21 January 2002
At-risk drinkers use safe ride services to avoid drinking and driving.
- Caudill BD, Harding WM, Moore BA. J Subst Abuse 2000; 11(2):149-159.
Correspondence: Barry D. Caudill, Center for Studies on Alcohol, Westat, 1650 Research Boulevard, Rockville, MD 20850, USA (email: caudilb1@westat.com).
BACKGROUND: Many communities provide free or low-cost rides home to drinking drivers as a means of reducing driving while intoxicated (DWI).
OBJECTIVES: A central question pertinent to the efficacy of safe rides (SRs) in preventing DWI is whether individuals at high risk for DWI use them.
METHODS: 472 barroom surveys and 51 in situ breath tests were conducted as part of an assessment of an alternative transportation intervention in a Maryland community. Bivariate analyses and stepwise logistic regression were performed comparing 42 barroom respondents who reported using a SR in the last 12 months to non-users.
RESULTS: Bivariate analyses showed that SR users drank more frequently outside the home and achieved higher estimated blood alcohol concentrations (BACs) when they did. Also, they were more likely to be heavy drinkers, to have driven when feeling intoxicated, and to have been arrested for DWI. Although SR users were more likely to ride with an intoxicated driver, they were also more likely to use a designated driver (DD). In situ breath test data showed SR users' BACs ranged from 0.031 to 0.248, with a mean of 0.146.
CONCLUSIONS: It is concluded that SR programs attract drinkers at high risk for DWI. DWI prevention efforts would benefit from future research exploring how at-risk drinkers make drinking and driving decisions.
Do companions of designated drivers drink excessively?
- Harding WM, Caudill BD, Moore BA. J Subst Abuse 2001; 13(4):505-514.
Correspondence: Wayne M. Harding, Social Science Research and Evaluation, Inc., 16 Chadwick Road, Burlington, MA 01803, USA (email: wayneh@gis.net).
BACKGROUND: Alcohol intoxication is associated not only with increased risk for traffic crashes but also with the occurrence of other types of injuries. A common criticism of designated driver programs (DDPs) is that they promote excessive drinking among companions of the designated driver (DD).
OBJECTIVES: To determine the drinking behavior and blood alcohol levels of alcohol drinkers when they use a designated driver and when they do not.
METHODS: Data were collected from two representative samples of drinkers using computer-assisted telephone interviews (CATIs), and questionnaires administered to customers in barrooms.
RESULTS: Most respondents drank moderately. They had usual estimated blood alcohol concentrations (BACs) of less than 0.10 when they used DDs. Differences between respondents' estimated BACs when they used a DD and when they drank outside their homes were very small: 0.017 in both samples. Additional analyses examined shifts between lower and higher categories of risk defined as a BAC of less than 0.10 and a BAC of 0.10 or greater. A minority, 15% of CATI and 30% of barroom respondents, switched to the higher risk category when using a DD. These CATI and barroom respondents increased their BACs by an average of 0.089 and 0.11, respectively. Risk associated with this increase was mitigated, however, by respondents' infrequent use of DDs.
CONCLUSIONS: Use of DDs was not generally associated with excessive alcohol consumption. Since a minority of respondents did drink heavily when using a DD, programs promoting DD use should caution drinkers that the availability of a DD is not an excuse for excessive consumption, and remind hosts and servers that they should not overserve their guests or customers even when they have a DD.
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Social inequalities in health: The impact of independent inquiries in the U.K.
- Carter YH. Injury Control Safety Promotion 2001; 8(3): 131-134.
Correspondence: Yvonne H. Carter, Department of General Practice and Primary Care, Queen Mary University, London, UK (email: y.h.carter@qmul.ac.uk).
Despite the burden of accidental injury, the topic has been one of the most neglected areas for preventive action, the commissioning of research, and the education and training of health professionals. In the U.K., historically no single agency or specialty has 'owned' the prevention of unintentional injuries, either at the national government or local levels. This can lead, at worst, to a failure to act or at best a lack of coordination or duplication of effort.
While there may be a lack of clarity of ownership, there is no lack of involvement on the subject. Over the past decade successive governments have targeted accident mortality in our nations health and road transport strategies. government policy initiatives such as The Health of the Nation, and Saving Lives: Our Healthier Nation have been positive moves towards defining the key role of the health sector. They have advocated better inter-departmental coordination of initiatives and defined more clearly the leadership role of the health sector for accident prevention as a whole.
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Evaluation of a first aid and home safety program for Hispanic migrant adolescents.
- Campbell NR, Ayala GX, Litrownik AJ, Slymen DJ, Zavala F, Elder JP. Am J Prev Med 2001; 20(4):258-65
Correspondence: John P. Elder, PhD, MPH, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123 USA (email: jelder@mail.sdsu.edu).
BACKGROUND: Unintentional injuries are the major cause of death among children, adolescents, and young adults. This article presents an evaluation of an injury-prevention program for 11- to 16-year-old, Hispanic migrant youth.
