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8 October 2001
Mandatory helmet legislation and children's exposure to cycling.
Macpherson AK, Parkin PC, To TM. Inj Prev 2001; 7(3): 228-230.
Correspondence: Alison Macpherson, Department of Pediatrics, Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, Ontario, CANADA M5G 1X8. (email: alison.macpherson@sickkids.on.ca).
BACKGROUND: Mandatory helmet legislation for cyclists is the subject of much debate. Opponents of helmet legislation suggest that making riders wear helmets will reduce ridership, thus having a negative overall impact on health. Mandatory bicycle helmet legislation for children was introduced in Ontario, Canada in October 1995.
OBJECTIVE: To examine trends in children's cycling rates before and after helmet legislation in one health district.
METHODS: Child cyclists were observed at 111 preselected sites (schools, parks, residential streets, and major intersections) in the late spring and summer of 1993-97 and in 1999, in a defined urban community. Trained observers counted the number of child cyclists. The number of children observed in each area was divided by the number of observation hours, resulting in the calculation of cyclists per hour. A general linear model, using Tukey's method, compared the mean number of cyclists per hour for each year, and for each type of site.
RESULTS: Although the number of child cyclists per hour was significantly different in different years, these differences could not be attributed to legislation. In 1996, the year after legislation came into effect, average cycling levels were higher (6.84 cyclists per hour) than in 1995, the year before legislation (4.33 cyclists per hour).
CONCLUSIONS: Contrary to the findings in Australia, the introduction of helmet legislation did not have a significant negative impact on child cycling in this community.
Pesticide-Related Illnesses Associated with the Use of a Plant Growth Regulator --- Italy, 2001
Davanzo F, Faraoni L, Miceli G, Conticello M, Bongiovanni L, Ballard T, Settimi L, Rubbiani M, Marcello I, Bascherini S, Mehler L, MD, and Surveillance Br, Div of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC. MMWR 2001; 50(39): 845-847.
Full text available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5039a1.htm.
During January--February 2001, eight cases of acute illness in the county of Ragusa, Italy, were reported to the Italian National Institute for Health (INIH) by the Milan Poison Control Center (MPCC) and were attributed to exposure to Dormex®, a plant growth regulator with hydrogen cyanamide as the active ingredient. These cases were identified during a pilot project for acute pesticide-related illness surveillance. Subsequent active case finding at health-care clinics by the Ragusa Occupational Health Unit identified six additional cases. MPCC identified nine cases in other areas of Italy. Of the 23 cases of acute illness, 22 resulted from occupational exposure during mixing and/or applying of Dormex®, and one was from unintentional ingestion. This report summarizes the investigation of these cases, which implicates a pesticide as the causative agent and demonstrates the usefulness of surveillance for detecting pesticide-related illnesses.
All 22 workers were male with a median age of 41 years (range: 16--76 years). It is not known whether personal protection equipment was used. Eighteen of the workers reported dermatologic manifestations, including macular or papular rash (11), erythema/hyperemia (nine), pruritus (two), and caustic burns to the hand (two). Two workers reported eye irritation. Fourteen workers had systemic signs and/or symptoms characteristic of adverse effects of the active ingredient, including tachycardia (four), weakness (four), dizziness (four), palpitations (three), headache (three), vomiting and/or nausea (three), dyspnea (three), and hypotension (one). Of 21 persons initially treated in an emergency department, 12 (52%) were hospitalized; one person was treated by a local physician. Thirteen patients had low severity effects (i.e., minimal effects that rapidly resolved), and nine had moderate severity effects (i.e., nonlife threatening effects that are more pronounced, prolonged, or of a systemic nature) (CDC, unpublished data, 2001).
The nonoccupational case occurred in a man aged 44 years who unintentionally ingested the product that had been placed in a plastic water bottle in the refrigerator. He became seriously ill with third degree shock, coma, miosis, and hepatic necrosis and required care in an intensive care unit.
In May 2001, INIH notified the Italian Ministry of Health (IMH) about the outbreak. IMH, which acts as the regulatory agency for pesticides and agricultural products, suspended use of the product in Italy.
Investigation of bias after data linkage of hospital admissions data to police road traffic crash reports.
Cryer PC, Westrup S, Cook AC, Ashwell V, Bridger P, Clarke C. Inj Prev 2001; 7(3): 234-241.
Correspondence: Colin Cryer, Centre for Health Services Studies, University of Kent, Oak Lodge, Broomhill Road, Tunbridge Wells, Kent, TN3 0TG, UK. (email: P.C.Cryer@ukc.ac.uk).
