27 May 2002
Review: Drugs and Traffic Collisions
- Vingilis E, Macdonald S. Traffic Injury Prev 2002; 3(1):1-11.
Correspondence: Scott Macdonald, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, London, Ontario, N6G 4X8 Canada (email: scotm@uwo.ca)
Three categories of drugs, and specific commonly used drug subcategories are examined in this paper: depressants (benzodiazepines, methadone), stimulants (cocaine), and hallucinogens (cannabis). Descriptive, epidemiological studies on the incidence of drugs in driving populations show that cannabis or benzodiazepines are the most common drugs detected in most industrialized countries. The large number of experimental studies on the impact of various drugs on psychomotor performance show that the effects of the three categories of drugs and specific drugs with each category vary considerably. Some psychoactive drugs within these three categories have the potential to alter the skills required for driving.
Analytic epidemiological studies, where comparison groups are utilized, provide the best information on the role of drugs in traffic crashes. The most rigorous epidemiological studies have been conducted on benzodiazepines and traffic crashes. Generally, benzodiazepine users are up to 6 times more likely to be in crashes than non-users, depending on the study; however, the effects can be mitigated by altering the mode and type of prescriptions. In terms of the other types of drugs, the research is less rigorous and has not clearly shown they are associated with increased rates of traffic crashes.
Alcohol's contribution to fatal injuries: A report on public perceptions.
- Girasek DC, Gielen AC, Smith GS. Ann Emerg Med 2002; 39(6): 622-630.
Correspondence: Deborah C. Girasek, Department of Preventive Medicine & Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room A2063, Bethesda, MD 20814 USA; (email: DGirasek@usuhs.mil).
OBJECTIVES: We determine whether members of the public understand that alcohol contributes to each of the leading causes of unintentional-injury death in the United States and not just to motor vehicle-related fatalities. Public opinions of selected alcohol control policies were also assessed.
METHODS: We used a national telephone survey of 943 adults, who were selected by random-digit dialing techniques. Respondents' mean estimates of alcohol's involvement in fatal injuries were compared with published data from a meta-analysis of medical examiner data.
RESULTS: The study population accurately estimated the proportion of fatal fall, drowning, and poisoning victims who were legally drunk when they died. Respondents overestimated the proportion of drivers killed in motor vehicle crashes who were intoxicated and underestimated the proportion of fire/burn victims. Fifty-seven percent of participants endorsed the myth that alcohol intoxication is protective against injury in the event of a motor vehicle crash. Participants were divided over whether increasing the legal drinking age to 21 had resulted in fewer injury deaths. Seventy-eight percent of participants did not believe that raising alcohol taxes would reduce fatal injuries. A majority (58%) of respondents supported taking blood alcohol levels on all "seriously injured" patients brought to the hospital.
CONCLUSIONS: This report suggests that public awareness of alcohol's contribution to the breadth of the injury problem in the United States is high. Conversely, public understanding of whether prevention strategies have proven to be effective is poor. Emergency medicine practitioners can serve as credible sources of more accurate information for patients and the community at large.
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Priorities for child safety in the European Union: Agenda for action.
- Vincenten J, Michalsen A. Injury Control Safety Promo 2002; 9(1): 1-8.
Correspondence: Joanne Vincenten, European Consumer Safety Association, European Child Safety Alliance, Amsterdam, THE NETHERLANDS; (email: j.vincenten@consafe.nl).
BACKGROUND: Children have a right to safety, but this is still not optimally implemented throughout Europe. Furthermore, no joint commitment to change has been undertaken by the European Parliament, European Commission, or collectively by the EU Member States. This paper summarizes a White Book presented to governments entitled "Priorities for Child Safety in the European Union," requesting concerted action.
METHODS: The report is based on statistics provided by the World Health Organization as well as by research centers in the European Union Member States. Original research was contracted to the Mori Social Research Institute in 2001 in order to obtain an update on parents' and leading government officials' views on child safety.
RESULTS: The leading causes of child injury deaths in the EU (road accidents, 48%, other unintentional 16%, intentional 13%, drowning 11%, fires 5%, falls 5%, and poisoning 2%) are the same in all Member States, but it is the distribution of injuries within each category that determines the unique profile of each. Adopting a number of best practices that have been identified for each injury area can reduce these injury deaths. Survey results show that the parents of children in Europe are concerned regarding child injuries, while government officials are still not making strong commitments to advance safety for children. A review of EU standards and legislation related to child safety shows that these are still incomplete and require changes.
CONCLUSIONS: A joint commitment to reduce child accidental injury deaths in the EU is advocated, with a clear set of recommendations to act upon. (Copyright © 2002 Swets & Zeitlinger)
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No reports this week
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Assessing homeland chemical hazards outside the military gates: industrial hazard threat assessments for department of defense installations.
