4 March 2002
Drink and drug driving: what's the skipper up to?
- Stevenson M, Palamara P, Rooke M, Richardson K, Baker M, Baumwol J. Aust N Z J Public Health 2001; 25(6):511-513.
Correspondence: Mark Stevenson, Injury Research Centre, Department of Public Health, The University of Western Australia, Crawley Australia (email: marks@dph.uwa.edu.au).
OBJECTIVES: Since the introduction of random breath testing (RBT) in Australia there has been a significant reduction in drink driving, as measured by alcohol-related crashes. In contrast, the prevalence of drug-related road fatalities is on the increase. One strategy that targets drink- and/or drug-driving is the promotion of a designated driver or 'skipper'. This paper determines to what extent the 'skipper' is driving alcohol or drug-free.
METHODS: A convenience sample of university students from The University of Western Australia completed a questionnaire that included questions on drug and alcohol use while driving as the designated 'skipper'.
RESULTS: The mean age of the 286 participants was 21 years. Among the students who reported acting as the designated 'skipper' during the past 12 months, 26% of the students drove, as the designated 'skipper,' while feeling the effects of alcohol. Similarly, 18% of students who reported using drugs drove, as the 'skipper', while feeling the effects of the drug. Multivariate analysis identified that the presence of random drug testing would act as a deterrent for drug driving while the designated 'skipper'.
CONCLUSIONS: Although three-quarters of designated 'skippers' do not drink and/or drug drive, a sizeable proportion of young drivers continue to place themselves and, more importantly, their passengers and the entire community at an elevated risk of injury. Campaigns that target the responsibility of the 'skipper' and that are included as part of drink-driving campaigns would be beneficial. It is premature to be making recommendations on random drug testing for drivers.
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Domestic fire injuries treated in New Zealand hospitals 1988-1995.
- Duncanson M, Woodward A, Langley J, Clements M, Harris R, Reid P. N Z Med J 2000; 113(1112):245-247.
Correspondence: Mavis Duncanson, Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, P.O. Box 7343, Wellington South, NEW ZEALAND (email: mduncanson@wnmeds.ac.nz).
AIM: To describe demographic features of people discharged from New Zealand hospitals following injury caused by fire and flame in domestic locations.
METHOD: Review of hospital discharge data for the years 1988-1995. A cross-sectional study was undertaken in Aotearoa, New Zealand to investigate the relationship between socioeconomic deprivation and risk of an unintentional fatal domestic fire incident. Addresses of unintentional fatal domestic fire incidents were geocoded to small area (census meshblock) level and analysed with the New Zealand index of socioeconomic deprivation.
RESULTS: From 1988-1995 there were 1493 discharges from New Zealand hospitals with injury as the result of fire and flame in domestic locations. Age-standardised hospitalisation rates for fire related injury over the period have been stable, with an overall discharge rate of 5.45 hospitalisations per 100000 person years. Male discharges exceeded female in all years (RR 1.97, 95% CI 1.73-2.14). Stratification by age indicated that discharge rates were highest among New Zealanders aged over 75 years and under fifteen years. Maori (the original people of New Zealand and the Cook Islands) discharge rates exceeded non-Maori over all age groups (RR 3.3, 95% CI 2.82-3.58). Fatal unintentional domestic fire incidents occurred disproportionately in dwellings in the most socioeconomically deprived meshblocks. Annual rates of fatal unintentional fire incidents per 100,000 households in the most deprived decile were significantly higher than rates in the least deprived decile (RR 5.6, 95%CI 1.9-16).
CONCLUSION: Strategies to prevent fire related deaths must overcome barriers to household fire safety in population groups experiencing increased risk, including the socioeconomically deprived, seniors, and ethnic minorities. Specific intervention strategies relevant to risks associated with socioeconomic deprivation include improving quality and affordability of housing; increasing prevalence of installed and functioning smoke detectors; and regulation of specific characteristics of cigarettes to reduce risk of ignition from abandoned heat sources. Maori discharge rates for fire related injury in the home are substantially higher than non-Maori in all age groups, and highlight the importance of developing culturally appropriate injury prevention strategies. Social and material determinants of injury need to be addressed through public policy, provision of quality housing and community development initiatives.
