|
|
13 August 2001
Fatal unintentional occupational poisonings by hydrofluoric acid in the U.S.
Blodgett DW, Suruda AJ, Crouch BI. Am J Ind Med 2001; 40(2):215-220.
Correspondence: Barbara I. Crouch, LS Skaggs Pharmacy, University of Utah Health Sciences Center, 30 S 2000 East, Room 201, Salt Lake City, UT 84132 USA (email: barbara.crouch@hsc.utah.edu ).
Case reports have identified hydrofluoric acid (HF) as causing fatal work injury, and HF has both local and systemic toxicity. Surveillance for HF-related mortality is problematic because of the lack of unique coding for this acid in hospital records and vital statistics. The researchers identified HF-related fatal work injuries investigated by the Occupational Safety and Health Administration (OSHA) for 1984-94 from coding of Hazardous Substance 1460 (HF) and requested case investigation files under the Freedom of Information Act. We attempted to identify HF-related deaths in the US for the same period through literature case reports, the Consumer Product Safety Commission, and the American Association of Poison Control Centers (AAPCC). For the 11 year period, OSHA investigated nine deaths in eight incidents which involved HF. Four deaths were from skin contact with concentrated HF, and five deaths involved both skin contact and inhalation of vapor. Unsafe work practices were factors in all of the deaths. Calcium chloride or gluconate was noted to have been administered to five of the nine victims. Calcium was administered 90 min after exposure to two victims, and more than 6 h after exposure to a third. We were able to establish that the regional poison control center had been contacted in regard to only one victim. For the period 1984-94, we were able to identify no additional deaths from CPSC reports, one additional death from AAPCC annual reports, and four other deaths from case reports in the medical literature. For the period of this study, OSHA records identified the greatest number of HF-related fatalities. The limited information in the records suggest that some victims did not receive appropriate medical care, nor was the regional poison center contacted regarding care. The full extent of health problems related to HF could be better quantified if usual surveillance sources, such as vital records, included unique coding for this acid.
Indoor rock climbing: who gets injured?
Wright DM, Royle TJ, Marshall T. Br J Sports Med 2001; 35(3): 181-185.
Correspondence: Mr Marshall, Department of Public Health and Epidemiology, The Public Health Building, University of Birmingham, Birmingham B15 2TT, UK (email: t.marshall@bham.ac.uk).
The authors report on the results of a study to determine the frequency of overuse injury in indoor climbers, the common sites of such injury, and the factors that influence the probability that a climber will have sustained an overuse injury while climbing indoors. A semi-supervised questionnaire was used to survey overuse injury in 295 spectators and competitors at the Entre-Prises World Climbing Championships held in Birmingham 3–5 December 1999. Statistical analysis included simple cross tabulations, calculation of odds ratios, and multiple logistic regression to explore the effect of several factors simultaneously. Some 44% of respondents had sustained an overuse injury, 19% at more than one site. The most common site of injury was the fingers. Univariate analysis showed that the probability of having sustained a climbing injury is higher in men (p = 0.009), those who have climbed for more than 10 years (p = 0.006), those who climb harder routes (p < 0.0005), and those who boulder or lead more than they top rope (p < 0.0005). The relation between lead grade and climbing injury is linear. Multivariate analysis removed the effect of sex as an independent predictor. Mountain biking injuries in rural England.
Jeys LM, Cribb G, Toms AD, Hay SM Br J Sports Med 2001; 35 (3): 197-199.
Correspondence: Lee M. Jeys, 27 Newton Park Road, West Kirby, Wirral CH48 9XE, UK (email: lee.jeys@btclick.com).
Off road mountain biking is now an extremely popular recreation and a potent cause of serious injury. To establish the morbidity associated with this sport, data were collected prospectively over one year on all patients presenting with an injury caused by either recreational or competitive off road mountain biking. Eighty four patients were identified, 70 males and 14 females, with a mean age of 22.5 years (range 8–71). Most accidents occurred during the summer months, most commonly in August. Each patient had an average of 1.6 injuries (n = 133) and these were divided into 15 categories, ranging from minor soft tissue to potentially life threatening. Operative intervention was indicated for 19 patients (23%) and several required multiple procedures. The commonest injuries were clavicle fractures (13%), shoulder injuries (12%), and distal radial fractures (11%). However, of a more sinister nature, one patient had a C2/3 dislocation requiring urgent stabilization, one required a chest drain for a hemo-pneumothorax, and another required an emergency and life saving nephrectomy.
