8 April 2002
Influence of a substance-abuse-prevention curriculum on violence-related behavior.
- Simon TR, Sussman S, Dahlberg LL, Dent CW. Am J Health Behav 2002; 26(2):103-110.
Correspondence: Thomas Simon, Behavioral Scientist, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA; (email: tsimon@cdc.gov).
OBJECTIVE: To test the impact of a school-based substance-abuse-prevention program, Project Towards No Drug Abuse (TND), on risk for violence.
METHODS: Logistic regression analyses tested whether victimization, perpetration, or weapon carrying differed for intervention students relative to control students within a sample of 850 continuation high school students followed over 12 months.
RESULTS: We observed a higher risk for victimization (OR=1.57) among male control students. No intervention effect was observed for female students or for perpetration among males.
CONCLUSION: The findings provide limited support for a generalization of TND's preventive effect.
Evaluation of a program to motivate impaired driving offenders to install ignition interlocks.
- Voas RB, Blackman KO, Tippetts AS, Marques PR. Proc Assoc Adv Automot Med Conf 2001; 45: 303-316. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Robert B. Voas, Pacific Institute for Research and Evaluation, Calverton, Maryland, USA.
Approximately 30,000 alcohol ignition interlocks, which prevent a drinking driver from operating a vehicle, are in use in the United States and Canada. Currently available studies indicate that interlocks reduce impaired driving recidivism while on the vehicle. However, in the United States, the practical effectiveness of these devices is limited because few offenders are willing to install them in order to drive legally. This paper reports on a study of a court policy that created a strong incentive for impaired driving offenders to install interlocks by making penalties (e.g., jail or electronically monitored house arrest) the alternative to the interlock. Comparison of the recidivism rates of offenders subject to this policy with offenders in similar, nearby courts not using interlocks indicated that the policy was producing substantial reductions in DUI recidivism.
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Setting priorities in injury prevention: the application of an incidence based cost model.
- Mulder S, Meerding WJ, Van Beeck EF. Inj Prev 2002; 8(1):74-78.
Correspondence: Saakje Mulder, Consumer Safety Institute, P.O. Box 75169, 1070 AD, Amsterdam, The Netherlands (email: s.muolder@consafe.nl).
OBJECTIVES: To make detailed calculations on the direct medical costs of injuries in the Netherlands to support priority setting in prevention.
METHODS: A computerised, incidence based model for cost calculations was developed and incidence figures derived from the Dutch Injury Surveillance System (LIS) which provides national estimates of the annual number of patients treated at an emergency department. A comprehensive set of cost elements (that is, health care segments) was obtained from health care registrations and a LIS patient survey. Patients were assigned to specific groups based on LIS characteristics (for example, age, injury type). Average costs per patient group were calculated for each cost element and total costs estimated by adding costs for all patient groups.
RESULTS: The direct costs of injury average 2000 guilders per injury patient attending an emergency department. Home and leisure injuries account for over half of the costs, although cost per patient is highest for motor vehicle injuries. Injuries to the lower extremities account for almost half of the total costs and are incurred mainly in the home or recreation. Motor vehicle crashes are the major cause of head injuries.
CONCLUSIONS: The model permits continuous and detailed monitoring of injury costs. Estimates can be compiled for any LIS patient group or injury subcategory. The results can be used to rank injuries for prioritisation of prevention by injury categories (for example, traffic, home, or leisure), or by specific scenarios (for example, fall at home).
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No reports this week
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Pedestrians who required admission to hospital after collisions with motor vehicles in Sweden from 1987 to 1994.
- 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.
CONCLUSION: 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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No reports this week
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Ocular trauma from paintball-pellet war games.
- Mason JO 3rd, Feist RM, White MF Jr. South Med J 2002; 95(2): 218-222.
Correspondence: John O. Mason, III, Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, 35233, USA.
BACKGROUND: We studied ocular injuries and visual outcome after blunt trauma from paintball pellets.
METHODS: We retrospectively reviewed cases of ocular injury from paintball pellets occurring over 32 months.
RESULTS: Ten cases of ocular injury from paintball pellets were recorded. Most patients (9) were injured at home or at a friend's home; only 1 was injured at a war game facility. Six patients had surgery. Final visual acuity was 20/25 or better in 6 patients, 20/30 to 20/50 in 2 patients, 20/60 to 20/100 in 2 patients, and 20/200 in 1 patient. Traumatic maculopathy and epiretinal membrane formation were determinants of worse final visual acuity.
