deprivation of an essential element such as oxygen, as in submersion. However, the additional risk associated with the underlying condition changes the dynamics of the injury process. Epidemiological studies have, for example, found that people with epilepsy have a greater risk of drowning and burns than those without the disease and that individuals with a sensory deficit are at greater risk of pedestrian injury. This commentary examines these issues but cautions that an instinctive reaction of restricting the activities of people with disabilities would, however, be wrong.
The perceptions of managers and accident subjects in the service industries towards slip and trip accidents.
Lehane P, Stubbs D. Appl Ergon 2001; 32(2):119-126.
Environmental Health & Trading Standards, Bromley Civic Centre, UK. paul.lehane@bromley.gov.uk
Slips and trips are a major cause of injury and lost time, and remain so despite specific initiatives. The work presented here focuses on how accident subjects and their managers each perceive the circumstances of an accident with respect to causal responsibility. To investigate this issue, a research questionnaire was designed, piloted and then applied to 33 occupational slip and trip accidents reported to a Local Authority Inspectorate. The results showed important differences in the attribution of causal responsibility between those who experience and those who investigate slips and trip accidents. The levels of agreement between individual accident subjects and their managers was at best fair (using kappa). The consequences of this and the limited scope of investigation carried out by managers is highlighted and the need for improved training and the development of a practical model of risk assessment and investigation for managers is advanced.
Baler and Compactor-Related Deaths in the Workplace --- United States, 1992--2000
Fatality Assessment and Control Evaluation Program, Div of Safety Research, National Institute for Occupational Safety and Health, CDC.
MMWR 2001; 50(16);309-313.
Equipment that compacts and bales loose solid waste materials into denser, more easily transported units is common in refuse disposal and recycling and is used routinely at recycling centers, manufacturing facilities, and retail and wholesale stores to compress paper, textiles, metals, plastic, and other material. Persons operating balers and compactors can become caught by the powered rams of the compression chambers while using these machines. Risk factors resulting from these incidents have been identified through surveillance findings and results of investigations conducted by CDC's National Institute for Occupational Safety and Health (NIOSH) Fatality Assessment and Control Evaluation (FACE) program and the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI), a nationwide multisource reporting system for occupational deaths. This report describes the results of two baler and compactor-related investigations conducted during 1992--2000, summarizes surveillance data from 1992 through 1998, which indicated that some employers and workers may have been unaware of the hazards of operating or working near compacting and baling equipment, and suggests safety recommendations for preventing future incidents. Nonfatal Occupational Injuries and Illnesses Treated in Hospital Emergency Departments --- United States, 1998.
Div of Safety Research, National Institute for Occupational Safety and Health, CDC.
MMWR 2001; 50(16);309-313.
The National Electronic Injury Surveillance System (NEISS) includes data about nonfatal occupational injuries and illnesses treated in U.S. hospital emergency departments (EDs). This report summarizes 1998 injury and illness estimates based on NEISS, which indicate that the magnitude and patterns of nonfatal occupational injuries and illnesses were comparable to estimates reported for 1996. Younger workers continue to have the highest rates of work-related injuries and illnesses; therefore, interventions should address the health and safety needs of young workers, most of whom lack substantial experience in the work place.
Tonic seizures are a particular risk factor for drowning in people with epilepsy.
Besag FMC. BMJ 2001; 322:975-976.
Learning Disability Service, Bedfordshire and Luton Community NHS Trust, Twinwoods Health Resource Centre, Bedford MK41 6AT UKFBesag@aol.com
It is accepted that people with epilepsy should be supervised when swimming. However, there is little or no guidance about special precautions that should be taken for particular types of seizures. During a tonic seizure the muscles of the chest wall contract and much of the air from the lungs may be expelled. If such a seizure occurs while a person is swimming, the average body density may become higher than the density of the water, causing rapid submersion. When the muscles of the chest wall relax, the person will still be submerged, with the result that water, not air, will enter the respiratory tract and the person will not rise to the surface. We present a case of fatal drowning in a 14 year old boy with epilepsy who had seizures with a marked tonic phase. This case raises an important question with regard to safety: should special precautions be taken to minimise the risk of drowning in patients with tonic seizures?
Emergency visits for sports-related injuries.
Burt CW, Overpeck MD. Ann Emerg Med 2001; 37(3):301-8.