METHODS: Design: Randomized controlled trial with two conditions: first aid and home safety training and tobacco and alcohol prevention. Participants were assessed at baseline, at immediate post-intervention, and at 1-year follow-up. Participants: A total of 660 Hispanic adolescent and parent pairs participated in a program entitled Sembrando Salud (sowing the seeds of health). Intervention: The intervention consisted of two conditions: first aid and home safety training and tobacco and alcohol prevention. Both groups were exposed to an eight-session, multimedia program presented by bilingual, bicultural college students. The sessions consisted of lectures, discussions, and skills development and practice. Outcome Measures: To examine the efficacy of the first aid and home safety intervention, adolescents were assessed for changes in first aid confidence, knowledge of items in a first aid kit, knowledge of how to respond in an emergency situation, acquisition of a first aid kit, and behavioral skills testing in response to two emergency scenarios.
RESULTS: Similar changes in confidence were observed in both groups after the intervention. Participants in the first aid and home safety program were better able to identify items to include in a first aid kit, how to respond in an emergency situation, and reported fewer erroneous victim-caring procedures than the tobacco and alcohol prevention group.
CONCLUSIONS: Sembrando Salud was successful at achieving and maintaining change in confidence and knowledge of first aid and emergency response skills over a yearlong period.
Persuading school-age cyclists to use safety helmets: Effectiveness of an intervention based on the Theory of Planned Behaviour.
- Quine L, Rutter DR, Arnold L. Br J Health Psychol 2001, 6(4): 327-345.
Correspondence: Lyn Quine, Department of Psychology, Keynes College, The University of Kent at Canterbury, Canterbury, Kent CT2 7NP UK (email: L.Quine@ukc.ac.uk).
BACKGROUND: It is well known that bicycle helmets reduce the severity of head injuries to cyclists who crash. It is also known that many cyclists don't wear them.
OBJECTIVES: To describe and evaluate a theory-based intervention to encourage the use of protective helmets in 11-15 year old cyclists.
METHODS: Subjects in the intervention group were presented with a booklet containing a series of persuasive messages based on the identified salient beliefs. The control group was presented with a different series of messages concerning a cycling proficiency and bicycle maintenance course. Initial beliefs were measured by questionnaire just before the intervention at Time 1; the immediate effects were evaluated by questionnaire at Time 2; and 5 months later, at Time 3, the long-term effects of the intervention on beliefs, intentions, and behavior were assessed.
RESULTS: The behavioral, normative and control beliefs and intentions of intervention subjects became more positive than those of controls, and the effect was maintained over time. There was also a significant effect on behavior: at 5-month follow-up, none of the 49 controls had taken up helmet wearing, while 12 (25%) of the 48 intervention subjects had.
CONCLUSIONS: The results suggest that in order to promote lasting helmet use in young cyclists, their beliefs need to be changed. The results point to the value of social cognition theories such as the Theory of Planned Behavior in the design of effective interventions to change health behaviors.
Pediatric injury prevention counseling: an observational study of process and content.
- Barrios LC, Runyan CW, Downs SM, Bowling JM. Patient Educ Couns 2001; 44(2): 141-149.
Correspondence: Lisa C. Barrios, Division of Adolescent and School Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop K-33, Atlanta, GA 30341-3717, USA (email: lbarrios@cdc.gov).
OBJECTIVES: To describe routine injury prevention counseling; to observe how three visit components -- printed prompts, parent remarks, and parent behaviors -- affect such counseling; to describe the process and content of discussions about car seats as an example of routine injury prevention.
METHODS: A total of 128 well-child visits of children under 7 months of age to a university pediatric clinic were videotaped (76% of eligible visits).
RESULTS: Three injury topics were mentioned, on an average, per visit. Parents or caregivers rarely introduced injury topics (5%). Physicians frequently introduced those topics listed on age-specific prompting sheets (73%). Car seat counseling typically began with a physician's question (82%). Most asked simply about ownership or use (93%). Few addressed difficult issues, such as consistency of use (11%).
CONCLUSIONS: Physicians bring up the injury topics that are prompted. However, most discussion is superficial. Printed prompts that address counseling process as well as content might be beneficial.
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See report on frostbite under Research Methods
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Hospitalized fall injuries and race in California.
- Ellis AA, Trent RB. Inj Prev 2001; 7(4):316-320
Correspondence: Arthur Ellis, Department of Health Services, Epidemiology and Prevention for Injury Control Branch, Sacramento, CA 94234-7320, USA. (aellis@dhs.ca.gov).
OBJECTIVE: To compare risks for falls and their consequences among four major race/ethnic groups in California.
METHODS: Cases are 104,902 hospital discharges of California residents with a same level fall injury as the principal external cause of injury. Included are all discharges for a first hospitalization for a given injury in any California non-federal hospital from 1995-97. Analysis includes crude and age standardized rates to describe risks, diagnoses, and consequences.
RESULTS: Rates per 100 000 for same level hospitalized fall injuries for whites (161) are distinctively higher than for blacks (64), Hispanics (43), and Asian/Pacific Islanders (35). Whites are more likely to have a fracture diagnosis and to be discharged to long term care rather than home, suggesting a poorer outcome or greater severity. Same level falls absorb a large proportion of hospital resources directed to the treatment of injuries.
CONCLUSIONS: In a four way comparison among race/ethnic groups, whites are distinguished by their high incidence, rates of fracture, and unfavorable discharge status. Prevention, particularly aimed at whites, has potential to improve health and save treatment resources.