Creatine Use Among Young Athletes.
Metzl JD, Small E, Levine SR, Gershel JC. Pediatrics 2001; 108(2): 421-425.
Correspondence: Jordan D. Metzl, Sports Medicine Service, Hospital for Special Surgery, Department of Pediatrics, 535 East 70th Street, New York, NY 10021, USA.
Creatine is a nutritional supplement that is purported to be a safe ergogenic aid in adults. Although as many as 28% of collegiate athletes admit taking creatine, there is little information about creatine use or potential health risk in children and adolescents. Although the use of creatine is not recommended in people less than 18 years of age, numerous anecdotal reports indicate widespread use in young athletes. The purpose of this study was to determine the frequency, risk factors, and demographics of creatine use among middle and high school student athletes. Before their annual sports preparticipation physical examinations, middle and high school athletes aged 10 to 18 in Westchester County, a suburb north of New York City, were surveyed in a confidential manner. Information was collected regarding school grade, gender, specific sport participation, and creatine use. Overall, 62 of 1103 participants (5.6%) admitted taking creatine. Creatine use was reported in every grade, from 6 to 12. Forty-four percent of grade 12 athletes surveyed reported using creatine. Creatine use was significantly more common (P < .001) among boys (53/604, 8.8%) than girls (9/492, 1.8%). Although creatine was taken by participants in every sport, use was significantly more common among football players, wrestlers, hockey players, gymnasts, and lacrosse players (P < .001 for all). The most common reasons cited for taking creatine were enhanced performance (74.2% of users) and improved appearance (61.3%), and the most common reason cited for not taking creatine was safety (45.7% of nonusers). Despite current recommendations against use in adolescents less than 18 years old, creatine is being used by middle and high school athletes at all grade levels. The prevalence in grades 11 and 12 approaches levels reported among collegiate athletes.
-
Temporal Variations in School-Associated Student Homicide and Suicide Events --- United States, 1992--1999.
Safe and Drug Free Schools Program, US Dept of Education. National Institute of Justice, US Dept of Justice. Div of Violence Prevention and Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC. MMWR 2001; 50(31): 657-660.
Full text available online: ( http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5031a1.htm ).
Recent, widely reported violent deaths associated with schools have led many adults to believe that a school shooting could occur in their community and many children to express increasing concern about their own safety at school. The United States Centers for Disease Control, in collaboration with the U.S. Education and Justice departments, has been tracking school-associated violent deaths [any homicide, suicide, legal intervention (victim killed by police officer in the line of duty), or unintentional firearm-related death] since the 1992--1993 school year. To evaluate whether the risk for school-associated violent death varies during the school year, the CDC analyzed monthly counts of school-associated homicide and suicide events that occurred among students in elementary and secondary (middle, junior high, and senior high) schools in the United States. This report summarizes the results of these analyses, which indicate that student homicide event rates are usually highest near the start of the fall and spring semesters, and suicide event rates are highest during the spring semester.
For these analyses, a school-associated violent death event was defined as a homicide or suicide of a student in which the fatal injury occurred 1) on the campus of a functioning public or private elementary or secondary school in the United States, 2) while the victim was on the way to or from regular sessions at such a school, or 3) while the victim was attending or traveling to or from an official school-sponsored event. Events resulted in the death of at least one student but may have included the deaths of nonstudents (e.g., faculty, school staff, family members, and community residents). Events were identified through a systematic search of two computerized newspaper and broadcast media databases (Lexis-Nexis and Dialog). To confirm events, a qualifying interview was conducted with at least one law enforcement or school official familiar with each event.
