SafetyLit: 12 August 2002

Other Information

Publications Available
On-Line from IPW Sites

12 August 2002

We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.

The Illinois .08 law. An evaluation.

Voas RB, Tippetts AS, Taylor EP. J Safety Res 2002; 33(1):73-80.

Correspondence: Robert Voas, Pacific Institute for Research and Evaluation, Calverton Office Park, Suite 300, 11710 Beltsville Drive, Calverton, MD 20705, USA; (email: voas@pire.org).

Lowering state blood alcohol concentration (BAC) limits to 0.08, though controversial, has been supported by most evaluation studies to date. The Illinois .08 BAC law implemented in 1997 provided a unique opportunity to evaluate the effect of the law without the simultaneous passage of an administrative license revocation (ALR) law, which has clouded some previous evaluations of the .08 laws. The proportion of all drinking drivers in fatal crashes was compared before versus after implementing the .08 law using time-series analysis to evaluate 12 years of fatal crash data for Illinois and five bordering states. The results showed that the proportion of drinking drivers in fatal crashes decreased by 14% in Illinois and increased by 3% in bordering states. The proportion of drinking drivers in fatal crashes in Illinois, though increasing since 1995, was sharply reduced after passage of the .08 law in 1997, saving more than 100 lives in 1998 and 1999 than it would have without the .08 law. (Copyright © 2002 Elsevier Science and National Safety Council)
Alcohol-related aggression during the college years: theories, risk factors and policy implications.

Giancola PR. J Stud Alcohol Suppl 2002; (14):129-139.

Correspondence: Peter Giancola, Department of Psychology, University of Kentucky, Lexington 40506-0044, USA; (email: peter@uky.edu).

OBJECTIVE: The purpose of this article is to present an overview of the research literature on alcohol-related aggression with a focus on college students.

METHOD: Data from both survey studies and experimental laboratory investigations conducted on college students are reviewed. Various methodological approaches to studying the alcohol-aggression relation, and their associated limitations, are then presented and discussed.

FINDINGS: The literature indicates that alcohol consumption facilitates aggressive behavior and increases the risk of being the victim of a violent act, particularly in heavy drinkers. Results from these studies are then placed into a context by reviewing 12 influential theories of aggression and alcohol-related aggression. On the basis of these theories and empirical data, a preliminary risk profile is presented to help identify which factors are likely to be important in predicting who will and who will not become aggressive after drinking alcohol.

CONCLUSIONS: Although much research is still needed to elucidate the intricate causes of alcohol-related aggression, current prevention efforts might focus on modifying key risk factors such as poor cognitive functioning and inaccurate expectations about the effects of alcohol. Other prevention efforts directed specifically at college students might focus on helping them to identify risky situations that might facilitate the expression of intoxicated aggression. (Copyright © 2002 Center of Alcohol Studies - Rutgers University)
Drinking and driving among Mexican American and non-Hispanic white males in Long Beach, California.

Ferguson SA, Burns MM, Fiorentino D, Williams AF, Garcia J. Accid Anal Prev 2002; 34(4): 429-437.

Correspondence: Susan A. Ferguson, Insurance Institute for Highway Safety, Arlington, VA 22201-4751, USA; (email: sferguson@iihs.org).

Although drinking and driving in the United States has declined substantially during the past two decades, this trend has not been seen among Hispanic drivers. Higher rates of driving while impaired (DWI) arrests and alcohol-related crashes, particularly among Mexican Americans, also have been noted. The extent to which this reflects a lack of understanding of DWI laws rather than a disregard for them is unknown. A survey was conducted among Mexican American and non-Hispanic white male DWI arrestees in Long Beach, California, to ascertain alcohol use, attitudes toward drinking and drinking and driving, and knowledge of DWI laws. The findings were compared with those of Mexican American and non-Hispanic white males recruited from the local community. Mexican American males, both DWIs and those from the community, reported heavier drinking than non-Hispanic white males. All four groups of respondents tended to underestimate the number of drinks needed to achieve the blood alcohol concentration (BAC) threshold at or above which it is illegal to drive under California law. Estimations were around 2-3 drinks rather than a more realistic estimate of 4-5 drinks. However, Mexican American DWIs and their comparison group vastly overestimated the number of drinks to make them unsafe drivers (8- 10 drinks). Furthermore, fewer than half were aware of the BAC threshold in California (0.08%) compared with between 60 and 78% of non-Hispanic whites. This study is limited in scope and needs to be replicated in other communities and with other racial/ethnic groups. However, the clear lack of knowledge of the DWI law in California and a lack of understanding of the relationship between number of drinks and BAC point to the need for culturally sensitive programs that are developed and implemented within the Mexican American community. (Copyright © 2002 Elsevier Science)
Evaluation of a program to motivate impaired driving offenders to install ignition interlocks.