CONCLUSIONS: Paintball pellet ocular injuries occur more frequently at home than at war game facilities. Advanced surgical techniques offer decreased ocular morbidity and improved visual acuity. Decreasing visual morbidity from paintball pellets requires public education, proper product labeling, and packaging of eye protection with all paintball-related products.
Ocular paintball injuries.
- Fineman MS. Curr Opin Ophthalmol 2001; 12(3):186-190.
Correspondence: Mitchell S. Fineman, MD, Retina Vitreous Consultants, 3501 Forbes Avenue, Suite 500, Pittsburgh, PA 15213, USA.
Paintballs are small (17 mm in diameter) gelatin capsules filled with nontoxic, water-soluble paint and are designed to explode on contact with an object. They were initially used by foresters to mark trees for harvest and were later adapted for use in "war games," an outdoor recreational activity in which two competing teams attempt to capture their adversary's flag while shooting one another with paintballs fired from CO2-powered guns. When a paintball strikes a player it releases the paint and marks the player as "hit" and out of the game. The CO2-powered guns, also called paintball markers, fire the paintballs at speeds up to 300 feet/s.
Paintball sport-related ocular injuries represent an increasing problem as the popularity of the sport increases and the number of participants grows. Although eye protective devices designed specifically for paintball sports are extremely effective in preventing such injuries, the failure to properly wear these devices has resulted in an alarming number of severe ocular injuries. Recent trends have indicated that an increasing percentage of paintball sport-related ocular injuries have occurred in unsupervised, noncommercial settings (i.e., backyard games) where the use of eye protective devices is not required. Paintball industry standards for eye protection have recently been developed and should be implemented for all participants.
Injury During Contact With Horses: Recent Experience With 75 Patients at a Level I Trauma Center
- Griffen M, Boulanger BR, Kearney PA, Tsuei B, Ochoa J. South Med J 2002; 95(2): 441-445.
Correspondence: Bernard R. Boulanger, Department of Surgery, University of Kentucky, USA (email: bboul@email.uky.edu).
BACKGROUND: The objective of this study was to examine equine-related trauma at a trauma center servicing a region in which there is significant contact between horses and humans.
METHODS: Data were collected on all patients admitted to the University of Kentucky Medical Center from January 1994 to December 1998 for treatment of horse-related injuries.
RESULTS: Seventy-five patients were admitted to our center after injuries due to contact with horses (0.75% of all trauma admissions). There were 42 men (55%). The mean age was 37 years (range, 3 to 81 years). The majority of patients (67/75) were injured during recreational activities, and most fell or were thrown (40/75). Only 14% of patients were wearing helmets. The most common injuries were extremity fractures and head injuries, but thoracic and abdominal injuries were not rare. Of the 75 patients, 34 required surgery. Five patients (6.7%) died, all of head injury. During the study period, 11 people died in Kentucky due to contact with horses.
CONCLUSIONS: Injury due to contact with horses is uncommon even at a center servicing a region with a large equine population. However, injuries are often serious and lead to significant morbidity and occasional mortality. Prevention of death from horse-related trauma is synonymous with prevention of head injury.
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Comparison of two methods for assessing injuries among preschool children.
- Fonseca SS, Victora CG, Halpern R, Lima R, Barros FC. Inj Prev 2002; 8(1):79-82.
Correspondence: Sylvia Fonseca, Department of Maternal and Child Health, Federal University of Pelotas, Brazil (email: silviasf@terra.com.br).
BACKGROUND: Most studies of injuries use health services records or recall rather than prospective methods, and there is no information on how these different methods compare. This study was aimed at comparing a report (retrospective) with a diary (prospective) for recording childhood injuries.
METHODS: The study included 1,273 and 620 children, the retrospective and prospective subsamples, respectively, from a population based birth cohort in Pelotas, southern Brazil. The reported incidence of injuries in the preceding month were compared with those reported over month by diary (prospective study).
RESULTS: Both methods were well accepted and 92.7% of the diaries were returned. One or more injuries per child month were reported for 20.8% (retrospective) and 48.4% (prospective) of the children. The total number of reported injuries for the 620 children were 145 (retrospective) and 715 (prospective). Using the prospective method as the gold standard, the retrospective method detected only 20.2% of all injuries. Under-reporting did not vary significantly with maternal education, but was greater (51.8%) for injuries requiring medical care than for those managed at home (18.3%; p=0.003).