- Kirkpatrick JS, Howard JM, Reed DA. Sci Total Environ 2002; 288(1-2): 111-117.
Correspondence: Jeffery Kirkpatrick, US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010-5403, USA; jeffrey.kirkpatrick@apg.amedd.army.mil).
As part of comprehensive joint medical surveillance measures outlined by the Department of Defense, the US Army Center for Health Promotion and Preventive Medicine (USACHPPM) is beginning to assess environmental health threats to continental US military installations. A common theme in comprehensive joint medical surveillance, in support of Force Health Protection, is the identification and assessment of potential environmental health hazards, and the evaluation and documentation of actual exposures in both a continental US and outside a continental US setting. For the continental US assessments, the USACHPPM has utilized the US Environmental Protection Agency (EPA) database for risk management plans in accordance with Public Law 106-40, and the toxic release inventory database, in a state-of the art geographic information systems based program, termed the Consequence Assessment and Management Tool Set, or CATS, for assessing homeland industrial chemical hazards outside the military gates. As an example, the US EPA toxic release inventory and risk management plans databases are queried to determine the types and locations of industries surrounding a continental US military installation. Contaminants of concern are then ranked with respect to known toxicological and physical hazards, where they are then subject to applicable downwind hazard simulations using applicable meteorological and climatological data sets. The composite downwind hazard areas are mapped in relation to emergency response planning guidelines (ERPG), which were developed by the American Industrial Hygiene Association to assist emergency response personnel planning for catastrophic chemical releases. In addition, other geographic referenced data such as transportation routes, satellite imagery and population data are included in the operational, equipment, and morale risk assessment and management process. These techniques have been developed to assist military medical planners and operations personnel in determining the industrial hazards, vulnerability assessments and health risk assessments to continental United States military installations. These techniques and procedures support the Department of Defense Force Protection measures, which provides awareness of a terrorism threat, appropriate measures to prevent terrorist attacks and mitigate terrorism's effects in the event that preventive measures are ineffective.
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Childhood injury: A status report, part 1
- Crawley-Coha T. J Pediat Nursing 2001; 16(5):371-374.
Childhood injury: A status report, part 2
- Crawley-Coha T. J Pediat Nursing 200217(2) 133-136.
Correspondence: Teri Crawley-Coha, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614 USA; (email: tcrawley@childrensmemorial.org).
The October 2001 issue of The Journal of Pediatric Nursing carried the first of two parts on childhood injury. That article reviewed the importance of prevention, the short- and long-term effects of injury on the child and the family, and how to incorporate prevention strategies at home and at work. Also reviewed were three of the most common mechanisms of injury, motor vehicle crashes, bicycle crashes, and pool drowning, and prevention measures. In the second part, the remaining primary areas of concern for common pediatric injuries are addressed: poisoning, fires and burns, and firearms. (Copyright © 2002, Elsevier Science)
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No reports this week
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Skateboarding injuries of today.
- Forsman L, Eriksson A. Br J Sports MedBr J Sports Med 2001; 35(5): 325-328.
Correspondence: Anders Eriksson, Section of Forensic Medicine, University of Umeå, PO Box 7642, SE-907 12 Umeå, SWEDEN; (email: anders.eriksson@rmv.se).
OBJECTIVE: To describe the injury pattern of skateboarding injuries today.
METHODS: The pattern of injuries, circumstances, and severity were investigated in a study of 139 people injured in skateboarding accidents during 1995 through 1998 inclusive and admitted to the University Hospital of Umea, Umea, Sweden. This is the only hospital in the area, serving a population of 135,000.
RESULTS: Of the 139 injured, 3 were pedestrains hit by a skateboard rider; the rest were riders. The age range was 7 to 47 years (mean, 16.0). The severity of the injuries was minor (Abbreviated Injury Scale 1) to moderate (Abbreviated Injury Scale 2); fractures were classified as moderate. The annual number of injuries increased during the study period. Fractures were found in 29% of the casualties, and four children had concussion. The most common fractures were of the ankle and wrist. Older patients had less severe injuries, mainly sprains and soft tissue injuries. Most children were injured while skateboarding on ramps and at arenas; only 12 (9%) were injured while skateboarding on roads. Some 37% of the injuries occurred because of a loss of balance and 26% because of a failed trick attempt. Falls caused by surface irregularities resulted in the highest proportion of the moderate injuries.
CONCLUSIONS: Skateboarding should be restricted to supervised skateboard parks, and skateboarders should be required to wear protective gear. These measures would reduce the number of skateboarders injured in motor vehicle collisions, the personal injuries among skateboarders, and the number of pedestrians injured in collisions with skateboarders. (Copyright © 2001, British Journal of Sports Medicine)
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No reports this week
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See item 1 under Suicide and Self-Harm
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Recruitment of older participants in frailty/injury prevention studies: Frailty and Injuries: Cooperative Studies of Intervention Techniques.
