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15 October 2001
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The role of cocaine in fatal crashes: First results of the Quebec drug study.
Dissault C, Brault M, Lemire AM, Bouchard J. 45th Annual Proceedings, Association for the Advancement of Automotive Medicine, 2001.
Proceedings may be purchased at: http://www.carcrash.org/.
OBJECTIVES: To examine the contribution of cocaine to the occurrence of road crashes in Quebec, Canada.
METHODS: Coroner, forensic laboratory and police crash records from April 1999 to December 2000 were matched for 265 fatally injured drivers of passenger vehicles. To establish a control group, two roadside surveys were conducted in August 1999 and 2000. The survey sample was distributed proportionately to the number of fatal crashes per time of day and day of week. A total of 11,952 drivers participated in the two surveys. Analyses of cocaine alone and in combination with other drugs were conducted.
RESULTS: Among those fatally injured, cocaine was found in 7.9 percent of the urine samples and 6.0 percent of the blood samples. Among the survey participants, cocaine was detected in 1.1 percent of the urine samples and 1.0 percent of the saliva samples. Case control analyses of a urine / urine comparison produced an odds ratio of 6.7 (95% CI= 1.5 - 30.1), Cocaine + cannabis OR=10.9 (3.6 - 33.2), cocaine + alcohol 28.9 (6.6 - 126.8).
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Injuries among teens employed in the homebuilding industry in North Carolina.
Lipscomb HJ, Li L. Inj Prev 2001; 7(3):205-209.
Correspondence: Hester J. Lipscomb, Division of Occupational and Environmental Medicine, Duke University, Medical Center, Durham, NC 27710, USA. (email: hester.lipscomb@duke.edu).
BACKGROUND: Construction is one of the largest and most dangerous industries in the United States. Information about teens employed in the construction industry is limited.
OBJECTIVES: To describe injuries of teens employed in the residential construction industry and to assess whether their injury experiences are significantly different from those of adults in this high risk industry.
METHODS: North Carolina homebuilders workers' compensation data for a 41 month period were analyzed. Injuries of teens were identified and described by body part injured, nature, and cause of injury. Proportionate injury ratios were used to summarize and compare the injury experience of teens with those of adult construction workers.
RESULTS: Teens had proportionately more injuries to the eye and foot and fewer injuries to the back than adults. They had more cuts and scratches and fewer sprains and strains. They also had proportionately fewer injuries from falls from elevations and overexertion, injuries that account for a significant cost burden in construction. Consistent with these findings, teens had significantly fewer injuries resulting in medical costs or lost time costs of $1,000 or more.
CONCLUSIONS: The analyses indicate that injuries of teens are less serious than those of adults. This finding may indicate that their work exposures are less dangerous than those of adults in comparable broad categories of construction. However, the data also provide documentation of injuries to teens resulting from work at heights, use of power tools, and motor vehicles with the majority of more expensive claims involving one of these exposures. Construction is dangerous work and these results add to the documentation of the need for additional measures to prevent work related injuries among all workers-teens and adults-in this industry.
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Host and environment factors for exposure to poisons: a case-control study of preschool children in Thailand.
Chatsantiprapa K, Chokkanapitak J, Pinpradit N. Inj Prev 2001; 7(3):214-217.
Correspondence: Kannikar Chatsantiprapa, Faculty of Pharmacuetical Sciences, Khon Kaen University, Khon Kaen, Thailand. (email: kannikar@kku.ac.th).
OBJECTIVES: To identify host and environment characteristics associated with poison exposure among preschool children in Thailand.
METHODS: A matched case-control study was conducted in 20 public hospitals in Khon Kaen province. Cases comprised 100 consecutive preschool children attending hospital between September 1997 and February 1999 because of reported exposure to a poison. Controls were three children matched by age, sex and area of residence to each case, who had never attended a hospital for this reason. Risk factors were elicited by interviewing the children's caregivers at their homes using a structured questionnaire and analyzed using conditional logistic regression.
RESULTS: Number of siblings, whether the child was "medicine eating" and "rushing to explore new objects", the child's activities while the caregiver was working during the daytime, the child's distance from the caregiver while the caregiver was working, whether the child was taken to a non-agricultural worksite, and the number of used containers around the residence, were all statistically significant in univariate analyses. However, when all significant variables were included in a multivariate model, only "medicine eating" and the number of used containers around the residence remained statistically significant.
CONCLUSIONS: Attention to "medicine eating" and used containers through increased supervision could be a protective factor against poison exposure for these children. To reduce risk, caregivers should not refer to medicines as foods and used containers should be systematically collected for disposal or recycling.
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Bicycle helmet use among schoolchldren--the influence of parental involvement and children's attitudes.
Berg P, Westerling R. Inj Prev 2001; 7(3):218-222.
Correspondence: Peter Berg, Department of Public Health and Caring Sciences, Uppsala Science Park, S-751 85, Uppsala, Sweden. (email: peter.berg@pubcare.uu.se).
