25 February 2002
Cross-border college drinking.
- Clapp JD, Voas RB, Lange JE. J Safety Res 2001; 32(3): 299-307.
Correspondence: John D. Clapp, San Diego State University, School of Social Work, San Diego, CA 92182 (email: jdclapp@mail.sdsu.edu).
BACKGROUND: Universities in the United States have a major problem with binge drinking by students. This problem is greater for universities near national borders where underage students can cross into areas where the legal age for drinking is younger. The legal age for drinking alcohol in the U.S. is 21 years.
METHODS:A telephone survey of students at two large universities, within an hour drive of the Mexican border, was conducted to determine the extent of the cross-border drinking problem.
RESULTS: On average, the students reported about 6.5 trips across the border to drink in the past year and indicated that when drinking in Mexico they consumed greater amounts of alcohol -- more than six drinks compared to 4.5 in the United States. Young males drank the most (8.7 drinks) when in Mexico compared to 4.7 drinks for those older than 21 and 4.5 drinks for women younger than 21 years.
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Motor performance deteriorates with simultaneously performed cognitive tasks in geriatric patients.
- Hauer K, Marburger C, Oster P. Arch Phys Med Rehabil 2002; 83(2):217-223.
Klaus Hauer, Bethanie-Kkrankenhaus/Geriatrisches Zentrum an der Universitat Heidelberg, Heidelberg, GERMANY (email: klhauer@web.de).
OBJECTIVE: To investigate whether simultaneous cognitive tasks influence maximal motor performance in frail geriatric patients with a history of injurious falls and different levels of cognitive function.
METHODS: DESIGN- Experimental 3-group design. SETTING- Geriatric rehabilitation hospital. PARTICIPANTS- Twenty-two healthy, young adults (mean age +/- standard deviation, 27.7 +/- 9y) and 23 geriatric patients (mean age, 80.9 +/- 5.4y) with a history of injurious falls with (Mini-Mental State Examination [MMSE] score, 20.5 +/- 1.6) and without (MMSE score, 28.1 +/- 1.2) cognitive impairment. INTERVENTIONS- Not applicable. MAIN OUTCOME MEASURE- Motor performance: peak and integral of maximal isometric strength of leg extensors. Cognition: semiautomated calculation steps (serial 2 forward) and nonautomated calculation steps derived from the MMSE (serial 7 retro). Motor and cognitive performances were examined as single and dual tasks.
RESULTS: In frail geriatric patients, especially in patients with cognitive impairment, maximal motor performance decreased significantly during all dual tasks. Cognitive performance was reduced, depending on the task and group.
CONCLUSION: In frail or cognitively impaired geriatric patients, additional tasks can substantially decrease maximal motor performance. Insufficient resources on dual tasking may thus be a link in connecting the high incidence of falls with frailty and cognitive impairment in geriatric patients with a history of injurious falls.
Intensive physical training in geriatric patients after severe falls and hip surgery.
- Hauer K, Specht N, Schuler M, Bartsch P, Oster P. Age Ageing 2002; 31(1):49-57.
Correspondence: Klaus Hauer, Bethanien Krankenhaus/Geriatrisches Zentrum an der Universitat Heidelberg, Rohrbacherstr. 149 69124 Heidelberg, Germany. Abt. Sport- und Leistungsmedizin, Med. Klinik u. Poliklinik der Universitat Heidelberg Hospitalstr., Heidelberg, Germany. (email: klhauer@web.de).
BACKGROUND: intensive exercise training can lead to improvement in strength and functional performance in older people living at home and nursing home residents. There is little information whether intensive physical exercise may be applicable and effective in elderly patients suffering from the acute sequelae of injurious falls or hip surgery.
OBJECTIVE: to assess the feasibility, safety and efficacy of intensive, progressive physical training in rehabilitation after hip surgery. METHODS: DESIGN- prospective, randomized, placebo-controlled intervention study of a 3-months training intervention and a 3-months' follow-up. SETTING- physical training 6--8 weeks after hip surgery. SUBJECTS: twenty-eight (15 intervention, 13 control) elderly patients with a history of injurious falls admitted to acute care or inpatient rehabilitation because of acute fall-related hip fracture or elective hip replacement. ASSESSMENT- progressive resistance and functional training to improve strength and functional performance.
