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10 September 2001
Ergogenic supplements and health risk behaviors.
Stephens MB, Olsen C. J Fam Pract 2001; 50(8): 696-699.
Correspondence: Mark B. Stevens, Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. (email: mstephens@usuhs.mil).
BACKGROUND: Since ancient times, athletes have ingested substances to gain a competitive edge. The use of such supplements, however, is not restricted to athletes. In 1996, Americans spent $6.5 billion on dietary supplements. Individuals cite many reasons for using such supplements, including to ensure good nutrition, prevent illness, improve performance, ward off fatigue, and enhance personal appearance.
OBJECTIVES: To determine the prevalence of ergogenic supplement use in a young healthy population and to examine the extent to which supplement use is associated with specific health risk behaviors.
METHODS: A cross-sectional survey of individuals entering military service for enlisted training examined previous use of any nutritional ergogenic supplements and self-reported health risk behaviors.
RESULTS: Of 550 eligible participants, 499 completed the survey (91% response rate). Individuals who used ergogenic supplements were more likely to drink alcohol (adjusted odds ratio [AOR]=1.8; 95% confidence interval [CI], 1.1-3.1), more likely to drink heavily (AOR=2.4; 95% CI, 1.5-3.9), more likely to ride in a vehicle with someone who had been drinking (AOR=2.2; 95% CI, 1.3-3.6), more likely to drive after drinking (AOR=2.4; 95% CI, 1.3-4.4), and more likely to have been in a physical fight (AOR=1.9; 95% CI, 1.0-3.5), compared with those who had not used supplements. Men were more likely to use supplements than women (P < .001). There were no differences in patterns of supplement use according to age or body mass index.
CONCLUSIONS: The authors state that the study indicates an association between individuals who use ergogenic nutritional supplements and specific health risk behaviors. This represents an important opportunity for preventive counseling.
A Population-Based Assessment of Pediatric All-Terrain Vehicle Injuries.
Cvijanovich NZ, Cook LJ, Mann NC, Dean JM. Pediatrics 2001; 108(3): 631-635.
Correspondence: Natalie Z. Cvijanovich, Division of Critical Care, Children's Hospital, 747 52nd Street, Oakland, CA 94609, USA. (email: Natalie.Cvijanovich@hsc.utah.edu).
BACKGROUND: Many injuries are sustained during recreational activities. All-terrain vehicles (ATVs) are 3- or 4-wheeled motorized vehicles with large low-pressure tires that are designed to be ridden in off-road environments. They represent a serious hazard for children. In 1988, the major manufacturers of ATVs and the US Consumer Product Safety Commission signed a consent decree that was intended to reduce the hazard. This decree included recommendations that young children not ride the vehicles and that older children only be allowed to ride vehicles that match the strength and coordination that matches the child's developmental age. State legislatures are not required to implement the age restrictions. For example, in Utah 8 year-olds have reached the minimum age to operate ATVs of any engine size.
Objective: To describe the types of injuries sustained by children who ride all-terrain vehicles (ATVs), to estimate the hospital charges associated with these injuries, and to determine adherence to existing rules and regulations governing ATV use.
METHODS: Analysis of statewide hospital admissions (1992-1996) and emergency department (ED) visits (1996) in Utah. All patients who were younger than 16 years and had an external cause of injury code for ATV use were included.
RESULTS: In 1996, 268 ED visits by children involved an ATV. Boys were twice as commonly injured as girls (male:female ratio: 2.1:1), and skin and orthopedic injuries were most frequent. The median ED charge was $368, and ED charges for these patients totaled $138 000. From 1992 to 1996, 130 children were hospitalized as a result of injuries sustained during ATV use, with median charges of $4240 per admission. Male to female ratio was 2.7:1, and the average age was 11.2 ± 3.6 years. Mean injury severity score was 8.0 ± 6.0, and median length of stay was 2 days (range: 0-43 days). Orthopedic injuries were most frequent, but 25% (n = 32) of children sustained head or spinal cord injury. Most children (94%) were discharged from the hospital, but 8 children died as a result of their injuries. Utah regulations prohibit children who are younger than 8 years from driving an ATV and advise against carrying passengers on ATVs. However, 25% (n = 15) of all injured children who were younger than 8 were driving the ATV when injured, and 15% (n = 60) of injured children were passengers on ATVs. Four of the 8 fatally injured children were younger than 8, and all were driving the ATV at the time of the crash. Finally, the estimated injury rate per 100 registered ATVs is significantly higher for children than for adults (3.41 vs 1.71).