BACKGROUND: Brain injuries from bicycle crashes and falls are a global problem. It is well documented that helmets, when properly worn, dramatically reduce bicycle-related brain injuries.
OBJECTIVES: To study attitudes towards and use of bicycle helmets among schoolchildren; to determine whether these attitudes are associated with the involvement of parents and school in bike safety.
METHODS: The study was conducted in nine intermediate level schools and five upper level schools in two Swedish municipalities. A survey with 1,485 participants aimed at pupils aged 12-15 years conducted during late spring 1997. Associations between parent and school involvement and children's attitudes and helmet use were studied using LisRel analyses.
RESULTS: At some point during their school years, a majority of the children stopped wearing bicycle helmets. Of 12-13 year olds, 80% said that they had used helmets when they were younger but at the time of the study, only 3% aged 14-15 years used helmets. Use decreased significantly during school years (p<0.001). The majority stated they quit using helmets because they were ugly, silly, uncomfortable, or inconvenient. There was a strong association between parental involvement, children's attitudes, and helmet use. However, parent involvement decreased as the children grew older.
CONCLUSIONS: To increase the voluntary use of bicycle helmets among schoolchildren their attitudes must be influenced. An intervention aimed at both parents and children may be required.
Epidemiology of severe brain injuries: a prospective population-based study.
Masson F, Thicoipe M, Aye P, Mokni T, Senjean P, Schmitt V, Dessalles PH, Cazaugade M, Labadens P. J Trauma 2001; 51(3):481-489.
Correspondence: Department of Anesthesia, University Hospital of Bordeaux, 33076 Bordeaux cedex, France.
OBJECTIVES: To estimate annual incidence of hospitalization for severe traumatic brain injury (TBI) (maximum Abbreviated Injury Score in the head region [HAIS] 4 or 5) in a defined population of 2.8 million.
METHODS: Severe TBI patients were included in the emergency departments in the 19 hospitals of the region. A prospective data form was completed with initial neurologic state, computed tomographic scan lesions, associated injuries, length of unconsciousness, and length of stay in acute care centers. Outcome at the time the patient left acute hospitalization was retrospectively assessed from medical notes.
RESULTS: During the 1-year period (1996), 497 residents fulfilled the inclusion criteria, leading to an annual incidence rate of 17.3 per 100,000 population; 58.1% were HAIS5. Mortality rate was 5.2 per 100,000. Men accounted for 71.4% of cases. Median age was 44 years, with a quarter of patients more than 70 years old. Traffic accidents were the most frequent causes (48.3%), but falls accounted for 41.8% of all patients. Age and severity were different according to the major categories of external causes. In HAIS5 patients, 86.5% were considered as comatose (coma lasting more than 24 hours or leading to immediate death) but only 60.9% had an initial Glasgow Coma Scale score < 9. In the HAIS4 group, 7.2% had an initial Glasgow Coma Scale score < 9. Fatality rates were 30.0% in the whole study group, 7.7% in HAIS4, 12.8% in HAIS5 without coma, and 51.2% in HAIS5 with coma.
DISCUSSION: This study shows a decrease in severe TBI incidence when results are compared with another study conducted 10 years earlier in the same region. This may be due to a decrease in traffic injuries. There was an increase in the proportion of falls in elderly patients and an increase in the median age in the patients. This increased age influences the mortality rate.
Statistical considerations for the design, conduct and analysis of the efficacy of safe community interventions.
Bangdiwala SI. Inj Control Safety Promo 2001; 8(2) 91-97.
Correspondence: Shrikant Bangdiwala, Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599 USA (email: kbangdiw@bios.unc.edu).
In injury research, the use of community-level intervention trials is quite common. Often, it is the only practical method for assessing the efficacy of countermeasures or preventive interventions. 'Safe Community' is an intervention concept aimed at establishing community-level programs and policies to ensure the safety of inhabitants. This paper presents statistical issues that need to be considered in the design conduct and analyses of community-level intervention trials.
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Risk of suicide in users of beta-adrenoceptor blockers, calcium channel blockers and angiotensin converting enzyme inhibitors.
Toft-Sorensen H, Mellemkjaer L, Olsen JH. Br J Clin Pharmacol 2001; 52(3):313-318.
Correspondence: H. Toft-Sorensen, The Department of Clinical Epidemiology of Aarhus University Hospital and Aalborg Hospital, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark. (email: HTS@soci.au.dk).
BACKGROUND: Beta-adrenoceptor blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors are widely used medications.
OBJECTIVES: To examine the risk of suicide in users of beta-adrenoceptor blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors.
METHODS: The authors conducted a cohort study based on linkage of a population-based prescription registry in North Jutland County, Denmark, and the nationwide Death Registry. From 1989 to 1995 there were 58 529 users of beta-adrenoceptor blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors. The mortality rates from suicides in the cohort members were compared with the rates in the general population.