RESULTS: no training-related medical problems occurred in the study group. Twenty-four patients (86%) completed all assessments during the intervention and follow-up period. Adherence was excellent in both groups (intervention: 93, 0[plus minus]13, 5% versus control: 96, 7[plus minus]6, 2%). Training significantly increased strength, functional motor performance and balance and reduced fall-related behavioral and emotional problems. Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training. Patients in the control group showed no change in strength, functional performance and emotional state during intervention and follow-up.
CONCLUSIONS: progressive resistance training and progressive functional training are safe and effective methods to increase strength and functional performance during rehabilitation in patients after hip surgery and a history of injurious falls. Because part of the training improvements were lost after stopping the training, a continuing training regime should be established.
Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers.
- Hyndman D, Ashburn A, Stack E. Arch Phys Med Rehabil 2002; 83(2):165-170.
Correspondence: Rehabilitation Research Unit, University of Southampton, Southampton, ENGLAND (email: dorit_@hotmail.com).
OBJECTIVES: To describe the frequency and circumstances of falls among a community sample of people with stroke and to compare characteristics of fallers and nonfallers. METHODS: DESIGN- Cross-sectional, observational study. SETTING- Community. PARTICIPANTS- Forty-one community-dwelling people with stroke (26 men, 15 women; mean age, 69.7 +/- 11.6y), of which 23 had right-hemisphere infarction, 16 left-hemisphere infarction, and 2 had a brainstem lesion. Time since onset of stroke ranged from 3 to 288 months (mean, 50mo). INTERVENTIONS- Not applicable. MAIN OUTCOME MEASURES- Standardized tests were used to measure mobility, upper limb function, activities of daily living (ADL ability), and mood. Information about fall events was collected by using a questionnaire.
RESULTS: Twenty-one participants (50%) were classed as fallers, of whom 10 had fallen repeatedly. No significant differences were found between fallers and nonfallers on any of the measures used. However, those who had 2 or more falls (n = 10) had significantly reduced arm function (P = .018) and ADL ability (P = .010), compared with those who had not fallen or experienced near falls (n = 5). Loss of balance, misjudgment, and foot dragging during walking, turning, and sit to stand were reported by fallers as the suspected causes and activities leading to falls.
CONCLUSIONS: The high risk of falling among people with stroke was evident in this community-based sample. Repeat fallers had greater mobility deficits and significantly reduced arm function and ADL ability than those who did not report any instability.
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Occupational accidents aboard merchant ships.
- Hansen HL, Nielsen D, Frydenberg M. Occup Environ Med 2002; 59(2):85-91.
Correspondence: HL Hansen, Institute of Maritime Medicine, Esbjerg, Denmark. (email: hlhansen@dadlnet.dk).
OBJECTIVES: To investigate the frequency, circumstances, and causes of occupational accidents aboard merchant ships in international trade, and to identify risk factors for the occurrence of occupational accidents as well as dangerous working situations where possible preventive measures may be initiated.
METHODS: The study is a historical follow up on occupational accidents among crew aboard Danish merchant ships in the period 1993-7. Data were extracted from the Danish Maritime Authority and insurance data. Exact data on time at risk were available.
RESULTS: A total of 1993 accidents were identified during a total of 31 140 years at sea. Among these, 209 accidents resulted in permanent disability of 5% or more, and 27 were fatal. The mean risk of having an occupational accident was 6.4/100 years at sea and the risk of an accident causing a permanent disability of 5% or more was 0.67/100 years aboard. Relative risks for notified accidents and accidents causing permanent disability of 5% or more were calculated in a multivariate analysis including ship type, occupation, age, time on board, change of ship since last employment period, and nationality. Foreigners had a considerably lower recorded rate of accidents than Danish citizens. Age was a major risk factor for accidents causing permanent disability. Change of ship and the first period aboard a particular ship were identified as risk factors. Walking from one place to another aboard the ship caused serious accidents. The most serious accidents happened on deck.
CONCLUSIONS: It was possible to clearly identify work situations and specific risk factors for accidents aboard merchant ships. Most accidents happened while performing daily routine duties. Preventive measures should focus on workplace instructions for all important functions aboard and also on the prevention of accidents caused by walking around aboard the ship.
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Why teenagers owning a bicycle helmet do not use their helmets.
- Lajunen T, Rasanen M. J Safety Res 2001; 32(3): 323-332.