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Work-related injuries from mandatory fitness training among Swedish firemen.
- de Loes M, Jansson BR. Int J Sports Med 2001 Jul;22(5):373-378.
Correspondence: Marianne de Loes, Karolinska Institutet, Dept of Public Health Sciences, Stockholm, Sweden. (email: Marianne.de.Loes@phs.ki.se).
A considerable amount of employees incur injuries in professions with mandatory on-duty fitness training. The training is necessary for maintaining a good health status, physical condition and strength in professions requiring such qualities. Injuries in Swedish firemen from on-duty fitness training between 1992 and 1998 were selected retrospectively from the Information System of Occupational Injuries (ISA) at the National Board of Occupational Safety and Health and, if having caused a sick-leave exceeding 2 weeks, to the Labour Market Insurance (AMF Insurance). The latter comprised injuries from 1995 only. During the seven-year period 1,468 injuries from fitness training occurred in male firemen. With an estimated 147 h per man and year the injury incidence was 2.6 per 10,000 h of exposure. The mean number of days of absence from work was 24.1 days (SD 39.8). In 1995, the mean cost per injury for medical treatment was close to 7,000 Euro and for production loss almost 4,500 Euro. By far the major part of the injuries, 75 %, occurred during team and contact sports (primarily floorball and soccer) and this sport category also accounted for 83% of the medical costs and 78% of the costs for production loss. It is suggested that a restriction of team and contact sports as mandatory on-duty fitness training for firemen should be tested and evaluated concerning the injury incidence.
Knowledge, attitude, and practice of sugarcane crushers towards hand injury prevention strategies in India.
- David SS, Goel K. Inj Prev 2001; 7(4):329-330.
Correspondence: Suresh David, Department of Accident and Emergency Medicine, Christian Medical College and Hospital, Vellore, INDIA; (email: suresh.david@cmcvellore.ac.in).
BACKGROUND: Injuries of the hand have an enormous impact on hand function and on quality of life. Occupational injuries are a major cause of morbidity and mortality in India and their incidence has been steadily increasing. Sugarcane crushers produce juice using dangerous procedures.
OBJECTIVES: The objective of this study was to determine the knowledge, attitudes, and practices among sugarcane crushers in India and thus assist in the formulation of effective preventive strategies.
METHODS: The study was conducted in a block (area) in the Vellore District, South India (population 100 000). All sugarcane crushers living in this area (n = 32) were included. A single observer, using a questionnaire, conducted personal on-site interviews.
RESULTS: Carelessness was involved in 63% of injuries. Sixteen per cent felt that machines with improved safety features are required; 40% supported the use of special gloves, although 19% considered them a hindrance. Eighty eight per cent did not consider the long duration of work as a risk factor and 38% were fatalistic (God's will); 50% thought the injuries were due to "bad luck".
CONCLUSIONS: Sugarcane crushers do not perceive the need for safer equipment. To overcome fatalistic views, and persuade this group to take other safety measures, safety education will need to take into consideration their socioeconomic and educational status.
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Outcomes of pediatric pedestrian injuries by locations of event.
Data from the National Pediatric Trauma Registry October 1995-October 2000, containing medical records of children under 20 years old hospitalized for pedestrian injuries, were examined. Demographics and outcome measures (nature and severity of injury, utilization of resources, deaths, and disability at discharge) were compared by location of occurrence. Pediatric pedestrian injuries resulted in severe outcomes whether the events occurred in driveways, public places, or in the road. Off the road injuries accounted for a significant proportion (13.2%) of all serious pedestrian injuries and disproportionately affected the youngest children. Prevention should consider the child's age and the location of injury occurrence.
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No reports this week
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Surveillance of acute occupational pesticide-related illness and injury: the US experience.
- Ballard TJ, Calvert GM. Ann Ist Super Sanita 2001; 37(2):175-179
Correspondence: Terri J. Ballard, Laboratorio di Igiene Ambientale, Istituto Superiore di Sanita, Rome, Italy.
In the United States there are numerous state-based and national surveillance systems that collect data on acute pesticide-related illnesses and injuries. On the state level, Arizona, California, Florida, Louisiana, New York, Oregon, Texas, and Washington routinely collect illness data due to pesticide exposure and conduct comprehensive case investigations. On the national level, the American Association of Poison Control Centers coordinates the Toxic Exposure Surveillance System, and the Bureau of Labor Statistics provides annual estimates of the number of occupational pesticide-related illnesses and injuries that result in days away from work. The various systems are described and compared, and examples are provided of prevention measures that have been implemented as a result of surveillance activities.
Emergency department visits for poisoning: Epidemiological changes in the last 10 years.
- [Article in Spanish]
Mintegui Raso S, Benito Fernandez J, Vazquez Ronco M, Fernandez Landaluce A, Gortazar Arias P, Grau Bolado G. An Esp Pediatr 2002; 56(1):23-29.
Correspondence: Dr. S. Mintegui Raso, Urgencias de Pediatría, Departamento de Pediatría, Hospital de Cruces, Pl. de Cruces, s/n. 48903 Baracaldo. Bilbao. email: smintegui@hcru.osakidetza.net).