CONCLUSIONS: The diary was well accepted and resulted in higher incidences of reported injuries than the recall method, particularly for injuries that did not require medical care. Use of this method should be promoted to provide more complete epidemiological information to guide preventive strategies.
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State Injury Indicators Report.
- Davies M, Connolly A Horan J. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2001.
Full text available online in Adobe Acrobat format: ( http://www.stipda.org/s-pubs/inj-ind.pdf ).
The Centers for Disease Control, Council of State and Territorial Epidemiologists, and State and Territorial Injury Prevention Directors' Association are pleased to bring you the first (US) State Injury Indicators Surveillance Report. The data -- provided by 12 state health departments that voluntarily participated in the surveillance effort -- represent an important step toward routine surveillance and reporting of injury indicators in all states. The indicators were calculated by using state-level data from death certificates, hospital discharge records, and data from several surveillance systems.
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No reports this week
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Child safety seats: do doctors know enough?
- McKay MP, Curtis LA. Am J Emerg Med 2002; 20(1):32-34.
Correspondence: Mary Pat McKay, MCP/Hahnemann School of Medicine, Department of Emergency Medicine, Center for Violence and Injury Control, Allegheny General Hospital, Pittsburgh, PA 15212, USA (email: mmckay@wpahs.org).
The purpose of the study was to assess the knowledge of physicians in training about child safety seats and to test the effectiveness of a brief didactic session on improving that knowledge. Pre-post quasi experimental design was used. A 25-minute didactic session on the need for and appropriate use of child safety seats was presented. Subjects took a multiple-choice test before and immediately after the lecture. Tests were scored and baseline differences as well as differences in score improvements were analyzed by subgroup. Basic fund of knowledge was poor with a mean pretest score of 54%. Mean posttest score improved to 81.5% (P <.001). The only significant difference among groups was that pediatric residents had higher pretest scores (65%, P =.011), than their colleagues in other specialties. Medical students and residents in many specialties, including emergency medicine, have little baseline knowledge on the appropriate use of child safety seats. Knowledge can be improved with a brief didactic session.
The effect of road improvements on motor vehicle crash injury and mortality in a developing country.
- Keough L, Rinkle J, Hage R, Brown LH, Hunt RC. Proc Assoc Adv Automot Med Conf 2001; 45: 369-375. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Lisa Keough, St. George's University, School of Medicine, Grenada, West Indies.
The developing island-nation of Grenada undertook a major road improvement project between 1995 and 1998. In order to determine the effect of those improvements on crash injury and mortality, we reviewed the number of crash-related injuries and deaths for the years 1994 and 1999. After the road improvements, the proportion of crashes that resulted in injury decreased from 22% to 15%. The raw number of crashes (818 vs. 1233), deaths (4 vs. 12) and deaths per 100,000 population (4.1 vs. 11.9) increased, but the proportion of crashes that resulted in death (0.5% vs. 0.7%) remained effectively unchanged.
Crash protection for children in ambulances.
- Bull MJ, Weber K, Talty J, Manary M. Proc Assoc Adv Automot Med Conf 2001; 45: 353-367. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Marilyn J. Bull, Department of Pediatrics, Developmental Pediatrics, Indiana University School of Medicine, Indianapolis, IN USA.
The objectives of the study were to determine the most effective and reliable means of restraining children on an ambulance cot and to develop recommended field procedures for emergency medical service providers. A series of crash tests at 48 km/h were conducted using convertible child restraints, car beds, and harness systems tested with 3-year, infant, and 6-year size dummies. Belt configuration and backrest position were varied. A new cot and fastener system significantly improved restraint performance over older systems previously tested. A two-belt attachment with elevated cot backrest was found to be the method with the least performance variability for securing either a convertible child restraint or a car bed. It was concluded that children who weigh up to 18 kg, fit in a convertible child restraint, and can tolerate a semi-upright seated position can be restrained in a convertible child restraint secured with two belts to an ambulance cot. Infants who must lie flat can be restrained in a car bed modified for two seatbelt paths and secured to a cot. In each case, the cot backrest must be elevated, and the cot and anchor system must be crashworthy. None of the harness configurations tested proved to be satisfactory, but an effective system could be developed by following accepted restraint design principles.
The role of driver distraction in crashes: An analysis of 1995-1999 Crashworthiness Data System data.