National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA. cwb2@cdc.gov
STUDY OBJECTIVE: We sought to estimate the effect and magnitude of patients with sports-related injuries presenting to hospital emergency departments in the United States and to examine differences in patient and visit characteristics between sports- and nonsports-related injuries. METHODS: Data from the 1997 and 1998 National Hospital Ambulatory Medical Care Survey, a national probabilistic sample of 496 US hospital EDs, were combined to examine emergency visits for sports-related injuries. Data from 16,997 sample ED encounter records for injuries that included narrative cause of injury text were analyzed. Narrative text entries were coded to 1 of 84 sport and recreational activity codes. Sample weights were applied to provide annual national estimates. Estimates of sports-related injury visits were based on 1,775 records with an assigned sports-related activity code. RESULTS: There were an average annual estimated 2.6 million emergency visits for sports-related injuries by persons between the ages of 5 and 24 years. They accounted for over 68% of the total 3.7 million sport injuries presented to the ED by persons of all ages. As a proportion of all kinds of injuries presenting to the ED, sports-related injuries accounted for more than one fifth of the visits by persons 5 to 24 years old. The use rate was 33.9 ED visits per 1,000 persons in this age group (95% confidence interval 30.3 to 37.5). The sports-related injury visit rate for male patients was more than double the rate for female patients (48.2 versus 19.2 per 1,000 persons between 5 and 24 years of age). Visits from sports-related activities for this age group were more frequent for basketball and cycling compared with other categories (eg, baseball, skateboarding, gymnastics). Compared with nonsports-related injuries for this age group, sports-related injuries were more likely to be to the brain or skull and upper and lower extremities. Patients with sports-related injuries were more likely to have a diagnosis of fracture and sprain or strain and less likely to have an open wound. They were also more likely to have diagnostic and therapeutic services provided, especially orthopedic care. CONCLUSION: Sports-related activities by school-age children and young adults produce a significant amount of emergency medical use in the United States. The ED is an appropriate venue to target injury prevention counseling.
Are closed-minded people more open to the idea of killing themselves?
Duberstein PR. Suicide and Life Threat Behav 2001; 31(1):9-14.
Center for the Study and Prevention of Suicide, University of Rochester School of Medicine and Dentistry 300 Crittenden Blvd., Rochester, NY 14642 paul_duberststein@urmc.rochester.edu
This report summarized the author's work on Openness to Experience (a personality trait) and suicidal behavior. it appears that people who obtain low scores on an inventory (NEOPI-R) measuring Openness to Experience are less likely to report suicidal ideation but more likely to take their own lives. How can this apparent discrepancy be reconciled? Based on the premise that the expression of suicidal ideation can have adaptive consequences (e.g., by mobilizing family and treatment providers), it is hypothesized that people with major depression who are low in Openness may be at increased risk for completed suicide in p[art because they are less likely to feel, or to report feeling, suicidal.
Immediate post intervention effects of two brief youth suicide prevention interventions.
Randell BP, Eggert LL, Pike KC. Suicide and Life Threat Behav 2001; 31(1):41-69.
Reconnecting Youth Prevention Research Program, Psychosocial and Community health, Box 357263, University of Washington School of Nursing, Seattle, WA 98195 bprand@u.washington.edu
This study evaluated the immediate postintervention effects of two brief suicide prevention protocols: a brief interview -- Counselors CARE (C-CARE), and C-CARE plus a 12-session Coping and Suppport Training (CAST) peer-group intervention. Subjects were students "at-risk" of high school dropout and suidice potential in grades 9 - 12 from seven high schools (n=341). Students were assigned randomly to C-CARE only, C-CARE plus CAST, or "intervention as usual." The predicted patterns of change were addessed using trend analysis on data available from three reported measures. C-CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C-CARE plus CAST and C-CARE only led to decreases in depression and to enhanced self-esteem and family goals met. All three groups showed equivalent decreases in suicide risk behaviors, anger control problems, and family distress.
New evidence concerning fatal crashes of passenger vehicles before and after adding antilock braking systems.
Farmer CM. Accid Anal Prev 2001; 33(3):361-369.
Fatal crash rates for passenger cars and vans were compared for the last model year before four-wheel antilock brakes were introduced and the first model year for which antilock brakes were standard equipment. A prior study, based on fatal crash experience through 1995, reported that vehicle models with antilock brakes were more likely than identical but 1-year-earlier models to be involved in crashes fatal to their own occupants, but were less likely to be involved in crashes fatal to occupants of other vehicles. Overall, there was no significant effect of antilocks on the likelihood of fatal crashes. Similar analyses, based on fatal crash experience during 1996-98, yielded very different results. During 1996-98, vehicles with antilock brakes were again less likely than earlier models to be involved in crashes fatal to occupants of other vehicles, but they were no longer overinvolved in crashes fatal to their own occupants.
Bicycle helmet efficacy: a meta-analysis.
Attewell RG, Glase K, McFadden M. Accid Anal Prev 2001; 33(3):345-352.
Bicycle helmet efficacy was quantified using a formal meta-analytic approach based on peer-reviewed studies. Only those studies with individual injury and helmet use data were included. Based on studies from several countries published in the period 1987-1998, the summary odds ratio estimate for efficacy is 0.40 (95% confidence interval 0.29, 0.55) for head injury, 0.42 (0.26, 0.67) for brain injury, 0.53 (0.39, 0.73) for facial injury and 0.27 (0.10, 0.71) for fatal injury. This indicates a statistically significant protective effect of helmets. Three studies provided neck injury results that were unfavourable to helmets with a summary estimate of 1.36 (1.00, 1.86), but this result may not be applicable to the lighter helmets currently in use. In conclusion, the evidence is clear that bicycle helmets prevent serious injury and even death. Despite this, the use of helmets is sub-optimal. Helmet use for all riders should be further encouraged to the extent that it is uniformly accepted and analogous to the use of seat belts by motor vehicle occupants.