Student homicide and suicide event rates were analyzed individually for the 10 months that define a typical school year (September--June). Events that involved the homicide of a student followed by the suicide of a student perpetrator were included in each analysis. Event totals for each month were calculated by summing over the 7 school years in the study period. For both homicide and suicide events, the relevant exposure period in each month was based on the total number of school days in that month over the entire 7-year period, estimated by inspection of several school calendars selected from each region of the country. For each event type, the number of events per school day was calculated for each month in the school calendar and plotted to allow visual assessment of trends. Poisson rate models were used to evaluate the trends over the school year. Each model was restricted to one monthly time-trend variable and one semester transition variable to account for the apparent increase in event rates following the semester/holiday break that usually occurs in late December through early January.
For the 7 school years during September 1, 1992--June 30, 1999, 209 school-associated violent death events occurred that involved either the homicide or suicide of a student. During the 7 school years of the study period, an average of 0.14 school-associated homicide events occurred each school day (one event every 7 school days) (Figure 1). For homicide events, rates decreased during each semester (monthly change in log rate: --0.2; p=0.0002) and increased markedly in association with the transition between the fall and spring semesters (increase in log rate: 0.98; p=0.001). These findings indicate that homicide event rates were relatively high near the beginning of the school year, gradually declined during the fall semester, and exhibited a similar pattern during the spring semester.
For suicides, an average of 0.03 events occurred each school day (one event every 31 school days). The estimated Poisson rate model for suicide events involved a nonsignificant time-trend variable. As a result, this variable was subsequently dropped and the resulting simplified model, which included only the semester transition variable, suggests that the suicide event rate was higher during the spring semester than the fall semester (increase in log rate: 1.0; p=0.0103).
-
The Effectiveness of a Home Visit to Prevent Childhood Injury.
King WJ, Klassen TP, LeBlanc J, Bernard-Bonnin A, Robitaille Y, Pham B, Coyle D, Tenenbein M, Pless IB. Pediatrics 2001; 108(2): 382-388.
Correspondence: W. James King, Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, CANADA (email: king@cheo.on.ca).
Using a multi-center randomized, controlled trial conducted at 5 hospitals in 4 Canadian urban centers, the authors examined the effects of a home visiting program on 1) parental injury awareness and knowledge; 2) the extent that families used home safety measures; 3) the rate of injury; and 4) the cost effectiveness of the intervention. Children less than 8 years old, initially enrolled in an injury case-control study, were eligible to participate. Subsequent to a home inspection conducted to determine baseline hazard rates for both groups, participants in the intervention group received a single home visit that included the provision of an information package, discount coupons, and specific instruction regarding home safety measures. The median age was 2 years, with males comprising about 60% of participants. The experimental groups were comparable at outset in terms of case-control status, age, gender, and socioeconomic status. Parental injury awareness and knowledge was high; 73% correctly identified injury as the leading cause of death in children, and an intervention effect was not demonstrated. The adjusted odds ratios (ORs) for the home inspection items indicated that significant safety modifications only occurred in the number of homes having hot water not exceeding 54°C (OR: 1.31, 95% confidence interval [CI]: 1.14, 1.50) or the presence of a smoke detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the intervention group reported home safety modifications of 62% at 4 months and significantly less injury visits to the doctor compared with the nonintervention group (rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of care for injuries were significantly lower in the intervention group compared with the nonintervention group with a cost of $372 per injury prevented. An intervention using a single home visit to improve the extent to which families use safety measures was found to be insufficient to influence the long-term adoption of home safety measures, but was effective to decrease the overall occurrence of injuries. Future programs should target a few, well-focused, evidence-based areas including the evaluation of high-risk groups and the effect of repeated visits on outcome.
-
Adoption as a Risk Factor for Attempted Suicide During Adolescence.
Slap G, Goodman E, Huang B.Pediatrics 2001; 108(2): e30.
Correspondence: Gail B. Slap, Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA ( email: gail.slap@chmcc.org).