- Stutts JC, Reinfurt DW, Rodgman EA. Proc Assoc Adv Automot Med Conf 2001; 45: 287-301. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
University of North Carolina, Highway Safety Research Center, Chapel Hill, North Carolina.
Five years (1995-1999) of national Crashworthiness Data System (CDS) data are analyzed to determine the role of driver distraction in traffic crashes and the specific sources of this distraction. Results show that 8.3 percent of the drivers were distracted at the time of their crash; after adjustment for the large percentage of drivers with unknown distraction status, the percentage rose to 12.9 percent. The most frequently cited sources of driver distraction were persons, objects or events outside the vehicle (29.4% of distracted drivers), adjusting the radio, tape or CD player (11.4%), and other occupants in the vehicle (10.9%). Other specific distractions (moving objects in vehicle, other objects brought into vehicle, adjusting vehicle or climate controls, eating and drinking, cell phones, and smoking) were each cited in only one to four percent of the cases. The likelihood of being distracted and the source of distraction varied by driver age but not by gender. Results are discussed in light of the limitations inherent in the CDS and other crash data, and the need for expanded data collection initiatives.
Booster seats: A community-based study of installation and use by parents and caregivers.
- Stepanski BM, Upledger Ray L, Nichols L. Proc Assoc Adv Automot Med Conf 2001; 45: 37-48. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Barbara M. Stepanski, Division of Emergency Medical Services, County of San Diego Health and Human Services Agency, San Diego, California.
This paper describes characteristics of child safety seat misuse among attendees at 41 inspections held between February 1999 - April 2001 in San Diego County, CA. Standardized criteria were assessed by certified technicians. These 41 events consisted of 988 inspections for proper installation and adjustment. 963 had a determined seat type (rear-facing, forward facing, belt positioning boosters, shield boosters, other restraint, vehicle safety belts). Each seat type had specific criteria for misuse ranging from 3 to 15 measures. 95.6% had at least one error, which could reduce the seat's protection of its occupant from injury in a crash.
Exposure-based death rates for child motor vehicle occupants.
- Anderson CL, Agran PF, Winn DG. Proc Assoc Adv Automot Med Conf 2001; 45: 95-105. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Craig Anderson, Health Policy and Research, University of California, Irvine, Irvine, California, USA
We used reports of additional occupants on trips from the Nationwide Personal Transportation Survey to estimate travel in cars and trucks for children age nine years and younger. For children age five to nine years these indirect estimates were 98% of directly reported travel. Using this travel data, the death rate was 4.0 per billion km of travel for children less than age one year and decreased to 1.7 for children age nine years. Infants have a higher exposure-based death rate for travel in cars and trucks than older children despite greater restraint use.
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Injury and violence prevention: a primer.
- Gielen AC. Patient Educ Couns 2002; 46(3):163-168.
Correspondence: Andrea C. Gielen, Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, 21205, Baltimore, MD, USA (email: agielen@jhsph.edu).
Unintentional and intentional injuries cause a great deal of human suffering throughout the world. They exact a huge toll on societies in terms of mortality, years of potential life lost, disability, and health care costs. The good news is that great strides have been made in understanding the causes of injuries and how to prevent them. Using seat belts and car seats, installing air bags in cars, replacing dangerous playground equipment, enforcing drinking and driving laws are but a few examples of modifying behavior, products, and environments to reduce injury risk. This paper provides an overview of the science of injury control and selected examples of how professionals in the field of patient education and counseling can contribute to enhancing the safety of the public.
Relation between racial discrimination, social class, and health among ethnic minority groups.
- Karlsen S, Nazroo JY. Am J Public Health 2002; 92(4):624-31.
Saffron Karlsen, Department of Epidemiology and Public Health, University College 1-19 Torrington Pl, London WC1E 6BT, England (email: s.karlsen@public-health.ucl.ac.uk).
OBJECTIVES: This study explored associations between racism, social class, and health among ethnic minority people in England and Wales.
METHODS: We conducted a series of regression analyses on cross-sectional data from the Fourth National Survey of Ethnic Minorities to explore the relation between different indicators of racism and health and household occupational class.
RESULTS: Marked independent associations existed between reported experience of racism and perceptions of Britain as a "racist society," household social class, age, sex, and various mental and physical health indicators. These associations showed reasonable consistency across the different ethnic groups.
CONCLUSIONS: The different ways in which racism may manifest itself (as interpersonal violence, institutional discrimination, or socioeconomic disadvantage) all have independent detrimental effects on health, regardless of the health indicator used.