- Ory MG, Lipman PD, Karlen PL, Gerety MB, Stevens VJ, Singh MA, Buchner DM, Schechtman KB; The FICSIT Group. Prev Sci 2002; 3(1): 1-22.
Behavioral and Social Research Program, National Institute on Aging, Bethesda, Maryland, USA.
Despite the lifelong health benefits of physical activity, frailer older adults have typically been excluded from studies promoting more active lifestyles. This study documents the recruitment process and costs from a multisite study to identify effective strategies for recruiting older adults in frailty/injury prevention research. Randomized controlled clinical trials were conducted at 7 sites; an 8th site was a compliance study. Interventions reflected center- and home-based health promotion programs. Site objectives, eligibility criteria, and contact and screening methods were obtained from manuals of operation. Recruitment results (number screened, eligibility rates, randomized to screened ratios) were ascertained from recruitment data. Sites furnished estimated recruitment costs (nonlabor expenses, investigator and staff time, fringe benefits) up to signing the consent form. The sites targeted diverse populations and sample sizes. The majority revised recruitment methods to meet their recruitment goals. Most sites estimated costs of recruitment at over $300 per participant randomized. Recruitment costs were affected by staff time spent alleviating concerns about participants' health, essential interactions with family members, and arranging for transportation. Neither frailty nor intervention intensity was found to be a major predictor of recruitment outcomes. Recruitment expense was associated with selection criteria and frailty status of the target population. Older people can be successfully recruited into beneficial health promotion programs, but it is often challenging. In planning health promotion studies, investigators need to be aware of the numbers of older people they may need to screen and different strategies for increasing recruitment success.
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Risks associated with spinal manipulation.
- Stevinson C, Ernst E. Am J Med 2002; 112(7):566-571.
Correspondence: Edzard Ernst, MD, PhD, Department of Complementary Medicine, School of Sport and Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter EX2 4NT, UK; (email: E.Ernst@ex.ac.uk).
The aim of this systematic review was to summarize the evidence about the risks of spinal manipulation. Articles were located through searching three electronic databases (MEDLINE, EMBASE, Cochrane Library), contacting experts (n=9), scanning reference lists of relevant articles, and searching departmental files. Reports in any language containing data relating to risks associated with spinal manipulation were included, irrespective of the profession of the therapist. Where available, systematic reviews were used as the basis of this article. All papers were evaluated independently by the authors. Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.
State Trends in Health Risk Factors and Receipt of Clinical Preventive Services Among US Adults During the 1990s.
- Nelson DE, Bland S, Powell-Griner E, Klein R, Wells HE, Hogelin G, Marks JS. JAMA 2002; 287(20): 2659-2667.
National Cancer Institute, Division of Cancer Control and Population Sciences, 6130 Executive Blvd, MSC 7365, EPN 4068, Bethesda, MD 20892-7365 USA; nelsond@mail.nih.gov).
BACKGROUND: Monitoring trends is essential for evaluating past activities and guiding current preventive health program and policy efforts. Although tracking progress toward national health goals is helpful, use of national estimates is limited because most preventive health care activities, policies, and other efforts occur at the state or community level. There may be important state trends that are obscured by national data.
OBJECTIVE: To estimate state-specific trends for 5 health risk factors and 6 clinical preventive services.
METHODS: Design- Telephone surveys were conducted from 1991 through 2000 as part of the Behavioral Risk Factor Surveillance System. Setting and Participants- Randomly selected adults aged 18 years or older from 49 US states. Annual state sample sizes ranged from 1188 to 7543. Main Outcome Measures- Statistically significant changes (P<.01) in state prevalences of cigarette smoking, binge alcohol use, physical inactivity, obesity, safety belt use, and mammography; screening for cervical cancer, colorectal cancer, and cholesterol levels; and receipt of influenza and pneumococcal disease vaccination.
RESULTS: There were statistically significant increases in safety belt use for 39 of 47 states and receipt of mammography in the past 2 years for women aged 40 years or older for 43 of 47 states. For persons aged 65 years or older, there were increases in receipt of influenza vaccination for 44 of 49 states and ever receiving pneumococcal vaccination for 48 of 49 states. State trends were mixed for binge alcohol use (increasing in 19 of 47 states and declining in 3), physical inactivity (increasing in 3 of 48 states and declining in 11), and cholesterol screening (increasing in 13 of 47 states and decreasing in 5). Obesity increased in all states and smoking increased in 14 of 47 states (declining only in Minnesota). Cervical cancer screening increased in 8 of 48 states and colorectal cancer screening increased in 13 of 49 states. New York experienced improvements for 8 of 11 measures, while 7 of 11 measures improved in Delaware, Kentucky, and Maryland; in contrast, Alaska experienced improvements for no measures and at least 4 of 11 measures worsened in Iowa, North Dakota, and South Dakota.