Correspondence: Timo Lajunen, Department of Psychology, Middle East Technical University, ODTU 06531, Ankra, TURKEY (email: timo@metu.edu.tr).
BACKGROUND:Recent reports about bicycle helmet wearing indicate that the number of helmet users is very small among teenagers.
OBJECTIVES: The objective of this prevalence study was to investigate why teenagers do not use a bicycle helmet even if they have one.
METHODS: Data were collected at two schools in Helsinki, Finland. High school students (N=965) completed a questionnaire about their cycling habits and bicycle helmet use.
RESULTS:A student's parents' positive attitude to bicycle helmet use was the strongest predictor of having a helmet. Analyses of responses given by bicycle helmet owners showed that having friends who use a helmet is strongly related to a student's decision to wear a helmet. In addition, parents' positive opinion of helmet wearing predicted helmet wearing frequency.
DISCUSSION: The present study shows that the most efficient way of increasing bicycle-helmet-wearing among students is to influence peer opinions and to inform students parents about the safety benefits of bicycle helmets.
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No reports this week
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Drowning and near-drowning in Northern Territory children.
- Edmond KM, Attia JR, Deste CA, Condon JT. Med J Aust 2001; 175(11-12):605-608.
Correspondence: Karen Edmond, Territory Health Services, Casuarina, NT, AUSTRALIA (email: karen.edmond@lshtm.ac.uk).
OBJECTIVE: To compare incidences of drowning for children in the Northern Territory (NT) with those in Queensland and the rest of Australia.
METHODS: DESIGN: Descriptive, retrospective, population-based analysis of death and hospitalization data for drowning and near-drowning. SETTING AND PARTICIPANTS: Children aged 0-14 years resident in Australia from 1983 to 1998. MAIN OUTCOME MEASURES: Age-standardized average annual incidence of drowning (1983-1998) and near-drowning (1994-1997) in children aged 0-4 and 5-14 years in the NT, Queensland and the rest of Australia.
RESULTS: The average annual incidence of drowning and near-drowning from 1994 to 1997 for children aged 0-4 years in the NT (67.82 per 100,000) was significantly higher than for Australia (24.45 per 100,000) (incident rate ratio [IRR], 2.77; 95% CI, 1.40-4.91) and for Queensland (32.55 per 100,000) (IRR, 2.13; 95% CI, 1.05-3.94). The proportion of children aged 0-4 years drowning or near-drowning in swimming pools from 1994 to 1997 was also significantly higher in the NT (83%) than Australia (64%) (difference, 0.19; 95% CI, 0.086-0.30) and Queensland (65%) (difference, 0.18; 95% Cl, 0.069-0.29). From 1983 to 1998, the incidence of drowning in NT children aged 0-4 years increased by 0.4% per year (IRR, 1.004; 95% Cl, 0.994-1.070), compared with a 5.0% reduction per year (IRR, 0.950; 95% Cl, 0.937-0.963) in Australian children.
CONCLUSIONS: The incidences of drowning and near-drowning in the NT are higher than in the rest of Australia and show no significant decrease. The NT should improve its measures for prevention of childhood drowning.
Horse-related injuries in children.
- Holland AJ, Roy GT, Goh V, Ross FI, Keneally JP, Cass DT. Med J Aust 2001; 175(11-12):609-612.
Correspondence: Andrew Holland, Department of Academic Surgery, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, The University of Sydney, NSW, AUSTRALIA (email: AndrewH3@chw.edu.au).
OBJECTIVES: To identify the frequency, spectrum and outcome of horse-related injuries in children.
METHODS: DESIGN AND SETTING- Retrospective case series of horse-related injuries in children admitted to the Children's Hospital at Westmead (CHW) from January 1988 to December 1999, the John Hunter Children's Hospital (JHCH) from January 1991 to December 1997 and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999. MAIN OUTCOME MEASURES- Circumstances of injury; helmet use; adult supervision; type and number of injuries identified.
RESULTS: 232 children were admitted with horse-related trauma, 97 to the CHW over 12 years and 135 to JHCH over seven years, with one death at each hospital. There were six deaths reported to the NPTD Registry over 12 years. The median age was 11 years (range, 1-17). Girls accounted for 65% of those injured and 75% of children were injured while riding. Falls caused the injury in 76.3% of cases. Head and upper-limb trauma accounted for 216 of the injuries (73%). Five out of six children with severe head injuries died. In the CHW group, helmet use was documented in only 24 riders (38%) and adult supervision in 22 (22.9%).
