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27 August 2001
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Children hospitalized early and increased risk for future serious injury.
McPhilips H, Gallaher M, Koepsell T. Inj Prev 2001; 7(2): 150-154.
Correspondence: Healther McPhillips, Children's Hospital Regional Medical Center, 4800 Sand Point Way NE, Box 5371 MS CH-30, Seattle, WA 98105, USA. (email: hmcphil@u.washington.edu).
OBJECTIVE: To determine if infants hospitalized for any reason before 90 days of age are at increased risk for future serious injury. SETTING: Washington State. METHODS: A population based retrospective cohort study, using data from Washington State birth and death certificates linked to a statewide hospital discharge database for the years 1989 through 1997. Participants included healthy full term infants born in Washington State between 1989 and 1995. A total of 29,466 infants hospitalized < 90 days of age (early hospitalization) were compared to 29,750 randomly selected infants not hospitalized early. The primary outcome was an injury resulting in hospitalization or death between 3-24 months. RESULTS: Among infants hospitalized early, 76/10,000 had a subsequent serious injury before age 2, compared with 47/ 10,000 infants without an early hospitalization (relative risk (RR) 1.6; 95% confidence interval (CI) 1.3 to 2.0). In a multivariate model including maternal age and parity, the adjusted RR for serious injury associated with early hospitalization was 1.5 (95% CI 1.2 to 1.8). Infants hospitalized early were three times as likely to be hospitalized between 3-24 months of age for intentional injury compared with infants not hospitalized early (RR 3.3; 95% CI 1.1 to 10.1). CONCLUSIONS: Infants hospitalized in the first three months of life for any reason were 50% more likely to have a subsequent serious injury compared with infants not hospitalized early and were also at increased risk of intentional injury. This identifiable group of infants might be suitable for targeted childhood injury prevention programs including those involving prenatal and postnatal visits.
Epidemiology of violent deaths in the world.
Reza A, Mercy JA, Krug E. Inj Prev 2001; 7(2): 104-111.
Correspondence: James A. Mercy, Division of Violence Prevention, National Center for Injury Control and Prevention, MS-K60, 4770 Buford Highway NE. Atlanta, GA 30341-3724, USA. (email: jam2@CDC.GOV).
OBJECTIVE: This study describes epidemiologic patterns of mortality due to suicide, homicide, and war for the world in order to serve as a benchmark against which to measure future progress and to raise awareness about violence as a global public health problem. SETTING: The world and its eight major regions. METHOD: Data were derived from The Global Burden of Disease series and the US National Center for Health Statistics to estimate crude rates, age adjusted rates, sex rate ratios, and the health burden for suicide, homicide, and war related deaths for the world and its eight major regions in 1990. RESULTS: In 1990, an estimated 1,851,000 people died from violence (35.3 per 100,000) in the world. There were an estimated 786,000 suicides. Overall suicide rates ranged from 3.4 per 100,000 in Sub-Saharan Africa to 30.4 per 100,000 in China. There were an estimated 563,000 homicides. Overall homicide rates ranged from 1.0 per 100,000 in established market economies to 44.8 per 100,000 in Sub-Saharan Africa with peaks among males aged 15-24 years old, and among females aged 0-4 years old. There were an estimated 502,000 war related deaths with peaks in rates for both sexes among people aged 0-4, 15-29, and 60-69 years old. CONCLUSION: The number of violence related deaths in the world is unacceptably high. Coordinated prevention and control efforts are urgently needed.
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Spreadsheet that shows P-value functions.
Aragaki C. Epidemiology 2001; 12(5): 588.
Correspondence: Corinne Aragaki. University of Texas, School of Public Health, 5323 Harry Hines Boulevard V8.112, Dallas, TX 75390-9128, USA (email: Corinne.Aragaki@UTSouthwestern.edu).
This abstract is about three times the length of the researcher's short (9-line) yet important letter to the editor. It is now fairly well accepted that the simple use of a P-value to report on the statistical significance of a test is unsatisfactory and that the conficence interval is superior. Yet, there are problems with the confidence interval, or at least with the way it is commonly interpreted -- look to see whether the null value of the parameter inside the interval or outside of it. Poole elequantly discussed this issue in the American Journal of Public Health in 1987 [77(2):195-199]. In that editorial he recommended using a graph of the p-value function to avoid the vagueness of the deductions that are drawn from reporting of (null) p-values or confidence intervals. He described the p-value finction as a graph of all possible p-values or of all possible confidence limits given the data. It is possible to immediately see the precision of the test by viewing the graph. It is also possible to quickly view the 95% confidence interval, or 90% conficence interval, or 99% confidence interval.