Voas RB, Blackman KO, Tippetts AS, Marques PR. Accid Anal Prev 2002; 34(4): 449-455.

Correspondence: Robert Voas, Pacific Institute for Research and Evaluation, Suite 300, 11710 Beltsville Drive, Calverton, MD 20705, USA; (email: voas@pire.org).

Approximately 30,000 alcohol ignition interlocks, which are designed to prevent the operation of a vehicle if the driver has been drinking, are in use in the US and Canada. Ignition interlock programs are also being initiated in Sweden and Australia. The best-controlled studies that are currently available suggest that ignition interlocks are effective in reducing impaired driving recidivism while on the vehicle. However, in the US, the practical effectiveness of these devices is limited because only a small number of 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 traditional penalties, such as jail or electronically monitored house arrest, the alternative to participation in an interlock program. 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. (Copyright © 2002 Elsevier Science)

The hidden value of safety.

Corcoran D. Occup Health Saf 2002; 71(6):20-24.

Correspondence: Daniel Corcoran, Occupational Health and Safety Administration, City Center Square 1100 Main Street, Suite 800, Kansas City, MO, USA; (email: unavailable)

For many years, those in the health and safety profession have been using the iceberg metaphor for explaining the high costs of accidents in the workplace. This metaphor has been used to point out that the direct or "insured" costs associated with accidents, such as medical expenses, constitute only the tip of the iceberg, and that the bulk of the costs are indirect or "uninsured" costs, hidden from view, yet comprising the vast majority of the iceberg's mass. A number of accident costing models have been developed for quantifying or estimating many of these uninsured costs using accounting methods akin to those used by managerial accountants for product costing. (Copyright © 2002 Stevens Publishing)
The relevance of social inequalities for designing intervention programs.

Sergerie D, Farley C. Inj Control Saf Promo 2001; 8(3): 155-161.

Correspondence: Diane Sergerie, Direction de Santé publique de la Montérégerie, 1255 rue Beauregard, Longueuil, Quebec, CANADA; (email: dsergerie@ssss.gouv.qc.ca).

Despite a general reduction in mortality, the excess mortality affecting disadvantaged groups is still growing, mainly due to external causes like injuries. For many categories of non-intentional injuries, poverty is a determinant associated with a higher risk of injury, particularly among youth. This paper explores the role of population-based strategies using universal interventions to prevent injuries in order to reduce inequalities between social groups.

The paper concludes that in addition to the necessary efforts to act upon the structural causes of poverty and the growing gap between rich and poor, it is also possible to work directly toward reducing inequalities in regards to injuries. For several categories of injuries, improved standards, laws and regulations concerning products, accessories, environmental measures and behavior, are most effective in reducing mortality and morbidity, especially since they include all groups and moreover the most disadvantaged. An added value is that the costs of these measures are being absorbed by society as a whole rather than on the basis of criteria discriminating for belonging to a high-risk group. (Copyright © 2001 Swets & Zeitlinger)

No reports this week

When the bough breaks: a 10-year review of logging injuries treated at a rural trauma center in Pennsylvania.

Johnson CM, Lagares-Garcia JA, Miller SL. Am Surg 2002; 68(7): 573-581.

Correspondence: C. M. Johnson, Department of Surgery, Conemaugh Memorial Medical Center/Temple University, Johnstown, Pennsylvania 15905-4398, USA; (email: unavailable)

The purpose of this study was to describe logging-related injuries at a Pennsylvania trauma center and evaluate the impact of helmets and profession. Charts of patients from 1990 through 1999 admitted after logging accidents were retrospectively reviewed. Most injuries were to the head (71 in 28 patients). Injury Severity Score was greater for helmeted loggers (21.0 vs 11.8; P = 0.02) but did not differ by profession. Mean hospital stay was not significantly different for helmeted loggers (9.6 vs 5.4 days, P = 0.499). Mean length of stay was 8.2 days and 3.5 days for professionals and nonprofessionals, respectively (P = 0.01). Professional loggers tended to remain hospitalized longer. Helmet use does not appear to affect injury severity; however, this could be a result of the catastrophic nature of many logging accidents. Most loggers in this study were not wearing helmets, which suggests that improved educational efforts are needed to improve safety in this dangerous occupation. (Copyright © 2002 Southeastern Surgical Congress)
Injuries and injury prevention among senior military officers at the Army War College.

Knapik JJ, McCollam R, Canham-Chervak M, Hoedebecke E, Arnold S, Craig S, Barko W. Mil Med 2002; 167(7): 593-599.

Correspondence: Joseph Knapik, Directorate of Epidemiology and Disease Surveillance, U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD, USA; (email: joseph.knapik@apg.amedd.army.mil).