OBJECTIVE: To study the epidemiological changes observed in pediatric poisonings treated in our Emergency Department between 1988 and 1999.
METHODS: Descriptive, observational study performed in three 12-month periods (1988, 1993 and 1999). The circumstances surrounding the visit, treatment in the Emergency Department and clinical evolution were registered.
RESULTS: Consultations for possible poisoning decreased between 1988 and 1999 (279 vs. 161, p 0). This decrease was noted both in poisonings caused by household products (91 vs. 48, -47 %) and those caused by drugs (112 vs. 87, -22 %). Antipyretics caused one-third of drug poisonings and psychotropics caused approximately 11 %. The most commonly implicated agent is currently paracetamol. Caustic alkali were the most common household products causing poisoning although the number of such poisonings decreased (48 episodes in 1988 and 18 in 1999). Hydrocarbons were the second most frequent cause of household product poisoning (12-16/year). Most episodes occurred at home. The poison, mainly household products, was kept in a container other than the original in nearly 5 % of episodes in 1988 and in 13.7 % in 1999. The number of children receiving treatment in the Emergency Department decreased between 1988 and 1993 and remained stable between 1993 and 1999 (62 % in 1988 and approximately 35 % in 1993 and 1999; p 0.000003). The number of admissions also decreased from 17 children in 1989 (6.0 %) to six in 1999 (3.7 %, p 0.39). No deaths were recorded.
CONCLUSIONS: In the last ten years, visits for possible episodes of pediatric poisoning have decreased, mainly those due to mild poisoning caused by household products. Paracetamol has replaced acetyl-salicylic acid as the most frequently implicated drug.
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Alcohol and other risk factors for drowning among male active duty U.S. army soldiers.
- Bell NS, Amoroso PJ, Yore MM, Senier L, Williams JO, Smith GS, Theriault A. Aviat Space Environ Med 2001; 72(12):1086-1095.
Correspondence: NS Bell, SSDS, Inc., Natick, MA, USA. (email: nbell@ssds.net).
BACKGROUND: Risk factors for drowning are largely undocumented among military populations. Hypothesis: Accident report narratives will provide important information about the role of alcohol use and other behaviors in drownings among active duty male U.S. Army soldiers.
METHODS: Using a case series design, we describe drowning deaths reported to the U.S. Army Safety Center (1980-1997), documenting associated demographic factors, alcohol use, and other risk-taking behaviors.
RESULTS: Drowning victims (n = 352) were disproportionately young, black, and single, with less time-in-service, and no college experience. Most drownings occurred off-duty (89%). Alcohol use was involved in at least 31% of the cases overall. Alcohol use was also associated with a 10-fold increase in reckless behavior (OR 9.6, 95% CI 4.5-20.7) and was most common among drownings in Europe (OR = 4.3, 95% CI 1.5-13.4). Most drownings occurred where no lifeguard was present (68%), but almost two-thirds occurred in the presence of others, with CPR initiated in less than one-third of these cases. Drownings involving minority victims were less likely to involve alcohol, but more likely to occur in unauthorized swimming areas. While most drownings did not involve violations of safety rules, over one-third of the cases involved some form of reckless behavior, particularly for those under age 21.
CONCLUSIONS: Intervention programs should be tailored to meet the needs of the demographic subgroups at highest risk since behavioral risk factors vary by race and age. CPR training and skills maintenance can improve survival rates. Narrative data are important for developing hypotheses and understanding risk factors for injuries.
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Retrospective study of 70 cases of severe frostbite lesions: a proposed new classification scheme.
- Cauchy E, Chetaille E, Marchand V, Marsigny B. Wilderness Environ Med 2001; 12(4):248-255.
Correspondence: Department of Mountain Medicine and Trauma, Chamonix Hospital, France. (email: m.cauchy@ch-sallanches-chamonix.fr).
OBJECTIVE: Previous frostbite classifications were mainly based on retrospective diagnosis and, most of the time, could not be used to predict the final outcome of the lesions and especially the probability of an amputation and its level. The aim of this study was to suggest a new classification at day 0 based mainly on the topography of the lesions and on early bone scan results, which are more convenient and accurate in predicting the final outcome of frostbite.
METHODS: The retrospective study of the clinical histories of 70 patients hospitalized at Chamonix Hospital (Mont-Blanc Massif) from 1985 to 1999 for severe frostbite injuries of the extremities has allowed us to classify the aspects of the initial lesions on day 0 and to compare them with final outcomes.
RESULTS: A strong correlation was found between the extent of the lesion and the outcome of each finger or toe. When the initial lesion was on the distal phalanx, the probability of bone amputation was around 1% for the digit, 31% for the middle phalanx, 67% for the proximal phalanx, 98% for the metacarpal/metatarsal, and 100% for the carpal/tarsal.
CONCLUSIONS: Based on these clinical results and on the results of bone scans (previously validated), a new classification of frostbite severity at day 0 is proposed. Four degrees of severity are defined: first degree, leading to recovery; second degree, leading to soft tissue amputation; third degree, leading to bone amputation, and fourth degree, leading to large amputation with systemic effects.
Traffic accidents in a city in Southern Brazil: an evaluation of coverage and quality of data.