CONCLUSIONS: Most states experienced increases in safety belt use, mammography, and adult vaccinations. Trends for smoking and binge alcohol use are disturbing, and obesity data support previous findings. Trend data are useful for targeting state preventive health efforts.
Valuation of Childhood Risk Reduction: The Importance of Age, Risk Preferences, and Perspective.
- Dockins C, Jenkins RR, Owens N, Simon NB, Wiggins LB. Risk Anal 2002; 22(2): 335-346.
Chris Dockins: United States Environmental Protection Agency, National Center for Environmental Economics,Mail Code 1809, Ariel Rios Building, 1200 Pennsylvania Avenue, N.W., Washington, DC 20460 USA; (email: dockins.chris@epa.gov).
This article explores two problems analysts face in determining how to estimate values for children's health and safety risk reductions. The first addresses the question: Do willingness-to-pay estimates for health risk changes differ across children and adults and, if so, how? To answer this question, the article first examines the potential effects of age and risk preferences on willingness to pay. A summary of the literature reporting empirical evidence of differences between willingness to pay for adult health and safety risk reductions and willingness to pay for health and safety risk reductions in children is also provided. The second dimension of the problem is a more fundamental issue: Whose perspective is relevant when valuing children's health effects-society's, children's, adults-as-children, or parents'? Each perspective is considered, followed ultimately by the conclusion that adopting a parental perspective through an intrahousehold allocation model seems closest to meeting the needs of the estimation problem at hand. A policy example in which the choice of perspective affects the outcome of a regulatory benefit-cost analysis rounds out the article and emphasizes the importance of perspective.
See items 1 and 3 under Violence
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No reports this week
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Deliberate self-poisoning in adolescents.
- Lifshitz M, Gavrilov V. Isr Med Assoc J 2002; 4(4):252-254.
Matityahu Lifshitz, Toxicology Unit, Division of Pediatrics, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, ISRAEL; (email: matyl@bgumail.bgu.ac.il).
BACKGROUND: Adolescent suicide has become increasingly more prevalent in recent years, with self-poisoning being a frequent means of suicide attempt.
OBJECTIVE: To investigate the factors associated with adolescent self-poisoning.
METHODS: Data on adolescents referred for intentional self-poisoning to the Adolescent Medical Unit during the years 1990-1998 were evaluated retrospectively. Data were obtained from the hospital medical records and included the following factors: sociodemographic data, educational status, agent and route of intake, motivation for overdose, and the extent of serious suicidal intent.
RESULTS: We evaluated 324 cases of adolescent self-poisoners aged 12-18 years (mean +/- SD 14.8 +/- 1.5 years). The female/male ratio was 8:1. Most of the patients were attending school and lived in urban areas. Oral ingestion was the only route of intake; 84.5% of the patients ingested drugs and 10.5% non-medicinal compounds. The drug most commonly taken was acetaminophen. The non-medicinal compounds were mostly pesticides and household materials. The suicide attempts were most frequently associated with transient depression, stemming from defects in child-family communication. As based on clinical psychiatric evaluation, patients who had ingested polydrugs and non-medical compounds evidenced a significantly greater suicidal intent (chi 2 = 11.9, P < 0.001) compared to those who took only one or two kinds of drugs.
CONCLUSIONS: We found that self-poisoning attempts occur most frequently in depressed females at junior high and high school, usually in the context of family dysfunction. Non-medicinal agents and polydrug ingestion are major risk factors for evaluating the seriousness of the suicidal intent.
Incidence of Completed and Attempted Suicide in Trabzon, Turkey
- Bilici M, Bekaroglu M, Hocaoglu C, Gurpinar S, Soylu C, Uluutku N. Crisis 2002; 23(1):
Correspondence: Mustafa Bilici, Karadeniz Technical University School of Medicine, Department of Psychiatry, 61080, Trabzon, TURKEY (email: mbilici@meds.ktu.edu.tr).
OBJECTIVE: Studies of completed and attempted suicide in Turkey are based on data of State Institute of Statistics (SIS) and emergency clinics of the large hospitals. This study seeks (1) to find, independent of the SIS and hospital data, the annual incidences of completed and attempted suicide in Trabzon, Turkey; (2) to examine the associated factors between the incidence of completed and attempted suicide.
METHODS: The data are derived by using a method specially designed for this study. Data sources include emergency clinics in all hospitals, village clinics, the Forensic Medical Center of Trabzon, the Governorship of Trabzon, "mukhtars" (local village representatives) of neighborhoods, the Office of the Public Prosecutor of Trabzon, the Police Headquarters and Gendarmerie, and the local press organs.