An evaluation of warning habits and beliefs across the adult life span.
- Hancock H E, Rogers W A, Fisk A D. Hum Factors 2001; 43(3): 343-354.
Correspondence: H. E. Hancock, Georgia Institute of Technology, Atlanta, USA (email: hhancock@sev-pop.gtrl.gatech.edu).
Beliefs about warnings and habits associated with reading them were assessed for 863 individuals of various ages. Information gathered for various common household products included (a) how frequently people attend to warning information, (b) the degree of risk they believe is involved during product usage, and (c) how important they believe warnings are for different product types. Also assessed were perceived helpfulness and comprehension for symbols commonly found on product labels or on signs in the environment. Respondents 55 years and older reported reading product warnings more frequently than did younger adults, although they generally perceived warnings as less important. However, no overall age-related differences were found for perceived level of risk involved in using different product types. Although older adults generally perceived symbols to be very helpful when using a particular product, their comprehension levels were poorer than those of younger adults for half of the symbols. Overall, these data suggest that adults of all ages do read warnings on a variety of product types and that they believe warning information is important. This research illustrates the importance of including older adults in usability studies during the development of warning systems, given age-related effects may be associated with some aspects of the warning processing but not others.
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Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system.
- Exadaktylos AK, Bournakas T, Eggli S, Zimmermann H, Iizuka T. Occup Med 2002; 52(1):45-48.
Correspondence: A.K. Exadaktylos, Department of Anaesthesia and Emergency Medicine, Notfallzentrum, University Hospital, Inselspital CH-3010, Bern, Switzerland (email: exaris@hotmail.com).
The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28 624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.
A prospective study of fatal occupational accidents -- relationship to sleeping difficulties and occupational factors.
- Akerstedt T, Fredlund P, Gillberg M, Jansson B. J Sleep Res 2002; 11(1):69-71.
National Institute for Psychosocial Factors and Health, Stockholm, Sweden, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
Very little is known about the association between sleep and (fatal) occupational accidents. This study investigated this relationship using register data of self-rated sleep difficulties, together with occupational and demographic characteristics. The variables were related to subsequent occupational fatal accidents. A national sample of 47 860 individuals was selected at regular intervals over a period of 20 years, and interviewed over the phone on issues related to work and health. The responses were linked to the cause of death register (suicides excluded) and the data set was subjected to a (multivariate) Cox regression survival analysis. One hundred and sixty six fatal occupational accidents occurred, and the significant predictors were: male vs. female: relative risk (RR)=2.30 with a 95% confidence interval (CI) of 1.56--3.38; difficulties in sleeping (past 2 weeks): RR=1.89 with CI=1.22--2.94; and non-day work: RR=1.63 with CI=1.09--2.45. No significant effect was seen for age, socio-economic group, hectic work, overtime (>50 h per week), or physically strenuous work. It was concluded that self-reported disturbed sleep is a predictor of accidental death at work, in addition to non-day work and male gender.
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Pedestrians who required admission to hospital after collisions with motor vehicles in Sweden from 1987 to 1994.
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Bostrom L, Nilsson B. Eur J Surg 2001; 167(11): 810-815.
Correspondence: Lennart Bostrom, Department of General Surgery, Vasteras Hospital, Sweden; (email: lennart.bostrom@ltvastmanland.se).
OBJECTIVES: To report the incidence, range of injury, medical consequences, and mortality of pedestrians in collisions with motor vehicles in Sweden.
METHODS: DESIGN- Retrospective case study. SETTING- The Swedish Hospital Discharge Register (SHDR). SUBJECTS- 8684 pedestrians in collisions with motor vehicles had a total of 12,036 episodes treated in Swedish hospitals from 1987-1994. INTERVENTIONS- Statistical analysis of the Register. MAIN OUTCOME MEASURES- Incidence of pedestrians in collisions with motor vehicles in Sweden, mortality, range of injuries, and medical consequences.