CONCLUSIONS: Horse-related trauma accounts for a considerable number of deaths and injuries in children in NSW. The use of a Standards-approved helmet for riding or horse-related activities might have decreased the severity of head injuries.
Diving accidents in sports divers in Orkney waters.
- Trevett AJ, Forbes R, Rae CK, Sheehan C, Ross J, Watt SJ, Stephenson R. Scott Med J 2001; 46(6):176-177.
Correspondence: A.J. Trevett, Heriot Watt University Dive Unit, ICIT Stromness, SCOTLAND (email: trevett@dial.pipex.com).
Scapa Flow in Orkney is one of the major world centers for wreck diving. Because of the geography of Orkney and the nature of the diving, it is possible to make relatively accurate estimates of the number of dives taking place. The denominator of dive activity allows the unusual opportunity of precise calculation of accident rates. In 1999, one in every 178 sports divers visiting Orkney was involved in a significant accident, in 2000 the figure was one in 102. Some of these accidents appear to have been predictable and could be avoided by better education and preparation of visiting divers.
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Cervical Spine Injuries in Patients 65 Years Old and Older: Epidemiologic Analysis Regarding the Effects of Age and Injury Mechanism on Distribution, Type, and Stability of Injuries.
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Lomoschitz FM, Blackmore CC, Mirza SK, Mann FA. Am J Roentgenol 2002; 178(3): 573-577.
FM Lomoschitz, Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
OBJECTIVE. Our objective was to describe types and distribution of cervical spine injuries in elderly patients in regard to causative trauma mechanism and patient age.
MATERIALS AND METHODS. The distribution and type of 225 cervical spine injuries in 149 consecutive patients 65 years old and older over a 5-year interval were retrospectively assessed. For each patient, initial admission imaging studies were reviewed, and injuries were classified. Trauma mechanism (falls from standing or seated height vs higher energy mechanisms) and initial clinical and neurologic status were recorded. Data were correlated according to patients' age (65-75 years and >75 years) and causative trauma mechanism.
RESULTS. Ninety-five (64%) of 149 patients had upper cervical spine injuries. Fifty-nine (40%) of 149 patients had multilevel injuries. Main causes for cervical spine injuries were motor vehicle crashes in "young elderly" (65-75 years old; 36/59, 61%) and falls from standing or seated height in "old elderly" (>75 years old; 36/90, 40%). Fracture patterns at risk for neurologic deterioration were common (>50%), even in the absence of acute myelopathy or radiculopathy. Patients older than 75 years, independent of causative mechanism, and patients who fell from standing height, independent of age, were more likely to have injuries of the upper cervical spine (p = 0.026 and p = 0.006, respectively).
CONCLUSION. Cervical spine injuries in elderly patients tend to involve more than one level with consistent clinical instability and commonly occur at the atlantoaxial complex. Old elderly patients and patients who fall from standing height are more prone to injuries of the upper cervical spine.
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Previous convictions or accidents and the risk of subsequent accidents of older drivers.
- Daigneault G, Joly P, Frigon JY. Accid Anal Prev 2002; 34(2):257-261.
Correspondence: Genevieve Daigneault, Reseau de Sante Richelieu-Yamaska, Departement des Soins longues durees, St. Hyacinthe, Quebec, Canada. (email: gedaigneault@hotmail.com).
The over-involvement of elderly drivers in collisions has a potentially adverse effect on highway safety. The question for most experts in traffic research is whether we can predict the individual risk of accidents and which variables are the best predictors, especially for this population. For a better understanding of the elderly drivers' problems, this study aimed to describe the most common types of accidents in the elderly population of drivers living in Quebec (> or = 65 years of age). The second objective of the study was to analyse the relationship between previous accidents or convictions and the risk of subsequent accidents. The results show that: (1) elderly drivers are characterized by error accidents involving more than one car, especially at intersections, (2) prior accidents are a better predictor for accident risk than prior convictions and (3) these trends steadily increase with each age group (drivers 65 years old to 80 years or more). The results are discussed in relation to the literature on risk behavior of the elderly drivers.
Aggressive driving: a preliminary analysis of a serious threat to motorists in a large metropolitan area.
- Fakhry SM, Salaita K; Smooth Operator Aggressive Driving Task Force. J Trauma 2002; 52(2):217-223 (discussion 223-224).