While visualizing the P-value function is desirable, it cannot be done using any of the standard statistical packages. Aragaki developed a spreadsheet using MS Excel 2000 that takes a 2 X 2 contngency table and P-value functions for both the corresponding odds and risk ratios. The author made this useful instructional aid available online at:
http://www2.utsouthwestern.edu/publichealth/aragaki/epitools.htm.
A short description of the use of the spreadsheet is also available at that URL.
Suicidal ideation, psychiatric disorder, and medical illness in a community epidemiological study.
Gili-Planas M, Roca-Bennasar M, Ferrer-Perez V, Bernardo-Arroyo M. Suicide Life Threat Behav 2001; 31(2): 207-213.
Correspondence: M. Gili-Plana, Department of Psychology, Universitat de les Illes Balears, Carretera de Valldemossa, km 7,5, 07071, Palma de Mallorca, SPAIN (email: mgili@uib.es
Many epidemiological studies have analyzed suicidal ideation in clinical samples, but only a few have been performed in the general population. We present the results of a two-stage epidemiological study in the general population on the island of Formentera (Balearic Islands, Spain), which used the 28-item General Health Questionnaire (GHQ-28) in the first stage (n = 697) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in the second (n = 242). We also recorded medical illnesses diagnosed in the subjects at the second stage. Four items on the GHQ-28 ask directly about suicidal thoughts or ideation. From the sample, 6.5% have reported suicidal ideation. Mental disorders are the most important factor associated with suicidal ideation; medical illnesses seem to play a secondary role.
Sensation seeking, risky driving and behavioral adaptation.
Jonah BA, Thiessen R, Au-Yeung E. Accid Anal Prev 200133(5): 679-684.
Correspondence: B. A. Jonah, Transport Canada, Road Safety Directorate, Ottawa, Ont. (email: jonahb@tc.gc.ca
A study on the relationship between sensation seeking (SS) and risky driving, aggressive driving and behavioral adaptation is reported on. College students completed a questionnaire concerning their driving behavior and level of sensation seeking. Results indicated that high SS's were significantly more likely than low SS's to speed, not wear belts, drink frequently, drive after drinking, perceive a low risk of detection for impaired driving, and perceive that they could drink more beer before being impaired. High SS's were also more likely to report aggressive driving habits. High SS's were significantly more likely than low SS's to say that they would drive faster on highways and on wet roads and drive after drinking, if operating a vehicle equipped with anti-lock brakes. The results are consistent with previous research. A geographic analysis of motor vehicle collisions with child pedestrians in Long Beach, California: comparing intersection and midblock incident locations.
Lightstone AS, Dhillon PK, Peek-Asa C, Kraus JF. Inj Prev 2001; 7(2): 155-160.
Southern California Injury Prevention Research Center, UCLA School of Public Health, Los Angeles 90095, USA.
OBJECTIVES: The purpose of this study was to use geographic information system (GIS) software to locate areas of high risk for child pedestrian-motor vehicle collisions in the city of Long Beach and to compare risk factors between midblock and intersection collisions. METHODS: Children 0-14 years of age involved in a motor vehicle versus pedestrian collision that occurred on public roadways in Long Beach, CA, between 1 January 1992 and 30 June 1995, were identified retrospectively from police reports. The GIS software program, ArcView, was used for spatial analysis and distance calculations. chi2 Tests were used to compare the distribution of the characteristics between intersection and midblock collisions. RESULTS: The average annual incident and fatality rate was 183.3/100,000 children/ year and 2.4/100,000 children/year, respectively. Children less than 5 years of age were significantly more likely to be hit at a midblock location while those aged 5-9 and 10-14 were more often hit at an intersection. Intersection collisions were more likely to occur on major arterials and local streets, and the driver to be the primary party at fault (p <0.001). While intersection incidents tended to occur further from the child's home (64.4%) the majority of midblock incidents (61.5%) occurred within 0.1 miles of the child's residence. For both midblock and intersection locations, pedestrian collisions tended to occur more frequently in those census tracts with a larger number of families per census tract-a measure of household crowding and density. CONCLUSIONS: Future studies taking into consideration traffic volume and vehicle speed would be useful to focus prevention efforts such as environmental modifications, improving police enforcement, and educational efforts targeted at parents of younger children. As GIS illustrative spatial relationships continue to improve, relationships between pedestrian collision sites and other city landmarks can advance the study of pedestrian incidents.