RESULTS: From 1987 to the end of 1994, a total of 8684 pedestrians were admitted to Swedish hospitals after collisions with motor vehicles. A mean of 17.6 persons were admitted/100,000 population/year. In all there were 12,036 admissions of injured pedestrians. There were 4593 men (53%) and 4091 women (47%), with a median age of 47 (range 1-100) years. The annual incidence of injured pedestrians (both men and women) decreased significantly during this period. Injuries to the extremities were commonest (39% fractures), followed by injuries to the head and neck (34%). The total number of deaths in our series of patients was 444 (5%). Of these, more than half had head injuries, 22% had fractures, and 5% abdominal or thoracic injuries.
CONCLUSIONS: The number of pedestrians in collisions with motor vehicles is low in Sweden. Injuries to the extremities were commonest, followed by injuries to the head and neck. Old people were most likely to be injured and 5% of the patients treated in hospital died.
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Stakeholder perceptions of risk in motor sport.
- Fuller CW, Myerscough FE. J Safety Res 2001; 32(3): 345-358.
Correspondence: C.W. Fuller, Scarman Centre, University of Leicester, Leicester, Leicestershire LE1 7QA, UK (email: cwf2@le.ac.uk).
BACKGROUND: Stakeholders have different reasons for their interest in the regulation of motor racing. These reasons include the provision of, for example, safety for drivers, excitement for spectators, financial success for racing teams, and a positive environment for sponsors' products and services. The acceptability/unacceptability of current risk levels in motor racing depends on these stakeholders' perceptions of risk, within the sport.
OBJECTIVES: This study assessed the risk perceptions and preferences of stakeholders through the use of structured interviews.
METHODS: Comparative data on fatal accident rates (FARs) in sport were obtained from published data. The number and type of vehicle incidents during competition were obtained from the circuit marshals' incident reports and post-race vehicle damage was assessed by visual inspection. Two hundred and three stakeholders, defined as spectators (49), race officials (69), race teams (63), and safety managers (22) were interviewed during open-wheel and closed-wheel motor racing competitions.
RESULTS: Significant differences (P < .05) were observed between stakeholders for the relative risk perception scores across five sports; however, their rank ordering of the relative risk perception scores were similar and consistent with FARs for these sports. Spectators demonstrated a reverse affiliation bias effect by overstating the relative risks of motor racing, compared to other stakeholders. All stakeholders perceived the relative risks associated with open-wheel racing to be significantly greater than closed-wheel racing and the relative risks associated with standing race starts to be significantly greater than rolling race starts. However, all stakeholders demonstrated a domain effect, and spectators and race officials also demonstrated cognitive dissonance, in their expressed preferences for the type of motor race starts. Nineteen of the 21 race team managers nominated just three motor racing circuits and 17 team managers nominated "run-off" or "drop-off" track features as presenting the greatest risk to drivers.
CONCLUSIONS: The results obtained confirm the complexities faced by governing bodies when setting acceptable levels of risk within professional sports regulations.
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The Youth Risk Behavior Surveillance System: updating policy and program applications.
- Sussman MP, Jones SE, Wilson TW, Kann L. J Sch Health 2002; 72(1):13-17.
Correspondence: Sherry E. Jones, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-33, Atlanta, GA 30341-3724, USA (email: sce2@cdc.gov).
To monitor behaviors that place adolescents at increased risk for premature morbidity and mortality, the Centers for Disease Control and Prevention developed the Youth Risk Behavior Surveillance System (YRBSS). This system measures six categories of behaviors, including behaviors that contribute to violence and unintentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and inadequate physical activity. This article summarizes how some education and health agencies and nongovernmental organizations, in collaboration with community agencies, school boards, parents, and youth, use YRBSS data to describe risk behaviors, create awareness, supplement staff development, set and monitor program goals, develop health education programs, support health-related legislation, and seek funding. Ways in which YRBSS data are distributed electronically also are summarized.
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The role of the pediatrician in preventing suicidal behavior.