- [Article in Portuguese]
Andrade SM, Mello-Jorge MH. Cad Saude Publica 2001; 17(6):1449-1456.
Departamento Materno-Infantil e Saude Comunitaria, Universidade Estadual de Londrina, Londrina, PR, 86020-071, Brasil.
OBJECTIVES: The aim of this study was to analyze police coverage and the validity of data on emergency and hospitalization records as well as on death certificates for traffic casualties in Londrina, Parana State, Brazil.
METHODS: Victims (3,643) of road accidents during the first semester of 1996 were investigated and followed up after 180 days to confirm whether death was due to the accident.
RESULTS: Police data recorded only 32.5% of the casualties, the coverage being higher for car occupants (71.6%) and lower for cyclists (8.1%) and pedestrians (24.8%). Agreement was low between original information and that derived from investigation of death certificates (Kappa coefficient 0.10; 95% CI: 0.02-0.17), fair for hospitalization records (Kappa coefficient 0.33; 95% CI: 0.27-0.40), and substantial for emergency records (Kappa coefficient 0.63; 95% CI: 0.61-0.65).
CONCLUSIONS: Results suggest that police data underestimate the number of traffic casualties and that it is necessary to improve the validity of medical records.
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Head injury in early adulthood and the lifetime risk of depression.
- Holsinger T, Steffens DC, Phillips C, Helms MJ, Havlik RJ, Breitner JC, Guralnik JM, Plassman BL. Arch Gen Psychiatry 2002; 59(1):17-22.
Correspondence: Brenda L. Plassman, 905 West main Street, Box 41, Durham, NC, 27701 USA (email: brenda.passman@duke.edu).
BACKGROUND: Depressive symptoms are common and can be debilitating in the months after head injury. Head injury can also have long-term cognitive effects, but little is known about the long-term risk of depression associated with head injury. We investigated the lifetime rates of depressive illness 50 years after closed head injury.
METHODS: Participants were male World War II veterans who served during 1944-1945 and were hospitalized at that time for a head injury, pneumonia, or laceration, puncture, or incision wounds. We used military medical records to establish the presence and severity of closed head injuries. Veterans with (n = 520) and without (n = 1198) head injuries were interviewed in 1996-1997 for their lifetime history of depressive illness. Men with dementia were excluded.
RESULTS: Veterans with head injury were more likely to report major depression in subsequent years and were more often currently depressed. Using logistic regression and controlling for age and education, the lifetime prevalence of major depression in the head injured group was 18.5% vs 13.4% in those with no head injury (odds ratio = 1.54, 95% confidence interval = 1.17-2.04). Current major depression was detected in 11.2% of the veterans with head injuries vs 8.5% of those without head injury (odds ratio = 1.63, 95% confidence interval = 1.07-2.50). This increase in depression could not be explained by a history of myocardial infarction, a history of cerebrovascular accident, or history of alcohol abuse. The lifetime risk of depression increased with severity of the head injury.
CONCLUSION: The risk of depression remains elevated for decades following head injury and seems to be highest in those who have had a severe head injury.
Patterns of trauma injuries in rural versus urban Jamaica.
- McDonald A, Dawkins N, Titus I. West Indian Med J 2001; 50(3):214-217.
A. McDonald, Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica.
Trauma admissions to St Ann's Bay Hospital in rural Jamaica and The University Hospital of the West Indies (UHWI) in the capital city of Kingston are compared. Trauma accounted for 19% and 22% of surgical admissions to UHWI and the St Ann's Bay Hospital, respectively. Sixty-three per cent of trauma cases admitted to the St Ann's Bay Hospital and 56% to the UHWI were due to unintentional injuries (95% CI, -0.05, 0.19). The main cause of unintentional injuries at both hospitals was motor vehicle accidents, accounting for 43% and 37% at UHWI and St Ann's Bay Hospital respectively (95% CI, -0.04, 0.17). The prevalence of falls was significantly higher in St Ann's Bay Hospital compared with UHWI, 41% and 26% respectively (95% CI, 0.10, 0.21). Intentional injuries accounted for 37% of cases in St Ann's Bay Hospital and 44% at UHWI (95% CI, -0.20, 0.04). The prevalence of firearm injuries was significantly higher at the UHWI than in St Ann's Bay Hospital, 55% and 18% respectively (95% CI, -0.15, -0.05). There was no significant difference in age and injury severity scores in the two hospitals but patients remained in hospital significantly longer at UHWI.
Intentional childhood injuries in Greece 1996-97--data from a population-based Emergency Department Injury Surveillance System (EDISS).
- Petridou E, Moustaki M, Gemanaki E, Djeddah C, Trichopoulos D. Scand J Public Health 2001; 29(4):279-284.
Correspondence: E. Petridou, Department of Hygiene and Epidemiology, Athens University Medical School, Greece (email: epetrid@cc.uoa.gr).
BACKGROUND: It has been gradually recognized that intentional injuries among children represent a largely hidden problem in modern societies. With the exception of mortality, population-based data from Greece have not been previously reported.
OBJECTIVES: To assess the magnitude and the characteristics of intentional injuries among children aged 0-14 years old.