RESULTS: One hundred and four suicides occurred in the cohorts. The standardized mortality ratio for suicide in users of beta-adrenoceptor blockers was 1.6 (95% confidence interval: 1.2-2.1), in users of calcium channel blockers 1.2 (95% confidence interval: 0.8-1.7), and in users of angiotensin converting enzyme inhibitors 1.2 (95% confidence interval: 0.7-1.8). In users of beta-adrenoceptor blockers, the risk of suicide was increased during the first 12 months after the start of therapy, standardized mortality ratio 2.1 (95% confidence interval: 1.2-3.5). There was a trend in the standardized mortality ratio of suicide from 0.9 (95% confidence interval: 0.4-1.9) in users of beta-adrenoceptor blockers with low lipid solubility, to 1.6 (0.8-2.8) and 2.7 (1.7-4.1) in users of beta-adrenoceptor blockers with medium and high lipid solubility, respectively.
CONCLUSIONS: Users of medium and high lipid soluble beta-adrenoceptor blockers may have an increased risk of suicide. Users of calcium channel blockers and angiotensin converting enzyme inhibitors do not seem to have a significantly increased risk of suicide.
Predicting offenses and crashes from young drivers' offense and crash histories.
Elliott MR, Waller PF, Raghunathan TE, Shope JT. J Crash Prevention Injury Control 2001; 2(3): 167-178.
Correspondence: Michael Elliott, University of Michigan, Department of Biostatistics, 1420 Washington Heights, Ann Arbor, MI 48109-2029 USA (email: mrelliot@umich.edu).
BACKGROUND: Previous research has indicated that offenses are better predictors of subsequent crashes than crashes themselves.
OBJECTIVES: To examine the predictive power of previous-year offenses and crashes for predicting subsequent-year offenses and crashes.
METHODS: Young, beginning drivers (N = 13,800) in Michigan were followed for up to nine years. Driver history data (gender; age; license tenure; number, date and type of violation convictions; and number of and details about reported crashes) were compared.
RESULTS: Previous-year offenses are better predictors of both subsequent-year offenses and crashes than either previous-year crashes or at-fault crashes. In the case of both offenses and crashes, the relationship to future incidents increases over time, that is, an incident in the sixth year of licensure is more predictive of a subsequent incident than is true for the same type of incident in the first year of licensure.
CONCLUSIONS: The finding that offenses have greater predictive power than crashes is consistent with the understanding that offenses are under greater volitional control than are crashes and consequently may be more attributable to individual characteristics.
Surveillance for homicide among intimate partners - United States, 1981--1998.
Paulozzi LJ, Saltzman LE, Thompson MP, Holmgreen P. MMWR 2001; 50(SS03): 1-16.
Full text available online at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5003a1.htm.
BACKGROUND: A substantial percentage of all homicides in the United States are committed by intimate partners of the victims. Among females, approximately 1 in 3 homicides are intimate partner homicides (IPHs). Intimate partner homicides cannot be tracked by using death certificates because death certificates do not record the victim's relationship to the perpetrator.
METHODS: This report summarizes information regarding IPHs that occurred in the United States during 1981--1998. This report is based on Supplemental Homicide Reports (SHRs) collected by the Federal Bureau of Investigation (FBI) as part of their Uniform Crime Reporting System. SHRs are filed voluntarily by police departments for homicides occurring within their jurisdiction. SHRs include demographic variables regarding victims and perpetrators, their relationship, and weapon(s) used. Data from the SHR file were weighted by comparison with homicide data from death certificates to compensate for underreporting. IPHs were restricted to victims aged >10 years.
RESULTS: The risk for death from IPH among males was 0.62 times the risk among females. However, the rate among black males was 1.16 times the rate among black females. Among racial groups, rates among blacks were highest, and the rates among Asian or Pacific Islanders were lowest. Rates were highest among females aged 20--49 years and among males aged 30--59 years. During the study period, rates among white females decreased 23%, and rates among white males decreased 61.9%. Rates among black females decreased 47.6%, and rates among black males decreased 76.4%. Highest rates occurred in the southern and western states among both white and black females. A graded increase in IPH risk occurred with community population size. Approximately 50% of IPHs were committed by legal spouses and 33% by boyfriends or girlfriends for both male and female victims. IPH rates were less than expected during the months of January, October, and November.
DISCUSSION: Although total homicide rates have fluctuated during 1981--1998, IPH rates have decreased steadily during this period, and among certain subpopulations, the decrease has been substantial. Decreases are temporally associated with the introduction of social programs and legal measures to curb intimate partner violence, but a causal relationship has not been established. Likewise, no confirmed explanation exists for the greater decrease in rates among males compared with rates among females. The differences in IPH rates by race indicate that economic, social, and cultural factors are involved. The analysis by community population size and state demonstrates that regional sociocultural differences might be involved also. Access to firearms might be a key factor in both male and female IPHs. The descriptive epidemiology of IPH is changing rapidly and should continue to be monitored. Understanding the reasons for the recent decreases in IPHs might help identify methods for primary and secondary prevention and further reduce IPH rates.
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Rev. 14-Oct-2001 at 17:09 hours.
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