SM Fakhry, Trauma Services, Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia 22042-3300, USA.
OBJECTIVE: Aggressive driving is consistently rated as the leading concern of motorists in our metropolitan area, ahead of even "drunken driving." Few objective data exist on the incidence of aggressive driving. The purpose of this study was to determine the incidence of selected aggressive driving behaviors and to establish a baseline for future interventions and research.
METHODS: Speeding, traffic signal violations ("red-light running"), and stop-sign violations were studied. Speeding data were recorded by inductance loops embedded in major roadways (n = 10). Data were collected from red-light cameras (n = 73 cameras, 82 sites) and by trained observers at intersections with traffic signals (n = 15) or stop signs (n = 15). Data included total traffic volume, numbers of violations, and each violator's speed.
RESULTS: The majority of motorists on major roadways drive at speeds exceeding the speed limit and between 40% and 80% of vehicles were traveling at 10 mph or more over the speed limit. Red-light running occurred at equivalent rates both by camera (1.5 violations/1,000 vehicles) and by observer (1.3 violations/1,000 vehicles). The absolute numbers of red-light violations were extremely high (approximately 30,000 per month), and 16% violated the signal at > 10 mph above the speed limit. The incidence of "at-speed" (i.e., without slowing) stop-sign violations was dramatic (17.5 violations/1,000 vehicles). These were confirmed by video review and represent high risk for crashes.
CONCLUSION: Aggressive driving behaviors are frequent and often include very dangerous actions. Currently available deterrents appear to have limited impact in our congested area. Inadequate resources for enforcement and limited public awareness may be partially responsible. We have adopted a multidisciplinary approach to this serious problem including public education, stepped-up enforcement, and psychological treatments.
Mortality of front-seat occupants attributable to unbelted rear-seat passengers in car crashes.
- Ichikawa M, Nakahara S, Wakai S. Lancet 2002; 359(9300):43-44.
Correspondence: Masao Ichikawa. Department of Community Health, School of International Health, Graduate School of Medicine, University of Tokyp, 7-3-1 Hongo, Bunkyo-ku 113-0033, Japan (email: masao@m.u-tokyo.ac.jp).
The risk of death of unbelted rear-seat occupants is obviously increased in car crashes. However, there is little epidemiological evidence that unbelted rear-seat occupants will also increase the risk of death of front-seat passengers. We compared risk of death and severe injury of front-seat occupants in car crashes with belted or unbelted rear-seat passengers. The risk of death of belted front-seat occupants with unbelted rear-seat passengers was raised nearly five-fold. If rear seatbelts had been used, almost 80% of deaths of belted front-seat occupants could have been avoided. Rear seatbelt use should be encouraged for the safety of all car occupants.
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Violent deaths: the hidden face of maternal mortality.
- Granja AC, Zacarias E, Bergstrom S. Brit J Obstet Gyn 2002; 109(1): 5-8.
Correspondence: AC Granja, Ministry of Health, Maputo, Mozambique.
OBJECTIVE: To review pregnancy-related deaths due to injuries, to identify the characteristics of these women and to compare the magnitude of injury-related maternal deaths to that of other causes of maternal death.
METHODS: DESIGN- A retrospective study was performed during a five-year period (1991-1995), covering deaths from injuries, including suicide, homicide and accidents in Maputo, Mozambique. SETTING- Department of Forensic Medicine at the Maputo Central Hospital, Mozambique. POPULATION- The pregnant or recently pregnant (post-abortion and postpartum) population of Maputo city, the national capital of Mozambique. Twenty-seven cases of pregnancy-related deaths caused by injuries were identified. MAIN OUTCOME MEASURES- Proportion of deaths due to homicide, suicide, and accidents in pregnant women or within 42 days after termination of pregnancy.
RESULTS: Ten cases were due to alleged homicide, nine to alleged suicide and six to alleged accident. Fifty-nine percent (16/27) of women suffering an injury-related maternal death were younger than 25 years of age. Eighty-five percent of pregnancies were less than 28 weeks of gestational age. The magnitude of the problem of violence-related maternal deaths compares with the magnitude of pregnancy-induced hypertension as the fourth cause of maternal death at Maputo Central Hospital.
CONCLUSION: The contribution of violence-related deaths to maternal mortality is significant and must not be neglected.
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