Effect of the incident at Columbine on students' violence- and suicide-related behaviors.
- Brener ND, Simon TR, Anderson M, Barrios LC, Small ML. Am J Prev Med 2002; 22(3):146-150.
Correspondence: Nancy D. Brener, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (email: nad1@cdc.gov).
BACKGROUND: This study examined the impact that the violent incident at Columbine High School may have had on reports of behaviors related to violence and suicide among U.S. high school students.
METHODS: Nationally representative data from the 1999 Youth Risk Behavior Survey (YRBS) were analyzed using logistic regression analyses.
RESULTS: Students who completed the 1999 YRBS after the Columbine incident were more likely to report feeling too unsafe to go to school and less likely to report considering or planning suicide than were students who completed the 1999 YRBS before the incident.
CONCLUSIONS: These results highlight how an extreme incident of school violence can affect students nationwide.
Patterns of violence in Karachi, Pakistan.
- Chotani HA, Razzak JA, Luby SP. Inj Prev 2002; 8(1):57-59.
Habib Chotani, UPMC McKeesport, Department of Medicine, 1500 Fifth Ave., McKeesport, PA 15132-2482 USA (email: chotanih@msx.upmc.edu).
OBJECTIVES: Government reports on violence in developing countries are almost universally based upon police data, which are typically incomplete and unreliable. Violence in Karachi was evaluated using ambulance service, not police, records.
METHODS: Setting: Karachi, Pakistan. The study was based on a case series of persons suffering from intentional injuries and transported by Edhi, the largest emergency service in Karachi, between October 1993 and January 1996. Main outcome variables were injury and death rates.
RESULTS: Edhi Ambulance Service transported 4,091 intentionally injured persons during the 29 month period from October 1993 to January 1996. Ninety five per cent (n=3,864) were males; 74% (n=2,823) were 20 to 40 years of age, and 2,400 (58%) died before reaching the hospital. Firearms were the most common mode of injury (n=3,396, 83%). Forty six per cent (n= 1,828) of violent injuries occurred in four neighborhoods of Karachi--22% in Korangi (n= 884) and 8% each in Orangi (n=337), Malir Colony (n=307), and Nazimabad (n=300). On the 32 days when a political strike was called, more people were injured (mean = 10.4 v 5.0 persons, p=0.01) and killed (mean 6.6 v 3.9 persons, p <0.01) compared with days without a political strike.
CONCLUSION: Violence is a major public health problem in Karachi, affecting predominantly wage earners. At least some of the violence is rooted within the political system. Detailed study of the causes of violence that explains the role that political and ethnic tensions play, may suggest strategies to lessen the toll of violence.
A statewide survey of domestic violence screening behaviors among pediatricians and family physicians.
- Lapidus G, Cooke MB, Gelven E, Sherman K, Duncan M, Banco L. Arch Pediatr Adolesc Med 2002; 156(4):332-336.
Correspondence: Gary Lapidus, Injury Prevention Center, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106 USA (email: glapidu@ccmckids.org).
OBJECTIVE: To assess rates of previous domestic violence (DV) training, current screening practices, and barriers to screening among Connecticut pediatric primary care physicians.
METHODS: DESIGN: Self-administered mail survey. SETTING: State of Connecticut. PARTICIPANTS: Pediatricians and pediatric care-providing family practice physicians (N = 903).
RESULTS: The response rate was 49% (n = 438). The demographic characteristics of the response sample were as follows: 70% male, 76% older than 40 years, 84% white, 87% in private practice, and 64% in suburban practice. Only 12% of the physicians reported routinely screening for DV at all well-child care visits, 61% reported screening only selective patients, and 30% said they did not screen for DV at all. Sixteen percent of the physicians reported having an office protocol for dealing with victims of DV. Respondents practicing in an urban setting were significantly more likely to screen routinely for DV than those practicing in a suburban setting (odds ratio, 1.77; 95% confidence interval, 1.12-2.79). Prior DV training was the strongest predictor of routine screening (odds ratio, 5.17; 95% confidence interval, 3.13-8.56). In fact, respondents with previous training made up 64% of those who routinely screened for DV.
CONCLUSIONS: Only a minority of Connecticut pediatric care physicians routinely screen mothers for DV. Primary care physicians with education and training about DV are screening at higher rates than physicians with no education and training. Pediatric physicians need training, protocols, and best-practice models on how to identify and intervene with families experiencing DV.
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