RESULTS: The incidences of completed and attempted suicide per 100,000 inhabitants turned out to be 2.60 and 31.5, respectively, whereas the SIS reported the incidence of completed suicide to be 1.11 per 100,000 inhabitants in Trabzon in 1995.
CONCLUSIONS: Our results demonstrate that SIS data are inadequate for suicide research in Turkey. Our findings show that the risk of completed and attempted suicide is high in young, unmarried, and unemployed persons, and that these groups must be carefully evaluated for suicide risk. The study highlights the need for culture-specific research on suicidal behavior in Turkey. ((Copyright © 2002 International Association for Suicide Prevention and Hogrefe & Huber Publishers)
Suicide and Suicide Attempts in Ankara in 1998: Results of the WHO/EURO Multicentre Study of Suicidal Behaviour.
- Sayil I, Devrimci-Ozguven H. Crisis 2002; 23(1):
Correspondence: Isik Sayil, Medical School of Ankara University, Psikiyatri Anabilim Dali, Dikimevi, Ankara 06590, TURKEY (email: ozguven@medicine.ankara.edu.tr).
BACKGROUND: The rates and associated basic demographic features of attempted and completed suicides in a catchment area in Turkey were investigated as part of the WHO/Euro Multicentre Study of Suicidal Behaviour.
METHODS: All hospitals in the catchment area were screened in order to identify attempted suicides. Statistics for completed suicides were obtained from the State Institute of Statistics (SIS).
RESULTS: The rates of attempted and completed suicides per 100,000 inhabitants over 15 years of age were 31.9 for males and 85.6 for females, and 9.9 for males and 5.6 for females, respectively. The majority of attempted suicides were in the 15-24-year-old age group, as is the case in all other European countries. The majority of completed suicides were also in the 15-24-year-old age group, although in other European centers most completed suicides occur in the 40+ age group. The most frequent methods were overdose for attempted suicide and hanging for completed suicide. The rates of both attempted and completed suicides were lower than those of other participating centers in Europe.
CONCLUSIONS: Male sex is a risk factor for completed suicide and female sex is a risk factor for attempted suicide, while an age of 15-24 years may be a risk factor for both groups.
Nonfatal Self-Inflicted Injuries Treated in Hospital Emergency Departments - United States, 2000.
- Ikeda R, Mahendra R, Saltzman L, Crosby A, Willis L, Mercy J, Holmgreen P, Annest JL. MMWR 2002; 51(20): 436-438.
Full text available online: ( Download Document ).
BACKGROUND: The US Centers for Disease Control (CDC), in collaboration with the Consumer Product Safety Commission (CPSC), expanded CPSC's National Electronic Injury Surveillance System (NEISS) in July 2000 to include all types and external causes of nonfatal injuries treated in U.S. hospital emergency departments (EDs). This ongoing surveillance system, called NEISS All Injury Program (NEISS-AIP), provides data to calculate national estimates for nonfatal injuries treated in EDs during 2000.
OBJECTIVE: This report provides national, annualized, weighted estimates of nonfatal self-inflicted injuries treated in U.S. hospital EDs.
METHODS: NEISS-AIP includes data from 66 of the 100 NEISS hospitals, which were selected as a stratified probability sample of all hospitals in the United States and its territories with a minimum of six beds and a 24-hour ED. The NEISS-AIP hospitals are a nationally representative sample of U.S. hospital EDs. NEISS-AIP provides data on approximately 500,000 injury- and consumer product--related ED cases each year. Data from these cases are weighted by the inverse of the probability of selection to provide national estimates. Annualized estimates for this report are based on weighted data for 2,008 nonfatal self-inflicted injuries treated in EDs during July--December 2000. The weight of each case was doubled, and then these weighted values were added to provide annualized estimates for the overall population and population subgroups (i.e., age, sex, and race/ethnicity*). A direct variance estimation procedure was used to calculate 95% confidence intervals and to account for the complex sample design.
RESULTS: Overall, self-inflicted injury rates were highest among adolescents and young adults, particularly females. Most (90%) self-inflicted injuries were the result of poisoning or being cut/pierced with a sharp instrument, and 60% were probable suicide attempts. NEISS-AIP data increase understanding of self-inflicted injuries and can serve as a basis for monitoring trends, facilitating additional research, and evaluating intervention approaches. During 2000, an estimated 264,108 persons were treated in EDs for nonfatal self-inflicted injuries (rate: 95.9 per 100,000 population); the rate for females (107.7) was higher than that for males (83.6). An estimated 170,222 (65%) injuries resulted from poisonings, 65,256 (25%) were attributed to injuries with a sharp instrument, and 3,016 (1%) involved a firearm. The causes of self-inflicted injuries were similar for males and females, although the proportion attributed to poisoning was higher for females (72%) than for males (55%). An estimated 129,832 (49%) persons were treated and released from EDs, 85,287 (32%) required hospitalization, and 41,784 (16%) were transferred to another institution for care. An estimated 158,466 self-inflicted injuries (60%) were considered probable suicide attempts, and 27,294 (10%) were considered possible attempts; for 78,358 self-inflicted injuries (30%), the information in the text field was unclear/unknown regarding intent. By age, rates were highest among adolescents aged 15--19 years and young adults aged 20--24 years (259.0 and 236.6, respectively), with the highest rate occurring among females aged 15--19 years (322.7). By race/ethnicity, rates were highest among white, non-Hispanic males (71.8) and females (93.9).