Gun deaths in rural and urban settings: recommendations for prevention.
Dresang LT. J Am Board Fam Pract 2001; 14(2):107-115.
Department of Family Medicine, University of Wisconsin Medical School, USA.
BACKGROUND: Family physicians can play a vital role in preventing gun violence, and better data on which to base their interventions might result in more effective prevention efforts. Using Washington State data, two assumptions on which interventions can be based were tested: compared with urban areas, rural areas have (1) a higher percentage of gun deaths from shotguns and rifles, and (2) a higher percentage of gun deaths from suicides and accidents METHODS: From 1990 to 1996, 4,271 gun deaths on Washington death certificates were classified as rural or urban. The data were retrospectively sorted and analyzed by gun type (handguns, rifles, shotguns, or other) and by intent (suicide, homicide, or accidental death). RESULTS: Compared with urban settings, rural areas had a higher percentage of gun deaths from shotguns and rifles and a higher percentage from suicides and accidents (P < .01). Two similarities, however, stand out as more important than the confirmed hypothesized differences: handguns accounted for more than 50% of gun deaths, and suicides accounted for nearly 70% of gun deaths in both urban and rural areas. CONCLUSIONS: Family physicians might want to focus their firearm safety efforts on preventing handgun deaths and suicides, which accounted for most gun deaths in rural and urban areas. Also, data from this study suggest that deaths from shotguns and rifles as well as accidental and suicide gun deaths deserve special attention in rural areas.
Bullying Behaviors Among US Youth: Prevalence and Association With Psychosocial Adjustment.
Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B, Scheidt P. JAMA. 2001; 285:2094-2100.
Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 7B05, MSC 7510, Bethesda, MD 20892-7510 nanselt@mail.nih.gov
CONTEXT: Although violence among US youth is a current major concern, bullying is infrequently addressed and no national data on the prevalence of bullying are available. OBJECTIVES: To measure the prevalence of bullying behaviors among US youth and to determine the association of bullying and being bullied with indicators of psychosocial adjustment, including problem behavior, school adjustment, social/emotional adjustment, and parenting. DESIGN, SETTING, AND PARTICIPANTS: Analysis of data from a representative sample of 15 686 students in grades 6 through 10 in public and private schools throughout the United States who completed the World Health Organization's Health Behaviour in School-aged Children survey during the spring of 1998. MAIN OUTCOME MEASURE: Self-report of involvement in bullying and being bullied by others. RESULTS: A total of 29.9% of the sample reported moderate or frequent involvement in bullying, as a bully (13.0%), one who was bullied (10.6%), or both (6.3%). Males were more likely than females to be both perpetrators and targets of bullying. The frequency of bullying was higher among 6th- through 8th-grade students than among 9th- and 10th-grade students. Perpetrating and experiencing bullying were associated with poorer psychosocial adjustment (P < .001); however, different patterns of association occurred among bullies, those bullied, and those who both bullied others and were bullied themselves. CONCLUSIONS: The prevalence of bullying among US youth is substantial. Given the concurrent behavioral and emotional difficulties associated with bullying, as well as the potential long-term negative outcomes for these youth, the issue of bullying merits serious attention, both for future research and preventive intervention.
Violent injuries among adolescents: declining morbidity and mortality in an urban population.
Cheng TL, Wright JL, Fields CB, Brenner RA, O'donnell R, Schwarz D, Scheidt PC. Ann Emerg Med 2001; 37(3):292-300.
Department of General Pediatrics and Adolescent Medicine, George Washington University School of Medicine and School of Public Health, USA.
STUDY OBJECTIVE: Adolescent homicide rates are decreasing nationally for unclear reasons. We explore changes in intentional injury morbidity and mortality within the context of other injuries and specific causes. METHODS: We performed surveillance of hospital, medical examiner, and vital records for nonfatal injury among adolescents age 10 to 19 years living in the District of Columbia from June 15, 1996, to June 15, 1998, and fatal injury from 1989 to 1998. RESULTS: Over the 2-year study period, 15,190 adolescents were seen for injury, resulting in an event-based rate of 148 injuries per 1,000 adolescents per year; 7% required hospitalization, and 0.8% died. Interpersonal intentional injuries accounted for 25% of all injuries, 45% of hospitalizations, and 85% of injury deaths. Assault morbidity decreased with no change noted for unintentional and self-inflicted injury. Firearm injuries, stabs, and assaults with other objects showed the largest decrease, with no decrease in unarmed assaults. Injury mortality peaked in 1993 and has declined since. Firearms caused 72% to 90% of all injury deaths from 1989 to 1998, most the result of homicide. CONCLUSION: There has been a decline in intentional injury rates over the study periods related to decreased weapon injury; data suggest a change in the lethality of fighting methods but no change in unarmed fighting behavior.
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