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June 25, 2001
Deaths and injuries from house fires
Istre GR, McCoy MA, Osborn L, Barnard JJ, Bolton A. New Engl J Med 2001; 344(25):1911-1916.
Correspondence: Dr. Gregory Istre at the Injury Prevention Center of Greater Dallas, P.O. Box 36067, Dallas, TX 75235 USA (no email address available)
The authors used population-based surveillance data to identify factors associated with house fires and house-fire related injuries. For the years 1991 - 1997, the authors linked data from the Dallas, Texas Fire Department for all house fires (excluding fires in apartments and mobile homes), records of patients transported by ambulance, hospital admissions, and reports from the medical examiner of fatal injuries. There were 223 injuries (91 fatal and 132 nonfatal) from 7190 house fires, for a rate of 5.2 injured persons per 100,000 population per year. Rates of injury related to house fires were highest among blacks (relative risk, 2.8; 95% CI= 2.1 to 3.6) and in people 65 years of age or older (RR, 2.6; 95% CI= 1.9 to 3.5). Census tracts with low median incomes had the highest rates of injury related to house fires (RR as compared with census tracts with high median incomes, 8.1; 95% CI= 2.5 to 32.0). The rate of injuries was higher for fires that began in bedrooms or living areas (RR, 3.7); that were started by heating equipment, smoking, or children playing with fire (RR, 2.6); or that occurred in houses built before 1980 (RR, 6.6). Injuries occurred more often in houses without functioning smoke detectors (RR, 1.5; 95% CI, 1.0 to 2.4). The prevalence of functioning smoke detectors was lowest in houses in the census tracts with the lowest median incomes (P<0.001).
The epidemiology of traumatic injury-related fetal mortality in Pennsylvania, 1995-1997: the role of motor vehicle crashes
Weiss HB. Accid Anal Prev 2001; 33(4):449-454.
Correspondence: Harold B. Weiss, Center for Injury Research and Control, 200 Lothrop Street, Suite B400, University of Pittsburgh, Pittsburgh, PA 15213 USA
The researcher conducted a manual review of all fetal death certificates (7131 cases) filed from 1995 to 1997 in Pennsylvania, USA to determine the rates and causes of death. Thirty-one traumatic injury cases were identified (6.5 per 100,000 live births). Motor vehicles were the leading cause of injury (81%). Placental separation was the leading diagnosis (42%). Most cases (94%) could be identified from the ICD-9 diagnosis code 760.5 (maternal injury) and 87% contained narratives indicating the specific injury mechanisms. Although it is not known how sensitive an indicator it is, the ICD-9 code 760.5 appears to be a specific indicator of traumatic fetal death. Sleep-related vehicle accidents: some guides for road safety policies
Horne J, Reyner L. Transportation Research Part F: Psychology and Behaviour 2001; 4(1): 63-74.
Correspondence: Jim Horne, Sleep Research Centre, University of Loughborough, Leicestershire LE11 3TU, UK j.a.horne@lboro.ac.uk
Sleep-related vehicle accidents (SRVAs) are a common form of highway accident, often wrongly attributed to other causes. SRVAs typically involve running off the road or into the back of another vehicle, with no braking beforehand. Because of a high impact speed these accidents are often serious. SRVAs peak around 02:00-06:00 h and 14:00-16:00 h, when daily sleepiness is naturally higher. Hence, time of day is a critical factor, as important as the duration of the drive. Most SRVAs are not due to sleep pathology. Many are work-related. Non-sleeping "rest" is no substitute for sleep. Sleep does not occur spontaneously without warning, and is preceded by feelings of increasing sleepiness of which drivers are quite aware. Driving impairment is usually worse than is realized by the sleepy driver. The best countermeasure is sleep, or even a short nap. Even more effective is the combination of a nap with caffeine.
Policies and practices of transport companies that promote or hinder the management of driver fatigue
Arnold PK, Hartley LR. Transportation Research Part F: Psychology and Behaviour 2001; 4(1): 1-17.