- Borowsky IW. Minerva Pediatr 2002; 54(1):41-52.
Correspondence: Iris W. Borowsly, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA (email: borow004@umn.edu).
Suicidality is a serious cause of morbidity and mortality among young people. Important risk factors for suicidal behavior are mental illness, alcohol and other substance use disorders, previous suicide attempt, impulsive and/or aggressive behavior, history of abuse, and access to lethal means. Emotional well-being and connectedness to family and school act to buffer or protect young people from involvement in self-directed violence. Pediatricians can play a major role in suicide prevention by identifying emotional and behavioral problems and intervening appropriately, promoting positive parenting skills and family cohesion, and providing injury prevention education to reduce access to lethal means. As part of a comprehensive strategy to prevent youth suicidal behavior, child health professionals are uniquely positioned to promote resiliency among youth and families as well as identify and provide appropriate treatment and service coordination for risk factors before injuries occur. Adequate training is critical to ensure that pediatricians are prepared to provide effective assessment, prevention and intervention for suicidal behavior.
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Anger and aggression among drivers in three European countries.
- Parker D, Lajunen T, Summala H. Accid Anal Prev 2002; 34(2):229-235.
Correspondence: Dianne Parker, Department of Psychology, University of Manchester, UK (email: parker@fs4.psy.man.ac.uk).
Recent reports of 'road rage' in the British media give the impression that driver aggression is escalating. In order to understand this phenomenon we need to know what it is about driving that provokes motorists to feel anger and then to go on to express that anger in the form of aggression. A postal questionnaire survey of more than 2500 drivers was carried out in three European countries: Britain, Finland and the Netherlands. The study had three main aims: (a) to discover how angry, if at all, a range of situations on the road make drivers, (b) to find out how many drivers are likely to react aggressively to those situations, and (c) to investigate individual and/or cultural differences in terms of anger and/or aggressive responses among motorists. Results indicate that the same types of behaviour provoke anger and aggression in all three countries, and that traffic density may play a role.
The relationship between body weight and risk of death and serious injury in motor vehicle crashes.
- Mock CN, Grossman DC, Kaufman RP, Mack CD, Rivara FP. Accid Anal Prev 2002; 34(2):221-228.
Correspondence: Charles N. Mock, Harborview Injury Prevention and Research Center, Harborview Medical Center, Seattle, WA 98104, USA (email: cmock@u.washington.edu).
We sought to investigate the effect of increased body weight on the risk of death and serious injury to occupants in motor vehicle crashes. We employed a retrospective cohort study design utilizing data from the National Automotive Sampling System, Crashworthiness Data System (CDS), 1993-1996. Subjects in the study included occupants involved in tow-away crashes of passenger cars, light trucks, vans and sport utility vehicles. Two outcomes were analyzed: death within 30 days of the crash and injury severity score (ISS). Two exposures were considered: occupant body weight and body mass index (BMI; kg/m2). Occupant weight was available on 27263 subjects (76%) in the CDS database. Mortality was 0.67%. Increased body weight was associated with increased risk of mortality and increased risk of severe injury. The odds ratio for death was 1.013 (95% CI: 1.007, 1.018) for each kilogram increase in body weight. The odds ratio for sustaining an injury with ISS > or = 9 was 1.008 (95% CI: 1.004, 1.011) for each kilogram increase in body weight. After adjustment for potentially confounding variables (age, gender, seatbelt use, seat position and vehicle curbweight), the significant relationship between occupant weight and mortality persisted. After adjustment, the relationship between occupant weight and ISS was present, although less marked. Similar trends were found when BMI was analyzed as the exposure. In conclusion, increased occupant body weight is associated with increased mortality in automobile crashes. This is probably due in part to increased co-morbid factors in the more overweight occupants. However, it is possibly also due to an increased severity of injury in these occupants. These findings may have implications for vehicle safety design, as well as for transport safety policy.
Changes in risky driving behavior from age 21 to 26 years.
- Begg D, Langley J. J Safety Res 2001; 32(4): 491-499.