METHODS: Data from the population-based Emergency Department Injury Surveillance System (EDISS) database during the period 1996-97 were used. METHODS: EDISS relies on personal interviews with children and their escorts who contact the emergency departments of three hospitals. Two of these hospitals are district hospitals of the county of Magnesia and the island of Corfu, whereas the other is a university children's hospital that covers the Greater Athens area on alternative days.
RESULTS: Among 46.807 children recorded in EDISS, 108 injuries (0.23%) were attributed to acts of violence. Among the 108 intentional injuries, only 11 were caused by firearms or other weapons and only 4 concerned infants. In comparison to unintentional home and leisure injuries, intentional childhood injuries increase significantly with age and they are more common among migrant children. They occur more frequently during late night and early morning hours, they are more serious, and they are more often multiple and concentrated on the head.
CONCLUSIONS: In Greece. a problem of violence directed against children does exist. The actual magnitude of this problem is difficult to estimate, but its size appears to be smaller in comparison with that reported in other populations.
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See item 2 under Risk Factor Prevalence
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The safe journeys of an enterprising school: negotiating landscapes of opportunity and risk.
- Collins DC, Kearns RA. Health Place 2001; 7(4):293-306.
Correspondence: Damian Colllins, Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6. (email: dcollins@sfu.ca).
In this paper, the authors discuss recent efforts to improve the safety of children travelling to and from New Zealand's largest primary school. The results of a travel survey completed by parents and pupils are reported, together with our recommendations for reducing congestion at the school gate and promoting healthy alternatives to car travel. Reflecting on this research, we find that market-oriented education reforms have provided schools with strong incentives for increasing their rolls--a course of action which may endanger pupils' well-being. At the same time, they have provided some schools with opportunities for resisting the present urban (dis)order and promoting community health.
Epidemiological features of injuries in middle and primary schools students of Hui and Han nationalities in Ningxia.
- [Article in Chinese]
Huang C, Zhao J, Meng N. Zhonghua Liu Xing Bing Xue Za Zhi 2001; 22(4): 252-255.
Correspondence: C. Huang, Ningxia Public Health and Anti-epidemic Station, Yinchuan 750004, China.
OBJECTIVES: To find out the present situation and causes of injuries and risk factors of accidental injuries among students and to provide evidence for prevention and reduction of accidental injuries.
METHODS: A cluster sampling study on the situation of injuries was conducted in 21 civic middle and primary schools with 7,000 (6-19 years old) students during the December 1999 and November 2000 in Ningxia province.
RESULTS: Results showed that the total rate of injuries was 20.40% with boys higher than girls (P < 0.01). Five kinds of injuries took the leading place: injuries from falls (9.27%), bumps (4.55%), knife-cutting (2.99%), traffic accidents (2.00%) burns and scalds (1.66%). The rate of injuries was 22.11% in students of Hui nationality, higher than the ones in Han nationality (19.6%, P < 0.025). The rate of injuries among junior middle school students was the highest (24.11%), followed by high school students 22.15%, and primary students 17.63%. Causes, times, places, parts of the bodies and the treatment regarding injuries were analyzed.
CONCLUSION: Unintentional injuries among middle and primary school students was found to be a serious but avoidable problem. Comprehensive and effective preventive measures should be actively undertaken.
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Female suicides in Berlin with the use of firearms.
- Schmeling A, Strauch H, Rothschild MA. Forensic Sci Int 2001; 124(2-3): 178-181.
Correspondence: A. Schmelling, Institute of Legal Medicine, Humboldt-Universitat zu Berlin, Hannoversche Strasse 6, 10115, Berlin, Germany. (email: unavailable).
The Statistical Office of Berlin recorded a total of 5488 suicides within the 10-year period 1990-1999 (3550 males, 1938 females). Firearms were used in 238 cases (218 males, 20 females). An autopsy was performed in 19 of the 20 female cases. The women's ages ranged from 21 to 88 years. Their marital status was single (n=6), married (n=5), divorced (n=5) and widowed (n=3). Eight of the women had one or more children. A suicide note was found in eight cases; six women had a history of psychiatric illness, and six had previously attempted suicide. Predominant among the suicide motives were mental (n=5) and organic (n=4) disorders as well as relationship problems (n=3) and financial difficulties (n=2). Most of the women (n=16) committed suicide in their own apartment, mainly in the bedroom. The weapons used were pistol (n=10), revolver (n=6), rifle (n=2) and a blank cartridge gun (n=1). In 16 cases we found a contact discharge at point blank range. Six of the dead women were found with the weapon still in their hands. The site of bullet-entry was the right temple (n=11), high-parietal (n=2), mouth (n=3), neck (n=1), and chest (n=2). A comparison of our results with the data of other authors for male or predominantly male collectives did not indicate any sex-specific differences regarding the type of weapon, location of the entry wound or the scene. However, alcohol was detected at a lower frequency compared with male gunshot suicides.
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The association between risk-taking behavior and the use of safety devices in adolescents.
- Mathews J, Zollinger T, Przybylski M, Bull M. Proc Assoc Adv Automot Med Conf 2001; 45: 23-36. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Jeff Matthews, Automotive Safety Program, Indiana University School of Medicine, 575 West Drive Room 004, Indianapolis, IN 46202 USA (email: jmmathew@iupui.edu).