Factors contributing to the amount of vehicular damage resulting from collisions between four-wheel drive vehicles and passenger cars.
Broyles RW, Clarke SR, Narine L, Baker DR. Accid Anal Prev 200133(5): 673-678.
Correspondence: Department of Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
This study examines the vehicular damage resulting from motor vehicle crashes involving four-wheel drive vehicles and passenger cars in the state of Oklahoma. In particular, the focus of the analysis is on differences in vehicular damage to passenger cars and four-wheel drive vehicles. Results indicate that passenger cars sustain significantly greater vehicular damage than four-wheel drive vehicles. In addition, several other factors significantly influence the level of damage resulting from collisions between four-wheel drive vehicles and passenger cars. Driver behavior or unsafe acts, represented by the rate of travel prior to the collision, failure to yield, failure to obey a stoplight or a stop sign, the consumption of alcohol and the use of drugs, also contributed to the amount of vehicular damage. In addition, results also indicate that the level of damage was influenced significantly by environmental factors, represented by a reduced intensity of light, wet or slippery roadways and the type of collision. The findings reinforce the importance of a number of policy initiatives that may reduce the vehicular damage resulting from collisions involving four-wheel drive vehicles and passenger cars. For example, the study indicates a need to initiate legislation that lowers the speed limit during dark and twilight hours, commits additional resources to road maintenance to reduce unsafe road conditions, and stimulates improvements in automotive design that provide better lateral protection to vehicles. The influence of demographic factors on seatbelt use by adults injured in motor vehicle crashes.
Lerner EB, Jehle DV, Billittier AJ 4th, Moscati RM, Connery CM, Stiller G. Accid Anal Prev 200133(5): 659-662.
Correspondence: E.B. Lerner, Center for Transportation Injury Research (CenTIR), Department of Emergency Medicine, Erie County Medical Center, State University of New York at Buffalo, 14215, USA. lerner@acsu.buffalo.edu
This study determined demographic factors associated with reported seatbelt use among injured adults admitted to a trauma center. A retrospective chart review was conducted including all patients admitted to a trauma center for injuries from motor vehicle crashes (MVC). E-codes (i.e. ICD-9 external cause of injury codes) were used to identify all patients injured in a MVC between January 1995 and December 1997. Age, sex, race, residence zip code (i.e. a proxy for income based on geographic location of residence), position in the vehicle, and seatbelt use were obtained from the trauma registry. Forward logistic regression was used to identify significant predictors of seatbelt use. Complete data was available for 1366 (82%) patients. Seatbelt use was reported for 45% of patients under age of 25 years, 52% of those 25-60 years, and 68% of those over 60 years. Overall, seatbelt use was reported for 45% of men and 63% of women, as well as for 56% of Caucasians (i.e. Whites) and 34% of African Americans. In addition, seatbelt use was reported for 33% of those earning less than $20,000 per year and 55% of those earning over $20,000. Finally, seatbelt use was reported for 57% of drivers and 43% of passengers. Logistic regression revealed that age, female gender, Caucasian race, natural log of income, and driver were all significant predictors of reported seatbelt use. These results show that seatbelt use was more likely to be reported for older persons, women, Caucasians, individuals with greater incomes, and drivers. Seatbelt use should be encouraged for everyone; however, young people, men, African Americans, individuals with lower incomes, and passengers should be targeted specifically. In-vehicle distraction and fatal accidents in England and Wales.
Stevens A, Minton R. Accid Anal Prev 200133(4): 539-545.
Correspondence: Transport Research Laboratory, Crowthorne, Berkshire, UK. astevens@trl.co.uk
The paper describes the coding and analysis of a database of police fatal accident reports to investigate the extent to which in-vehicle distraction is a contributory factor in vehicle crashes. A particular focus has been the involvement of mobile telephones and entertainment systems. Analysis of accidents occurring over the period 1985-1995 shows that in-vehicle distraction is reported as a contributory factor in about 2% of fatal accidents (although this figure may be a conservative estimate). Specific examples of distraction attributed to entertainment systems and telephones have been identified. Electronic driver information systems are also of particular interest, but have not featured in the available data. Work is progressing, on an annual cycle, to obtain, code and analyse further data and this is expected to provide an invaluable source of information for accident researchers.
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