Correspondence: Dorothy Begg, Injury Prevention Research Unit, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand (email: dorothy.begg@ipru.otago.ac.nz).
OBJECTIVES: The aim of this study was to determine whether the prevalence of risky driving behavior changed between ages 21 and 26 years, among a cohort of young people.
METHODS: This study was part of the Dunedin Multidisciplinary Health and Development Study, which is a longitudinal study of a birth cohort. This study involved examining changes in the prevalence of risky driving behavior among young adults at ages 21 and 26 years. At both ages, 936 members of the cohort were administered face-to-face interviews, using a structured questionnaire that included items on a range of risky driving and thrill-seeking activities.
RESULTS: The results showed that risky driving was predominantly a male activity, but by 26 years of age, many had "matured out" of this behavior. At the same time, the desire for thrill-seeking increased among the males. Among the females, there were few significant changes between ages 21 and 26 years, but at both ages, the prevalence of risky driving and thrill-seeking was relatively low.
CONCLUSIONS: These results show that the main target population for road safety interventions aimed at reducing risky driving behavior should be young, male drivers.
A human factors commentary on innovations at railroad-highway grade crossings in Australia.
- Wigglesworth EC. J Safety Res 2001; 32(3): 309-321.
Correspondence: Eric C. Wigglesworth, Accident Research Centre, Monash University, P.O. Box 70A, Clayton, Victoria 3800, Australia (email: eric.wigglesworth@general.monash.edu.au).
BACKGROUND: In the decade 1970-1979, some 537 persons were killed in Australia in crashes between motor vehicles and trains at railway crossings.
METHODS: A study of 85 consecutive crossing deaths showed that flashing light signals provided an inadequate stimulus at busy metropolitan crossings, while field studies at rural crossings showed that many drivers behaved similarly at both active and passive crossings. This suggested the need for different signs at the two types of crossings.
RESULTS: The number of motor-vehicle occupants killed at railroad highway grade crossings in the 1990-1999 decade in Australia was 172 a reduction of 68% from the 1970-1979 total.
CONCLUSIONS: Most of this paper is devoted to the recent change in advance warning signs at passive crossings. Because of the small volumes of both road and rail traffic, it is difficult to measure the effectiveness of these or other innovations at passive crossings. The paper ends with a plea for the development of some reliable surrogate measures that can be used for this purpose.
Human performance models and rear-end collision avoidance algorithms.
- Brown T L, Lee J D, McGehee D V. Hum Factors 2001; 43(3):462-482.
Correspondence: John D. Lee, Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City 52242, USA (email: jdlee@engineering.uiowa.edu).
Collision warning systems offer a promising approach to mitigate rear-end collisions, but substantial uncertainty exists regarding the joint performance of the driver and the collision warning algorithms. A simple deterministic model of driver performance was used to examine kinematics-based and perceptual-based rear-end collision avoidance algorithms over a range of collision situations, algorithm parameters, and assumptions regarding driver performance. The results show that the assumptions concerning driver reaction times have important consequences for algorithm performance, with underestimates dramatically undermining the safety benefit of the warning. Additionally, under some circumstances, when drivers rely on the warning algorithms, larger headways can result in more severe collisions. This reflects the nonlinear interaction among the collision situation, the algorithm, and driver response that should not be attributed to the complexities of driver behavior but to the kinematics of the situation. Comparisons made with experimental data demonstrate that a simple human performance model can capture important elements of system performance and complement expensive human-in-the-loop experiments. Actual or potential applications of this research include selection of an appropriate algorithm, more accurate specification of algorithm parameters, and guidance for future experiments.
Distance perception of vehicle rear lights in fog.
- Cavallo V, Colomb M, Dore J. Hum Factors 2001; 43(3): 442-451.
Correspondence: Viola CaLaboratoire de Psychologie de la Conduite, Institut National de Recherche sur les Transports et leur Securite, Arcueil, France (email: cavallo@inrets.fr).