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Physical injury risks associated with drinking water arsenic treatment: A comparison of the transportation risks of treatment to the risks to the public from the untreated contamination.
- Frost FJ, Chwirka J, Craun GF, Thomson B, Stomps J. Risk Anal 2002; 22(2): 235-243.
Correspondence: Floyd J. Frost, Lovelace Clinic Foundation, Albuquerque, NM 87108, USA; (email: ffrost@lrri.org).
We estimated the number of transportation deaths that would be associated with water treatment in Albuquerque to meet the EPA's recently proposed revisions of the Maximum Contaminant Level (MCL) for arsenic. Vehicle mileage was estimated for ion exchange, activated alumina, and iron coagulation/microfiltration water treatment processes to meet an MCL of 0.020 mg/L, 0.010 mg/L, 0.005 mg/L, and 0.003 mg/L. Local crash, injury, and death rates per million vehicle miles were used to estimate the number of injuries and deaths. Depending on the water treatment options chosen, we estimate that meeting an arsenic MCL of 0.005 mg/L will result in 143 to 237 crashes, 58 to 98 injuries, and 0.6 to 2.6 deaths in Albuquerque over a 70-year period, resulting in 26 to 113 years of life lost. The anticipated health benefits for Albuquerque residents from a 0.005 mg/L arsenic MCL, estimated using either a multistage Weibull or Poisson model, ranged from 3 to 80 arsenic-related bladder and lung cancer deaths prevented over a 70-year period, adding between 43 and 1,123 years of life. Whether a revised arsenic MCL increases or reduces overall loss of life in Albuquerque depends on the accuracy of EPA's cancer risk assessment. If the multistage Weibull model accurately estimates the benefits, the years of life added is comparable or lower than the anticipated years lost due to transportation associated with the delivery of chemicals, disposal of treatment waste, and operation of the water treatment system. Coagulation/microfiltration treatment will result in substantially fewer transportation deaths than either ion exchange or activated alumina.
Biomechanical Mechanisms of Whiplash Injury.
- Yoganandan N, Pintar FA, Gennarelli TA. Traffic Injury Prev 2002; 3(2):98-104.
Correspondence: Narayan Yoganandan, Department of Neurosurgery, Medical College of Wisconsin, and Department of Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA (email: yoga@mcw.edu).
It is common knowledge that whiplash-associated disorders are soft-tissue-related. Rear-end crashes account for a majority of trauma. Specific objective diagnoses have eluded clinicians because of the soft tissue nature of the disorder. Sophisticated tools such as magnetic resonance images are inconclusive. The disorder is recognized in the Western world with significant societal impact and staggering economic costs. An increased level of awareness towards safety from the vehicle user coupled with the above factors and an interest by the automotive community to improve vehicle component designs have accelerated research in the area of whiplash-associated disorders from various perspectives. One of the main emphases has been to clearly delineate the mechanisms of the disorder. Consequently, the objective of this article is to describe the postulated mechanisms of injury and biomechanical studies attempting to prove the hypotheses. Results indicate that structures such as the facet joint are involved in chronic pain, and the kinematics of this joint are such that it undergoes characteristic motions during the early stages of rear impact acceleration. The presence of the transient nonphysiologic reverse curve, i.e., upper head-neck flexion is attributed to headaches, and the concomitant existence of lower cervical extension (particularly the inferior facet joints) during the early stages of rear impact acceleration are attributed to the mechanism of neck pain in whiplash. These studies have provided a fundamental basis for understanding the mechanism of the two most common complaints in whiplash, headache and neck pain. (Copyright © 2002 Taylor & Francis)
Transport safety for older people: A study of their experiences, perceptions and management needs.
- Peel N, Westmoreland J, Steinberg M. Injury Control Safety Promo 2002; 9(1): 19-24.
Correspondence: Nancye Peel, University of Queensland Medical School, School of Population Health, Herston, Australia (email: n.peel@sph.uq.edu.au).
BACKGROUND: With evidence of increasing accident risk due to age-related declines in health and cognition affecting driver performance, there is a need for research promoting safe mobility of older people.
OBJECTIVES: The present study aimed to identify transport options and licensing issues for a group of older people in an Australian community.