Correspondence: Laurence R. Hartley, Institute for Research in Safety and Transport, Murdoch University, South Street, Western Australia 6150, Australia hartley@socs.murdoch.edu.au
This report describes long-distance transport companies' managerial practices and how these might contribute to on-road driver fatigue. Some companies engaged in practices that were inconsistent with the management of fatigue. Very few had formulated fatigue management policies, but many reported having policies that could aid in managing driver fatigue. However, the potential benefit of such policies was often compromised by their operational practices. This included setting limits on driving time, but failing to communicate them to drivers or take action when drivers exceeded them. Companies were prepared to hire drivers with little industry experience, but did not provide them with education about fatigue. Companies monitored driver fitness for duty and fatigue, but used methods that relied on others' observations or investigations after a problem had arisen. There was also acknowledgement that punitive action could be taken against drivers who were unfit for duty, or unable to meet the companies' delivery deadlines. Almost all companies had drug and alcohol policies and believed their drivers did not use drugs, though they believed drug use was common in other companies. Field-based validations of a work-related fatigue model based on hours of work
Fletcher A, Dawson D. Transportation Research Part F: Psychology and Behaviour 2001; 4(1): 75-88.
Correspondence: Drew Dawson, Centre for Sleep Research, Queen Elizabeth Hospital, University of South Australia, CDRC Building Level 5, Woodville Road, Woodville, SA 5011, Australia drew.dawson@unisa.edu.au
Shift work, and in particular night work, is associated with decreased quantity and quality of sleep. Such changes to sleep manifest themselves in measures such as increased sleepiness, fatigue and accident risk. To manage these risks, particularly in operational environments, a work-related fatigue model has been developed. To date, strong correlations have been observed with a range of measures in empirical and laboratory experiments. This study aimed to determine if these observed relationships between predicted fatigue, alertness and performance also exist in the workplace. Data was analyzed from 193 train drivers who filled in sleep and work diaries, wore actigraphs, performed subjective alertness and objective performance tests before and after each shift for a period of two weeks during a normal schedule. Work-related fatigue scores were calculated and compared to alertness and performance measures. The findings of the present study show that there was a stronger relationship between predicted fatigue and self-rated alertness than between predicted fatigue and performance. Furthermore, the fatigue model predicted self-rated alertness better in the afternoon and evening hours, when employees worked up to four consecutive shifts. With further field validation of the current model, there is potential for work-related fatigue to be predicted from actual or potential hours of work. In the future, such models may help to clarify the direct and indirect costs of poor fatigue management on safety, productivity and efficiency.
Love our kids, lock your guns: A community-based firearm safety counseling and gun lock distribution program.
Coyne-Beasley T, Victor J. Schoenbach VJ, Johnson RM. Arch Pediatr Adolesc Med 2001;155(6):659-664.
Correspondence: Tamera Coyne-Beasley, MD, MPH, Department of Pediatrics and Internal Medicine, University of North Carolina at Chapel Hill, Campus Box 7225, Wing C, Medical School, Chapel Hill, NC 27599-7225 USA coybea@med.unc.edu
The authors evaluated a firearm safety counseling and gun lock distribution program to assess its effect on improving storage practices. Using a community-based before-after trial in an urban county in central North Carolina, the researchers recruited 112 adult gun owners recruited through a mass media advertising campaign. In the parking lot of a shopping mall, participants completed a survey, and were then provided with tailored counseling, gun safety information, a gun lock, and instructions to use it. Firearm storage practices, were assessed at baseline by survey and personal interview and telephone interview (6-month follow-up). Most participants were white (62%), men (63%), had children (58%), and owned a gun for protection (74%). At follow-up, of the 82 participants, 63 (77%) (up from 39 [48%]) reported storing their gun(s) in a locked compartment (P = .004), 59 (72%) (up from 0) reported using gun locks (P = .001), 61 (74%) (up from 57 [69%]) reported storing their ammunition locked in a separate location, 59 (72%) (up from 52 [63%]) reported storing their gun(s) unloaded, and 6 (7%) (down from 15 [18%]) reported storing firearms unlocked and loaded. Participants with children were more likely at baseline to store weapons unlocked and loaded (38 [59%] vs 19 [41%]; P = .02) but were more likely after counseling to lock their weapons (29 [58%] vs 14 [44%]) and remove guns from the home (5 [10%] vs 0 [0%]).
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