Perceptual difficulty is one of the main explanations given for the behavioral modifications and high accident rate associated with driving in fog. The present study investigates how fog and the characteristics of vehicle rear lights affect distance perception. Two experiments in a fog chamber (meteorological visibility range of 5-15 m) were run under conditions simulating nighttime fog. The participants gave verbal estimates of the distance (8-28 m) of vehicles simulated by rear-light arrangements. The results revealed an average increase of 60% in the perceived distance of vehicles in fog as compared with normal visibility conditions. Distance overestimation was particularly pronounced when the vehicle had only 1 fog light instead of 2 and when the lights were close together. No effect of light height was observed. These results suggest that the perception of vehicle distance in nighttime fog could be significantly improved by the presence of 2 lights with maximal spacing. Actual or potential applications of this research include vehicle rear light design.
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Effectiveness of safety measures recommended for prevention of workplace homicide.
- Loomis D, Marshall SW, Wolf SH, Runyan CW, Butts JD. JAMA 2002; 287(8): 1011-1017.
Correspondence: Dana Loomis, Department of Epidemiology, CB-7435 UNC-CH, Chapel Hill, NC 27599-7435 USA (email: Dana.Loomis@unc.edu).
BACKGROUND: Homicide is the second leading cause of death on the job for US workers. Government agencies recommend that employers prevent violence against workers by adopting interventions originally designed to prevent robbery, but the effectiveness of these interventions is unknown.
OBJECTIVES: To investigate the effectiveness of existing administrative and environmental interventions recommended for preventing workplace homicide. METHODS: DESIGN, SETTING, AND PARTICIPANTS- Population-based case-control study of North Carolina workplaces where a worker had been killed between January 1, 1994, and March 31, 1998, identified through a statewide medical examiner system (cases; n = 105) and an industry-matched random sample of workplaces at risk during the same period, selected from business telephone listings (controls; n = 210). MAIN OUTCOME MEASURE- Risk of death of a worker due to homicide.
RESULTS: Among environmental interventions, strong and consistent reductions in the risk of a worker being killed on the job were associated with bright exterior lighting (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3-1.0). Among administrative interventions, the largest beneficial effect was for staffing practices that prevented workers from being alone at night (OR, 0.4; 95% CI, 0.2-0.9). Keeping doors closed during working hours was also associated consistently with substantially reduced risk (OR, 0.4; 95% CI, 0.1-1.1) but was not statistically significant. Combinations of 5 or more administrative measures were associated with significantly lower levels of risk (OR, 0.1; 95% CI, 0.0-0.5).
CONCLUSIONS: We found evidence suggesting that eliminating solo work at night could reduce the risk of homicide for workers. Keeping doors closed and using bright exterior lighting or combinations of administrative interventions also appear to be beneficial, but there was no evidence of effectiveness for a number of other recommended measures.
The prevalence of violence investigated in a pregnant population in Sweden.
- Stenson K, Heimer G, Lundh C, Nordstrom ML, Saarinen H, Wenker A. J Psychosom Obstet Gynaecol 2001; 22(4):189-197.
National Center for Battered and Raped Women, Department of Obstetrics and Gynecology, University Hospital, Uppsala, Sweden (email: 018-230654@telia.com).
All women registered for antenatal care within a Swedish municipality during a 6-month period were assessed regarding acts of violence. The Abuse Assessment Screen was used on two occasions during pregnancy, and once between 4 and 20 weeks after delivery. The efficacy of repeated interviews was investigated, and characteristics of abused and non-abused women were compared. The participation rate was 93% (1038 women). Physical abuse by a close acquaintance or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. The lifetime prevalence of emotional, physical or sexual abuse was 19.4%. Repeated questioning increased the detection of abuse. Women abused during pregnancy reported more preceding ill-health and more elective abortions than non-abused women. Intervention against sexual violence has been on the political agenda in Sweden for several decades. Even so, physical abuse is a risk factor comparable in frequency to obstetric complications such as gestational diabetes and pre-eclampsia. Routines need to be established to make questioning about violence an integral part of the standardized screening for risk factors during pregnancy.
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