OBJECTIVES: The purpose of this research study was to measure the association between risk taking behavior in adolescents and their use of safety devices.
METHODS: The study focused on three safety devices: seat belts, motorcycle helmets, and bicycle helmets. This is a secondary data analysis using data from the Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention.
RESULTS: The results of this study indicate that risky behavior in adolescents is associated with their non-use of safety devices. In general, risky behavior was more associated with the non-use of seatbelts than the use of other safety devices.
CONCLUSIONS: The results of this study suggest that a comprehensive approach to reducing risky behaviors in adolescent should be considered when planning injury prevention programs.
Epidemiology, prevention and countermeasures against severe traumatic brain injury in Japan and abroad.
- Nakamura N, Yamaura A, Shigemori M, Ono J, Kawamata T, Sakamoto T; Japanese Data Bank Committee for Traumatic Brain Injury. Neurol Res 2002; 24(1):45-53. (Forefront Publishing Group, 5 River Road, Suite 113, Wilton, CT, 06897 USA (Phone: 203-834-0631 Fax: 203-834-0940.)
Correspondence: N. Nakamura, Office of the Japan Society of Neurotraumatology, Department of Neurosurgery, Tokyo Jikei University School of Medicine.
On the basis of accurate statistical reports in regard to traffic accidents and safety in Japan, it is clear that traffic accidents on the road, injured victims and all other losses due to these accidents have been increasing since around 1980. Nevertheless, the number of deaths due to traffic accidents has been gradually declining over the last six years. More detailed analysis of data revealed that the most significant factor for the recent reduction of traffic accident deaths was the marked reduction of deaths related to head injury. From the neurosurgical viewpoint, the Japanese Data Bank Committee for Traumatic Brain Injury began its formal activity in 1998. Although the registered number of severe head injuries is statistically too small at present to arrive at conclusions, some interesting points draw our attention. As for intracranial pathology diagnosed by the image of cranial CT scans, two thirds of nontraffic cases have focal brain lesions alone. On the other hand, in traffic cases one third of patients have focal lesions alone and one fourth have diffuse brain lesion exclusively. In this study, in 23% of traffic accidents and 12% of nontraffic accidents, consumption of alcohol led indirectly to head injuries. The schedule and details of countermeasures taken against traffic accidents are discussed from an international viewpoint.
Motor vehicle crashes and abnormal driving behaviours in patients with dementia in Mendoza, Argentina.
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Zuin D, Ortiz H, Boromei D, Lopez OL. Eur J Neurol 2002; 9(1):29-34.
Correspondence: Oscar L. Lopez, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; (email: ollopez@pitt.edu).
BACKGROUND: Studies conducted in industrialized countries have shown that elderly demented subjects have increased risk of car accidents. However, there is no information about the effect of dementia on driving habits in non-industrialized countries.
OBJECTIVES: To assess the risk of car crashes and abnormal driving behaviors among elders with dementia in a non-industrialized country.
METHODS: The number of motor vehicle crashes (MVC) and abnormal driving behaviors (ADB) (e.g. not recognizing traffic lights, driving in the middle of the road, etc.) were assessed with a semi-structured interview in 56 demented subjects and 31 elderly controls, all of whom were active drivers, at the Regional Registry of Dementia in Mendoza. Detailed neurological, psychiatric and neuropsychological examinations were also conducted on each subject.
RESULTS: The presence of dementia and sex (male) predicted ADB, MVC and number of MVC (two or more). Among demented patients, ADB and MVC were associated with sex (male) and number of MVC was associated with sex (male) and Blessed Dementia Rating Scale for activities of daily living scores. Neither ADB, MVC, or number of MVC were associated with education level, or with cognitive or psychiatric measures.
CONCLUSIONS: These findings showed that in developing countries, dementia has a significant contribution to MVC and ADB, as occurs in industrialized nations. Consequently, legislation to curb the risk of accidents caused by demented patients should be implemented. Furthermore, physicians must encourage demented patients (or their families) to discontinue driving, even those with mild dementia syndrome.
The World Health Organization and the prevention of road injuries: phone book analysis.
- Roberts I, Hosford T, Edwards P. BMJ 2001; 323:1485.
Correspondence: Ian Roberts, Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London WC1B 3DP, UK; (email: Ian.Roberts@lshtm.ac.uk).
BACKGROUND: Every day about 3000 people die and about 30 000 people are seriously injured in road crashes. 1 2 Most casualties occur in low and middle income countries, and most are vulnerable road users: pedestrians, cyclists, and motorcyclists. The World Health Organization has a lead role in the control of global epidemics, and the work is coordinated from its headquarters in Geneva, Switzerland.
OBJECTIVES: We conducted a phone book analysis to assess how the WHO is responding to the global problem of road injuries.
METHODS: Briefly, phone book analysis involves obtaining a phone book and analyzing its contents. The phone book of the WHO headquarters lists the name of each employee, a series of symbols indicating the employee's position within the WHO, and the employee's phone number. We determined the area of work of each employee from the key at the front of the book and the reference symbols. We conducted our analysis on the October 2000 phone book (the most recent edition available), taken (borrowed) from room M-505 of the WHO headquarters in April 2001. The phone book has now been returned. We extracted the names and reference symbols of all employees from the phone book, put them into a database, and calculated the number of employees working within the different parts of the WHO. We conducted our analyses in both French and English. We did not seek approval from the ethics committee.