Depression, impulsivity, and aggression during adolescence have been associated with both adoption and suicidal behavior. Studies of adopted adults suggest that impulsivity, even more than depression, may be an inherited factor that mediates suicidal behavior. However, the association between adoption and adolescent suicide attempts and the mechanisms that might explain it remain unknown. The objective of this study was to determine the following: 1) whether suicide attempts are more common among adolescents who live with adoptive parents rather than biological parents; 2) whether the association is mediated by impulsivity, and 3) whether family connectedness decreases the risk of suicide attempt regardless of adoptive or biological status. A secondary analysis of Wave I data from the National Longitudinal Study of Adolescent Health was conducted, which used a school-based, clustered sampling design to identify a nationally representative sample of 7th- to 12th-grade students, with oversampling of underrepresented groups. Of the 90 118 adolescents who completed the National Longitudinal Study of Adolescent Health in-school survey, 17 125 completed the in-home interview and had parents of identified gender who completed separate in-home questionnaire. The subset of adolescents for this study was drawn from the in-home sampling according to the following criteria: 1) adolescent living with adoptive or biological mother at the time of the interview, 2) adolescent had never been separated from mother for more than 6 months, 3) mother was in first marriage at the time of the interview, and 4) the adoptive mother had never been married to the adolescent's biological father. Of the 6577 adolescents in the final study sample, 214 (3.3%) were living with adoptive mothers and 6363 (96.7%) were living with biological mothers.
Univariate analyses were used to compare adoptees versus nonadoptees, suicide attempters versus nonsuicide attempters, and adopted suicide attempters versus nonadopted suicide attempters on all variables. Variables that were associated with attempted suicide were entered into a forward stepwise logistic regression procedure, and variables that were associated with the log odds of attempt were retained in the model. The area under the model's receiver operating characteristic curve was calculated as a measure of its overall performance. After the association of adoption with attempted suicide was demonstrated, the potential mediating effect of impulsivity was explored by adding it to the model. The same procedure was followed for any variable that was associated with adoption in the full sample or the subsample of suicide attempters. To determine whether any variable in the model moderated the association between adoption and suicide attempt, the interaction term for that variable x adoption was forced into the model.
Adoptees differed significantly from nonadoptees on 4 of 26 variables. They were more likely to have attempted suicide (7.6% vs 3.1%) and to have received psychological or emotional counseling in the past year (16.9% vs 8.2%), and their mothers reported higher parental education and family income. Attempters differed significantly from nonattempters on all variables except for age, race/ethnicity, parental education, family income, and routine examination in the past year. On logistic regression, 9 variables were independently associated with attempted suicide: depression (adjusted odds ratio [AOR]: 3.41), counseling (AOR: 2.83), female gender (AOR: 2.31), cigarette use (AOR: 2.31), delinquency (AOR: 2.17), adoption (AOR: 1.98), low self-image (AOR: 1.78), aggression (AOR: 1.48), and high family connectedness (AOR: 0.60). The receiver operating characteristic curve for the model had an area of 0.834, indicating performance significantly better than chance. The AOR for adoption did not change when parental education, family income, and impulsivity were forced into the model. None of the interaction terms (adoption x another risk factor) demonstrated a significant effect.
Attempted suicide is more common among adolescents who live with adoptive parents than among adolescents who live with biological parents. The association persists after adjusting for depression and aggression and is not explained by impulsivity as measured by a self-reported tendency to make decisions quickly. Although the mechanism underlying the association remains unclear, recognizing the adoptive status may help health care providers to identify youths who are at risk and to intervene before a suicide attempt occurs. It is important to note, however, that the great majority of adopted youths do not attempt suicide and that adopted and nonadopted youths in this study did not differ in other aspects of emotional and behavioral health. Furthermore, high family connectedness decreases the likelihood of suicide attempts regardless of adoptive status and represents a protective factor for all adolescents.
Causal influence of car mass and size on driver fatality risk.
Evans L. Am J Public Health 2001; 91(7):1076-1081.
Correspondence: Leonard Evans, Science Serving Society, 973 Satterlee, Bloomfield Hills, MI 48304-3153, USA (email: le@scienceservingsociety.com).