BACKGROUND: There has been an ongoing discussion among injury researchers about the value of linking hospital data with police crash investigation data.
OBJECTIVES: To determine if a database of hospital admission data linked to police road traffic accident (RTA) reports produce less biased information for the injury prevention policymaker, planner, and practitioner than police RTA reports alone?
METHODS: Data linkage study. Non-fatal injury victims of road traffic crashes in southern England who were admitted to hospital. The data came from hospital admissions and police RTA reports. The estimated proportion of road traffic crashes admitted to hospital were included on the linked database. Also included were distributions by age, sex, and road user groups: (A) for all RTA injury admissions and (B) for RTA serious injury admissions defined by length of stay or by nature of injury.
RESULTS: An estimated 50% of RTA injury admissions were included on the linked database. When assessing bias, admissions data were regarded as the "gold standard". The distributions of casualties by age, sex, and type of road user showed major differences between the admissions data and the police RTA injury data of comparable severity. The linked data showed smaller differences when compared with admissions data. For RTA serious injury admissions, the distributions by age and sex were approximately the same for the linked data compared with admissions data, and there were small but statistically significant differences between the distributions across road user group for the linked data compared with hospital admissions.
DISCUSSION: These results suggest that investigators could be misinformed if they base their analysis solely on police RTA data, and that information derived from the linked database is less biased than that from police RTA data alone. A national linked dataset of road traffic crash data should be produced from hospital admissions and police RTA data for use by policymakers, planners and practitioners.
Maternal use of baby walkers with young children: recent trends and possible alternatives.
DiLillo D, Damashek A, Peterson L. Inj Prev 2001; 7(3): 223-227.
Correspondence: David DiLillo, Department of Psychology, University of Nebraska, 238 Burnett Hall, Lincoln, Nebraska 68588-0308, USA. (email: ddilillo@unl.edu).
BACKGROUND: Although they pose a serious threat to a child's well-being, baby walkers are a very popular consumer product.
OBJECTIVES: To examine recent trends in baby walker and exersaucer use, and to assess maternal motivations for choosing to use or not use these devices with children.
METHODS: Retrospective telephone survey with a sample of 329 mothers who provided information about their use of walkers and exersaucers with 463 children born in Columbia, Missouri between January 1994 and April 1999.
RESULTS: Baby walker use in the sample declined fairly steadily from 1994 to 1999, whereas exersaucer use increased during the same period. Altogether 88% of mothers were aware of the injury risks associated with walkers, and this knowledge was the most commonly reported reason for abstaining from walker use. Remarkably, 38% of participants with knowledge of walker risks nevertheless used these devices. Participants reported many reasons for using walkers and exersaucers, including child entertainment, perceived developmental benefit, easy availability, and improved safety of exersaucers.
DISCUSSION: Public knowledge of the hazards of walkers seems to be high, and this awareness is a likely factor in many caregivers' decisions not to use them. Future interventions should focus particular attention on those caregivers who continue to use walkers despite knowledge of the associated risks. In addition to persuasive interventions, alternatives to walkers should be encouraged. Exersaucers represent one viable alternative, and should be promoted as such by the media, pediatricians, and other child care professionals.
Self strangulation by hanging from cloth towel dispensers in Canadian schools.
Le D, Macnab AJ. Inj Prev 2001; 7(3): 231-233.
Correspondence: Andrew Macnab, Critical Care Research Office, L317, Children's and Women's Hospital of British Columbia, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada. (email: amacnab@cw.bc.ca).
BACKGROUND: Injuries among children and adolescents are often the result of thrill-seeking through risky behavior. Injuries from this sort of activity may tend to occur in clusters.
OBJECTIVE: To investigate a local "epidemic" of incidents of strangulation by hanging from continuous cloth towels in dispensers.
METHODS: The coroner's office in all provinces and territories were contacted. Five cases of hanging from continuous cloth towels in Canadian schools were identified and reviewed.
RESULTS: There were four deaths, and one near-death, all males age 7 to 12. Two cases were attributed to a "choking game" that provides a sensation (impending loss of consciousness) described as "cool". In three cases, the child was alone at the time. All deaths were due to strangulation from hanging and all occurred in school washrooms. One child (playing with two friends) recovered after admission to an intensive care unit. Towel dispensers were removed from the two index schools. In one province the Ministry of Education encouraged removal of towel dispensers from all schools and education of students of the dangers of "choking games".