RESULTS: The phone book listed the phone numbers of 2184 employees (figure). The general management unit had the most staff phones (472) and the office of the director general the fewest (48). The department for injuries and violence prevention (within the non-communicable diseases and mental health unit) had 14 (7%) of the 192 phones within the unit. Of these 14 phones, six were for staff dealing with the prevention of violence, six for staff dealing with the epidemiology of violence and non-intentional injuries, and two for staff dealing with land mines (public safety promotion). It was not possible to determine how many of the six phones allocated for violence and non-intentional injuries were for staff dealing with the prevention of road injuries, and so we obtained this information directly from the department: there was one phone.
CONCLUSIONS: Road crashes are responsible for over 10 million serious injuries each year. In some low and middle income countries over 25% of hospital beds are occupied by people injured in road crashes.3 Our study showed that there is only one phone for staff dealing with road injuries at the WHO headquarters, compared with 472 for staff dealing with general management. Given the magnitude of the problem of road injuries, it seems implausible that only one member of staff deals with road injuries. Staff dealing with the prevention of road injuries at WHO headquarters are therefore being denied access to phones. In support of this interpretation, a 1996 WHO report noted that fewer resources are available for research and development in road injuries than for almost any other cause of human misery.4 Although email is effective, we believe that an appropriate use of resources would be to provide phones for people dealing with preventing road injuries. In particular it would help to establish the links between researchers, practitioners, and victims' organizations that are needed to raise the profile of this important but neglected problem.
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Incidence and circumstances of nonfatal firearm-related injuries among children and adolescents.
- Powell EC, Jovtis E, Tanz RR. Arch Pediatr Adolesc Med 2001; 155(12):1364-1368.
Correspondence: E.C. Powell, Division of Pediatric Emergency Medicine, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA (email: epowell@northwestern.edu).
OBJECTIVE: To describe the incidence and circumstances of nonfatal firearm-related injuries among children and adolescents treated in US emergency departments.
METHODS: Data were obtained from the Firearm Injury Surveillance Study, 1993-1997; data were collected through medical record review at hospitals participating in the National Electronic Injury Surveillance System. Setting- The hospitals participating in National Electronic Injury Surveillance System are a stratified probability sample of all US hospitals. OUtcome measures- Numbers and population rates for nonfatal firearm-related injuries among children and adolescents younger than 20 years old.
RESULTS: An estimated 115,131 (95% confidence interval, 76,769-153,493) children and adolescents were treated for a nonfatal gunshot wound during the study period. The estimated annual rates of injury (per 100,000) were 2.0 (children 0-4 years old), 2.2 (children 5-9 years old), 15.4 (children 10-14 years old), and 106.5 (adolescents 15-19 years old). The ratios of nonfatal to fatal firearm-related injuries were 4.0 (children 0-4 years old), 4.4 (children 5-9 years old), 5.0 (children 10-14 years old), and 4.4 (adolescents 15-19 years old). An additional estimated 103,814 children (95% confidence interval, 69,223-138,405) were shot with a nonpowder firearm (BB or pellet gun). Boys 5 to 9 and 10 to 14 years old had the highest rates of injury related to nonpowder firearms, an estimated 36.2 and 99.8 per 100,000, respectively. Fifty-six percent of those 15 to 19 years old were assault victims. An estimated 48% of children and adolescents with powder firearm-related gunshot wounds and an estimated 4% with nonpowder firearm injuries were admitted to the hospital.
CONCLUSIONS: Nonfatal injuries related to powder firearms and nonpowder firearms (BB or pellet guns) are an important source of injury among US children and adolescents. Ongoing surveillance of nonfatal firearm-related injury among children and adolescents is needed.
Women in danger: intimate partner violence experienced by women who qualify and do not qualify for a protective order.
- Gist JH, McFarlane J, Malecha A, Fredland N, Schultz P, Willson P. Behav Sci Law 2001; 19(5-6):637-647.
Correspondence: Julia Henderson Gist, 16222 Willowpark Drive, Tomball, TX 77375, USA (email: (jgist92280@aol.com).
BACKGROUND: Not all women who apply qualify for a civil protective order.
OBJECTIVES: This study compares the type and severity of violence reported by women who qualified with that experienced by women who did not qualify.
METHODS: Ninety women seeking a protective order against a male intimate were interviewed. Findings indicated that 28% of women applying for a protective order did not qualify primarily because of cohabitation requirements or childbearing status. Actual and threatened violence was measured with the 46-item Severity of Violence Against Women Scale. A 17-item questionnaire measured stalking behavior. Levels of reported violence for the preceding 3 months were measured for the two groups.
RESULTS: The symbolic threat behavior only of throwing, smashing, or breaking an object was significantly higher for qualifying women. The physical abuse behavior only of being pushed, shoved, or pulled was significantly higher. None of the stalking behaviors were significantly different.
CONCLUSIONS: Data are urgently needed that document the barriers to abused women receiving protective orders, the relevancy of qualifying criteria, and the effectiveness of protective orders issued.
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