CONCLUSIONS: ATV use results in significant injuries to children. Efforts to educate parents regarding the risks of ATV use, proper supervision, and use of safety equipment are warranted. Manufacturers of ATVs should continue to improve the safety profile of these inherently unstable vehicles.
The safety of commercial fishing: Determinants of vessel total losses and injuries.
Jin D, Kite-Powell H, Talley W. Journal of Safety Research 2001; 32(2): 209-228.
Correspondence: Di Jin, Marine Policy Center, Woods Hole Oceanographic Institution, Mail Stop 41, Woods Hole, MA 02543-1138, USA. (email: djin@whoi.edu).
Background: Commercial fishing is a dangerous occupation.
Objectives: This study investigates determinants of vessel losses and number of fatal and nonfatal crew injuries resulting from commercial fishing vessel accidents.
Methods: An injury and vessel damage accident model is developed. Total vessel loss and crew injury models are estimated using probit and negative binomial regressions, respectively, and a unique micro data set of commercial fishing vessel accidents.
Results: Estimation results indicate that the probability of a total loss is the greatest for a capsizing, followed by a sinking accident. Fire/explosions and capsizings are expected to incur the greatest number of crew fatalities 3.5 and 3.8 for every 100 such accidents. For every 100 collisions, 2.1 nonfatal crew injuries are expected. The probability of a total loss and the expected number of crew fatalities vary inversely with the price of fish catches.
Conclusions: Policy implications: (a) policies that reduce capsizings and sinkings will be effective in reducing fishing vessel accident total losses; (b) policies that reduce fire/explosions and capsizings (collisions) will be effective in reducing fatal (nonfatal) injuries. Policymakers should find the results of this study useful in developing regulation and enforcement mechanisms for reducing fishing vessel injuries and total losses.
Explanations for 'understating' in self-reported speeding behaviour
Corbett C. Transportation Research: Psychology and Behaviour 2001; 4(2): 133-150.
Correspondence: Claire Corbett, Law Department, Brunel University, Uxbridge UB8 3PH, UK. (email: claire.corbett@brunel.ac.uk).
BACKGROUND: Self-report is a valuable methodology of social research, especially in regard to offending behavior on and off the road. While assessing the validity of self-report is rarely easy, taking objective measures of drivers' speed choice behavior does provide an opportunity to assess the correlation with subjective measures.
METHODS: Literature review and studies of reported and observed driving speed.
RESULTS: Significant correlations resulted between reported and observed speed in all six surveys comprising the research, but they were of a low order. Analysis of the data showed a consistent and systematic bias towards drivers travelling above the 30 mph speed limit reporting their normal speeds as lower than those observed, with those travelling below the 30 mph speed limit reporting their speeds as higher than those observed.
CONCLUSIONS: Psychophysical limitations on accuracy of self-report and the social and cognitive processes that could mediate them are considered. In particular, the notion that drivers may seek to comply with normative speeds, and that these can be perceived as safer than complying with posted limits are discussed in light of normal police practice to tolerate low margins of excess speed. Do safety practices differ between responders and non-responders to a safety questionnaire?
Kendrick D, Hapgood R, Marsh P. Injury Prevention 2001; 7(2): 100-103.
Correspondence: Denise Kendrick, Division of General Practice, University Park, Nottingham, UK. (email: denise.kendrick@nottingham.ac.uk).
BACKGROUND: The use of surveys to gather information about safety behavior has been criticized. It is said that the results of any such survey will be biased because people who follow safety recommendations may be more likely to respond to surveys than people who don't follow safety recommendations.
OBJECTIVE: To compare reported safety practices between responders and non-responders to a safety survey.
METHODS: Cross sectional survey at baseline compared with safety practices reported at subsequent child health surveillance checks. Parents of children aged 3-12 months registered with practices participating in a controlled trial of injury prevention in primary care that did, and did not, respond to the baseline survey and who subsequently attended child health surveillance checks.
RESULTS: No difference in safety practices was found between responders and non-responders to the survey at the 6-9 month check. Responders were more likely to report owning a stair gate (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.82 to 4.16) and socket covers (OR 2.16, 95% CI 1.53 to 3.04) at the 12-15 month check, and owning socket covers (OR 2.19, 95% CI 1.34 to 3.61) at the 18-24 month check. Responders were more likely to report greater than the median number of safety practices at the 18 month check.