This study estimated how adding mass, in the form of a passenger, to a car crashing head-on into another car affects fatality risks to both drivers. The study distinguished the causal roles of mass and size. Head-on crashes between 2 cars, one with a right-front passenger and the other with only a driver, were examined with Fatality Analysis Reporting System data. Adding a passenger to a car led to a 14.5% reduction in driver risk ratio (risk to one driver divided by risk to the other). To divide this effect between the individual drivers, the author developed equations that express each driver's risk as a function of causal contributions from the mass and size of both involved cars. Adding a passenger reduced a driver's frontal crash fatality risk by 7.5% but increased the risk to the other driver by 8.1%. The presence of a passenger reduces a driver's frontal crash fatality risk but increases the risk to the driver of the other car. The findings are applicable to some single-car crashes, in which the driver risk decrease is not offset by any increase in harm to others. When all cars carry the same additional cargo, total population risk is reduced. The role of driver distraction in traffic crashes.
Stutts JC, Reinfurt DW, Staplin L, Rodgman EA. Washington, DC: AAA Foundation for Traffic Safety, 2001. (Available online at: http://www.aaafts.org/Text/research.cfm).
Correspondence: Jane C. Stutts, Highway Safety Research Center, University of North Carolina, 730 Airport Road, Suite 300,CB # 3430, Chapel Hill, NC 27599 USA (email: jane_stutts@unc.edu).
Driver inattention is a major contributor to highway crashes. The National Highway Traffic Safety Administration estimates that at least 25% of police-reported crashes involve some form of driver inattention. Driver distraction is one form of inattention and is a factor in over half of these crashes. Distraction occurs when a driver "is delayed in the recognition of information needed to safely accomplish the driving task because some event, activity, object, or person within or outside the vehicle compels or induces the driver’s shifting attention away from the driving task." The presence of a triggering event distinguishes a distracted driver from one who is simply inattentive or "lost in thought."
The CDS is an annual probability sample of approximately 5,000 police-reported crashes involving at least one passenger vehicle that has been towed from the crash scene. Data are collected by trained, professional crash investigation teams that collect information at the scene of the crash, from an examination of the crash-involved vehicles, directly from interviews with the crash victims and other witnesses, as well as from available medical records. Beginning in 1995, a variable for coding the "Driver’s Distraction/Inattention to Driving" was added to the CDS. The variable contains codes for attentive, looked but did not see, and sleepy, along with more than a dozen specific distractions (eating or drinking, other occupants, moving object in vehicle, talking on cellular phone, etc.).
For the current analyses two variables were defined – one identifying the attention status of the driver (attentive, distracted, looked but did not see, sleepy/asleep, or unknown), and the second the specific distracting event for those drivers identified as distracted. The CDS driver distraction data is vehicle rather than crash oriented and consequently it underestimates the role of distraction in actual crashes.
For the overall 1995-1999 CDS data, 48.6% of the drivers were identified as attentive at the time of their crash; 8.3% were identified as distracted, 5.4% as "looked but did not see," and 1.8% as sleepy or asleep. The remaining 35.9% were coded either as unknown or no driver present. This high percentage of drivers with unknown attention status has the effect of diluting the percentages in the other categories. Without the unknowns, the percentage of drivers identified as distracted increases to 12.9%. The percentage of actual crashes involving driver distraction would be still higher.
-
Relationship between life satisfaction and violent behaviors among adolescents.
Valois RF, Zullig KJ, Huebner ES, Drane JW. Am J Health Behav 2001; 25(4):353-366.
Correspondence: Robert F. Valois, School of Public Health, University of South Carolina, Columbia, SC 29208 USA. (email: RValois@sph.sc.edu).
The researchers explored the relationships between life satisfaction and violent behaviors among 5,032 adolescents. Adjusted polychotomous logistic regression analyses and multivariate models were used (via SUDAAN) with the 1997 Youth Risk Behavior Survey conducted by the US Centers for Disease Control. Carrying a weapon; carrying a gun; carrying a weapon at school; physical fighting; physical fighting at school; physical fighting that required physician treatment; drinking and driving; riding with a drinking driver; having property stolen/damaged at school; feeling unsafe while at, going to or returning from school; and being injured/ threatened with a weapon were associated (p=.05) with reduced life satisfaction. Measures of life satisfaction as a component of comprehensive assessments of adolescent violence/aggression in field-work, research, and program-evaluation efforts should be considered.
Back to "New This Week" Menu
|