METHODS: Ninety-five participants aged 75 and over were interviewed about their driving status and accident record and tested for cognitive ability. After stratification on cognitive level and driver status (current, ex-driver or non-driver), 30 were selected for further in-depth interviews concerning demographics, licence status and impact of change, travel options available and used, and travel characteristics.
RESULTS: Considerable reliance on the motor vehicle as the mode of transport and the decision to cease driving were major quality-of-life issues. There was little evidence of planning and support in making the decision to stop driving. Some differences in transport decisions on the basis of cognitive level were evident; however, people with severely compromised cognitive ability (and, therefore, unable to give informed consent) had been excluded.
CONCLUSIONS: The study suggested the need for resources to assist older people/carers/health professionals to plan for the transition from driver to non-driver and to manage alternative transport options more effectively. (Copyright © 2002 Swets & Zeitlinger)
When Do AIS 1 Neck Injuries Result in Long-Term Consequences? Vehicle and Human Factors.
- Krafft M. Traffic Injury Prev 2002; 3(2): 89-97.
Correspondence: Maria Krafft, Folksam Research, S23, 106 60 Stockholm, SWEDEN; (email: maria.krafft@folksam.se).
AIS 1 neck injuries are the most frequent injury among car occupants in car collisions. The main public-health problem concerning neck injuries are those resulting in long-term consequences. Yet epidemiological studies mostly focus on data based on the initial injury outcome. This study compares the characteristics of rear impacts causing both short- and long-term consequences to the neck. Real life data from Swedish insurance material during 1990-1993 were used, where the resultant impact injuries to the neck were divided into two groups: occupants self-reporting initial symptoms shortly after the crash and a subgroup were the initial symptoms later developed into long-term consequences, estimated by medical specialists (chronic symptoms at least one year after the impact). The influence of change of velocity, crash pulse of the struck car, and the risk of long-term consequences to the neck in different car models, were evaluated. The relative risk of neck injury in terms of initial injury was strongly influenced by the mass ratio between the struck and the striking car while other parameters such as crash pulse seemed to be an influencing factor in crashes causing long-term consequences. Also, there was a 2.7 times higher risk of sustaining long-term consequences to the neck in a vehicle manufactured in the end of the 1980s or beginning of the 90s than in one manufactured in the beginning of 1980. If one of the main reasons for the increasing number of long-term disabling neck injuries is associated with the influence of crash-pulse and factors related to newer car models, the situation will gradually become worse as the older car fleet is replaced. There is an increasing need for effective preventive measures, based on long-term disability data.
Dedicated Child Attachment System (ISOFix).
- Lowne R, Le Claire M, Roy P, Paton I. Traffic Injury Prev 2002 3(1): 19-29.
Correspondence: Richard Lowne, Transport Research Laboratory, Old Wokingham Road, Crowthorne, Berks, RG45 6AU, UK; (email: aroy813806@aol.com.uk).
Problems with the current methods of attaching child restraints to the vehicle structure have led to the development of new attachment systems. These proposals have been coordinated by the International Standards Organization (ISO) with the intention of generating an international standard system for the attachment of child restraints--ISOFix. These proposals attempt to balance the requirements for good impact performance with ease of use, low misuse, and reasonable cost, against possible complexity of the child restraint and its installation into the vehicle. This research program investigated the use of a range of four different prototype systems by parents. These systems were also subjected to frontal, side, and rear impacts. Various degrees of slack were introduced into the systems to determine the sensitivity to misuse and its effect on impact performance. A conventional child restraint using the same child seat shell was used for comparison. The results demonstrated that all systems could perform well, particularly in the frontal impact tests, provided that any adjustment in the attachment system was tightened. However, some systems were particularly sensitive to slack. Overall, those systems with rigid attachments performed best, particularly in side impacts. Also these were favored by the user group.
A Perspective on Motor Vehicle Crash Injuries and Speeding in the United Arab Emirates.
- Bener A, Alwash R. Traffic Injury Prev2002; 3(1): 61-64.
Correspondence: Abdulbari Bener, Department of Community Medicine, Faculty of Medicine & Health Sciences, UAE University, Al Ain, United Arab Emirates; (email: abener@uaeu.ac.ae).
The objective of this study was to assess how high-speed driving of motor vehicles affects traffic safety in United Arab Emirates. A retrospective descriptive study was conducted. The motor vehicle accidents statistics used in this study were taken from the Ministry of Interior's Yearly Statistical Report and the Annual Reports of the Directorate of Traffic (Directorate of Traffic Annual Reports 1990 to 1998) and in collaboration with the Traffic Department, United Arab Emirates. The study was based on the collection of data about all fatal motor vehicle accidents that occurred in United Arab Emirates during the period 1 January 1990 to 31 December 1998. The effect of speed limits on motor vehicle accidents, casualties, and fatalities for the period 1990 to 1998 indicates that with the introduction of radar system and speed cameras in 1994, speeding declined significantly. Also, monitoring radar systems and video cameras reduced traffic accidents, casualties, and fatalities. Urban speed limits vary narrowly between 48 and 60 km/h and rural speed limits ranged between 70 and 140 km/h. In conclusion, motor vehicle crashes are a major cause of mortality and morbidity in the United Arab Emirates. Simple measures such as the strict imposition of speed limits and the wearing of seat belts will be effective in reducing this substantial wastage of life and national resources.