CONCLUSIONS: Non-responders to a safety survey appear to be less likely to report owning several items of safety equipment than responders. Further work is needed to confirm these findings. Extrapolating the results of safety surveys to the population as a whole may lead to over estimation of safety equipment possession. Respiratory Instability of Term and Near-Term Healthy Newborn Infants in Car Safety Seats.
Merchant JR, Worwa C, Porter S, Coleman JM, deRegnier R. Pediatrics 2001; 108(3): 647-652.
Correspondence: Raye-Anne O. deRegnier, Prentice Women's Hospital, 333 E. Superior St., Chicago, IL 60611, USA.
(email: r-deregnier@northwestern.edu).
BACKGROUND: Premature infants who are discharged from intensive care nurseries are known to be at increased risk for apnea, bradycardia, and oxygen desaturation while in the upright position. These small infants also do not fit securely in standard infant car seats. Because of these problems, the American Academy of Pediatrics recommends a period of observation in a car seat for all infants who are born at < 37 weeks' gestation. It is not clear whether this recommendation should apply to the minimally pre-term infants (born at 35-36 weeks' gestation) who are healthy at birth and are hospitalized in the normal newborn nursery.
OBJECTIVES: Evaluate the respiratory stability and safety requirements of healthy, minimally pre-term infants in car seats compared with term infants.
METHODS. Fifty healthy, nonmonitored, pre-term infants (mean gestational age: 35.8 +/- 0.6 weeks) and 50 term infants (mean gestational age: 39.5 +/- 1.4 weeks) were recruited from a level I newborn nursery in a community hospital. Appropriateness of car seat fit was documented for each infant. Heart rate, respiratory rate, and pulse oximetry were evaluated while infants were supine and in their car seats. Apneic and bradycardic events were recorded in addition to a continuous recording of oxygen saturation values.
RESULTS. Twenty-four percent of pre-term and 4% of term newborn infants did not fit securely into suitable car seats despite the use of blanket rolls. Mean oxygen saturation values declined significantly in both pre-term and term infants from 97% in the supine position (range: 92%-100%) to 94% after 60 minutes in their car seats (range: 87%-100%). Seven infants (3 pre-term and 4 term) had oxygen saturation values of < 90% for longer than 20 minutes in their car seats. Twelve percent of the pre-term infants (95% confidence interval: 4.5%-24.3%) but no term infants had apneic or bradycardic events in their car seats.
CONCLUSIONS. The data support the current American Academy of Pediatrics recommendations that all infants who are born at < 37 weeks' gestation, including those who are admitted to level I community hospitals, be observed for respiratory instability and secure fit in their car seats before hospital discharge. Because lowering of oxygen saturation values was seen uniformly in all newborn infants, car seats should be used only for travel, and travel should be minimized during the first months of life.
Pupil injury risks as a function of physical and psychosocial environmental problems experienced at school
Laflamme L, Menckel E. Injury Prevention Injury Prevention 2001; 7(2): 146-149.
Correspondence: Lucie LaFlamme, Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden. (email: lucie.laflamme@phs.ki.se).
BACKGROUND: There is a popular perception that violence in the school setting is increasing. Some have suggested that this may be related to psychosocial problems at school.
OBJECTIVES: To investigate relations between physical and psychosocial environmental problems in schools, as perceived by school principals, and injuries among pupils.
METHOD: Proportionate injury ratios (PIRs) were computed for 77 public sector Swedish schools (33,248 pupils), and divided into four classes based on types of environmental problems reported. Sports related injuries, injuries during recesses, and violence related injuries were considered.
RESULTS: The schools reporting psychosocial problems (9.1% of schools and 7.3% of pupils) had more injuries than expected by chance than all types of injuries aggregated (PIR = 1.92; 95% confidence interval (CI) 1.64 to 2.27), and in the case of sports related injuries (PIR = 1.79; 95% CI 1.37 to 2.34) and injuries due to physical violence (PIR = 2.20; 95% CI 1.33 to 3.65). There were no significant excess risks of injuries for schools facing physical problems or a combination of physical and psychosocial problems.
CONCLUSIONS: Psychosocial problems may exacerbate the risk of intentional and unintentional injuries among pupils. The results offer a reminder that school environment must be planned as part of any assessment of youth safety.
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Rev. 08-Sep-2001 at 22:02 hours.
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