DISCUSSION: Thrill seeking from partial asphyxiation appears to underlie these incidents. Awareness of such cases should prompt appropriate education strategies to highlight the serious consequences of this form of risk taking behavior in young males. In Canada, these incidents have resulted in changes in the design of, and legislation regarding, cloth towel dispensers.
Initial Effects of Graduated Driver Licensing on 16-Year-Old Driver Crashes in North Carolina.
Foss RD, Feaganes JR, Rodgman EA. JAMA 2001; 286(13):1588-1592.
Correspondence: Robert D. Foss, Highway Safety Research Center, University of North Carolina at Chapel Hill, 730 Airport Rd, Chapel Hill, NC 27599-3430 (e-mail: rob_foss@unc.edu).
BACKGROUND: Since 1997, 32 states have enacted graduated driver licensing (GDL) systems to reduce crash rates among young novice drivers.
OBJECTIVES: To determine the initial effect of the North Carolina GDL system on crashes among 16-year-old drivers.
METHODS: Comparison of population-based North Carolina motor vehicle crash rates before (1996-1997) and after (1999) 16-year-old drivers were licensed under the GDL system. To control for other factors that might have influenced crashes, changes for 16-year-old drivers were compared with those of drivers 25 to 54 years of age. Crashes per licensed driver were also examined. The North Carolina GDL system, enacted December 1, 1997, requires beginning drivers 15 to 17 years of age to hold level 1 licenses, allowing driving only while supervised by a designated adult for a full year; followed by level 2 licensure, allowing unsupervised driving from 5 AM to 9 PM and supervised driving at any time for at least 6 months; and, finally, level 3a full, unrestricted license. Rates of motor vehicle crashes among 16-year-old drivers in 1996-1997 vs 1999, overall and by crash severity (fatal, injury, and noninjury), time (night vs day), type (single vs multiple vehicle), driver alcohol use, and driving environment (more vs less rural counties).
RESULTS: Crash rates declined sharply for all levels of severity among 16-year-old drivers after the GDL program was implemented. Following GDL, 16-year-old driver crashes were substantially less likely. Comparing 1996 with 1999, fatal crashes declined 57%, from 5 to 2 per 10 000 population (rate ratio [RR], 0.43; 95% confidence interval [CI], 0.27-0.70); crashes with no or minor injuries decreased 23%, from 1068 to 826 per 10 000 (RR, 0.77; 95% CI, 0.75-0.80). Nighttime crashes were 43% less likely (156 vs 88 per 10 000; RR, 0.57; 95% CI, 0.52-0.61) and daytime crashes decreased by 20% (951 vs 764 per 10 000; RR, 0.80; 95% CI, 0.78-0.83). Single-vehicle crashes (245 vs 175; RR, 0.71; 95% CI, 0.67-0.76) declined somewhat more than multiple-vehicle crashes (866 vs 681; RR, 0.79; 95% CI, 0.76-0.81).
CONCLUSIONS: In its initial years, the North Carolina GDL system produced substantial declines in 16-year-old driver crashes.
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Age of Drinking Onset and Involvement in Physical Fights After Drinking
Hingston R, Heeren T, Zakocs R. Pediatrics 2001; 108(4): 872-877.
Correspondence: Ralph Hingson, Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts.
BACKGROUND: It is well documented that alcohol drinking is associated with physical fighting and aggression.
OBJECTIVES: To explore whether people who start drinking at an early age are more likely to have been in physical fights after drinking, independent of respondent history of alcohol dependence and frequency of heavy drinking.
METHODS: In 1992, the US Census Bureau interviewed, in person, 42 862 randomly selected adults age 18 or older, mean age 44, household response rate 91.9%, and in-person response rate 97.4%. The survey included questions regarding the age respondents started drinking, frequency of heavy drinking, and whether respondents were ever or in the past year in a physical fight after drinking alcohol.
RESULTS: Relative to respondents who did not begin drinking until age 21 or older, those who started drinking before age 17 were 2.9 to 4.1 times more likely ever in their lives, and at least 3 times more likely in the past year, to have been in a fight after drinking. These relationships were found even after controlling for personal history of alcohol dependence, years of drinking, frequency of heavy drinking, smoking, drug use, and other personal characteristics associated with the age respondents started drinking.
DISCUSSION: An early age of drinking onset was associated with alcohol-related violence not only among persons under age 21 but among adults as well. Physicians need to query adolescent patients about the age they began drinking and counsel them about the increased risks associated with early drinking onset, such as an increased risk of being involved in alcohol-related violence.
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Rev. 07-Oct-2001 at 21:28 hours.
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