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Inpatient costs and paramilitary punishment beatings in Northern Ireland.
- O'Neill C, Durkin P, McAlister D, Dogra AS, McAnespie M. Eur J Pub Health 2002; 12(1): 69-71.
Correspondence: Ciaran O'Neill, School of Public Policy, Economics and Law, University of Ulster at Jordanstown, Newtownabbey BT37 0QB, UK; (email: c.oneil2@ulst.ac.uk).
BACKGROUND: Paramilitary punishment beatings are a common occurrence in Northern Ireland. Little is known about the costs such attacks impose on the health service.
METHODS: Data was collected retrospectively on victims treated by Northern Ireland's regional specialist orthopaedics unit. Data related to all victims treated in the unit between January 1999 and May 2000.BBRESULTS: Average inpatient care costs were 2010 ($2914). There was no significant difference in these between patients who were shot and those who were beaten.
CONCLUSION: Punishment beatings present a small but significant cost burden to the health service. A fuller understanding of them from a health care perspective is warranted. (Copyright © 2002 Oxford University Press)
Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: a retrospective study.
- Mahajna A, Aboud N, Harbaji I, Agbaria A, Lankovsky Z, Michaelson M, Fisher D, Krausz MM. Lancet 2002; 359(9320): 1795-1800.
Correspondence: Prof Michael M Krausz, Department of General Surgery, Rambam Medical Center, POB 9602, 31096 Haifa, Israel; (e-mail: m_krausz@rambam.health.gov.il).
BACKGROUND: Low-velocity rubber bullets were used by Israeli police to control riots by Israeli-Arabs in early October, 2000. We aimed to establish the factors that contribute to severity of blunt and penetrating injuries caused by these missiles.
METHODS: We analysed medical records of 595 casualties admitted. We assessed relation of severity of injury to type of bullet, anatomical region of injury, and final outcome. Severity of injury was established by the abbreviated injury scale, and we calculated injury severity score.
RESULTS: 151 males and one female (age range 11-59 years) were included in the study, in whom 201 proven injuries by rubber bullets were detected. Injuries were distributed randomly over the body surface and were mostly located in the limbs (n=73), but those to the head, neck, and face (61), chest (39), back (16), and abdomen (12) were also frequently noted. 93 (61%) patients had blunt injuries and 59 (39%) penetrating ones. Severity of injury was dependent on ballistic features of the bullet, firing range, and anatomic site of impact. Two casualties died after a penetrating ocular injury into the brain and one died as a result of postoperative aspiration after a knee injury.
CONCLUSIONS: Resistance of the body surface at the site of impact (elastic limit) is the important factor that ascertains whether a blunt or penetrating injury is inflicted and its severity. Inaccuracy of rubber bullets and improper aiming and range of use resulted in severe injury and death in a substantial number of people. This ammunition should therefore not be considered a safe method of crowd control. (Copyright © 2002 Lancet Publishing Group)
Years of potential life lost by children and adolescent victims of homicide, Recife, 1997.
- Arnold MW, Neto GH, Figueiroa JN. J Trop Pediatr 2002; 48(2):67-71.
Correspondence: Marianne Weber Arnold, Instituto Materno Infantil de Pernambuco, Recife, BRAZIL.
This is a study of years of potential life lost (YPLL) by children and adolescents aged between 1 month and 19 years who were victims of homicide in Recife during 1997. It also draws a profile of the victims. A descriptive, cross-sectional study was made of death certificates of Recife residents, aged between 1 month and 19 years, occurring during 1997, to identify homicides and the three other most frequent causes of death in the age group, in order to make a profile of homicide victims. YPLL was calculated for this cause of death and the other three. Homicide was responsible for 36.6 per cent of the deaths, followed by pneumonia (9.4 per cent), vehicle accidents (6.3 per cent) and other accidents (6.0 per cent). Most of the murder victims were 15-19-year-old male students, but their level of schooling was unknown in 96.6 per cent of cases. Death was caused by firearms in 93.2 per cent of the cases. Homicides were responsible for 59.1 per cent of YPLL, followed by pneumonia, vehicle accidents and other accidents. The risk of losing years of potential life by homicide in the group studied was 27.20 in 1000. These figures show the magnitude of homicides as a cause of premature death and how they have become a public health problem. (Copyright © 2002 Oxford University Press)
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