Injuries and activities associated with injuries were extracted from a retrospective review of the medical records of officers attending the U.S. Army War College during academic years 1999 and 2000 (AY99 and AY00). In AY99, cumulative injury incidence (officers with one or more injuries) was 56%. The next year (AY00), there was command emphasis on injury reduction and education of students on injury prevention strategies. Cumulative injury incidence in AY00 was 44%, significantly lower than in AY99 (p = 0.01, risk ratio [AY99/AY99] = 1.3, 95% confidence interval = 1.1-1.5). Among activities that could be linked to injuries, sports were associated with 41% in AY99 and 45% in AY00. Recommendations for ongoing injury reduction include the following: (1) continued command emphasis and instruction on injury reduction techniques; (2) encouraging the use of semirigid ankle braces to reduce ankle sprains; (3) reducing the number of practice and game sessions in sports activities; (4) encouraging overrunning of second and third base in softball; (5) prohibiting contact with the center line below the net in volleyball; and (6) encouraging medical care providers to record the activity associated with each injury in the medical records. (Copyright © 2002 Association of Military Surgeons of the United States)
Perceived safety climate, job demands, and coworker support among union and nonunion injured construction workers.

Gillen M, Baltz D, Gassel M, Kirsch L, Vaccaro D. J Safety Res 2002; 33(1): 33-51.

Correspondence: Marion Gillen, Department of Community Health Systems, School of Nursing, University of California, San Francisco, Box 0608, San Francisco, CA 94143-0608, USA; (email: marion.gillen@nursing.ucsf.edu).

OBJECTIVES: This study evaluated injured construction workers' perceptions of workplace safety climate, psychological job demands, decision latitude, and coworker support, and the relationship of these variables to the injury severity sustained by the workers.

METHODS: Injury severity was assessed using the Health Assessment Questionnaire (HAQ), which evaluates functional limitations. Worker perceptions of workplace variables were determined by two instruments: (a) the Safety Climate Measure for Construction Sites and (b) the Job Content Questionnaire (JCQ).

FINDINGS: The overall model explained 23% of the variance in injury severity, with unique contributions provided by union status, the Safety Climate Score, and Psychological Job Demands. A positive significant correlation was found between injury severity and the Safety Climate Scores (r = .183, P = .003), and between the Safety Climate Scores and union status (r = .225, P < .001).

DISCUSSION: There were statistically significant differences between union and nonunion workers' responses regarding perceived safety climate on 5 of the 10 safety climate items. Union workers were more likely than nonunion workers to: (a) perceive their supervisors as caring about their safety; (b) be made aware of dangerous work practices; (c) have received safety instructions when hired; (d) have regular job safety meetings; and (e) perceive that taking risks was not a part of their job. However, with regard to the 49-item JCQ, which includes Coworker Support, the responses between union and nonunion workers were very similar, indicating an overall high degree of job satisfaction. However, workers who experienced their workplace as more safe also perceived the level of management (r = -.55, P < .001) and coworker (r = -.31, P < .001) support as being higher. The findings of this study underscore the critical need for construction managers to alert workers to dangerous work practices and conditions more frequently, and express concern and praise workers for safe work in a manner that is culturally acceptable in this industry. Workplace interventions that decrease the incidence and severity of injuries, but that are flexible enough to meet a variety of potentially competing imperatives, such as production deadlines and client demands, need to be identified. (Copyright © 2002 Elsevier Science)

Pedestrian risk decrease with pedestrian flow. A case study based on data from signalized intersections in Hamilton, Ontario.

Leden L. Accid Anal Prev 2002; 34(4): 457-464.

Correspondence: Lars Leden, VTT Building and Transport, P.O. Box 1901, Sahkomiehentie 3, Espoo, FIN-02044 VTT, FINLAND; (email: lars.leden@vtt.fi)

A unique database provided information on pedestrian accidents, intersection geometry and estimates of pedestrian and vehicle flows for the years 1983-1986 for approximately 300 signalized intersections in Hamilton, Ont., Canada. Pedestrian safety at semi-protected schemes, where left-turning vehicles face no opposing traffic but have potential conflicts with pedestrians, were compared with pedestrian safety at normal non-channelized signalized approaches, where right-turning vehicles have potential conflicts with pedestrians. Four different ways of estimating hourly flows for left- and right-turning vehicles were explored. Hourly flows were estimated for periods of 15 min, hours, two periods a day (a.m. and p.m.) and the 'daily' period (7 h). Parameter estimates were somewhat affected by the time period used for flow estimation. However, parameter estimates seem to be affected far more by the traffic pattern (left- or right-turning traffic), even though approaches were selected such that the situation for left- and right-turning traffic was similar (no opposing traffic, no advanced green or other separate phases and no channelization). Left-turning vehicles caused higher risks for pedestrians than right-turning vehicles. At low vehicular flows right turns and semi-protected left turns seemed to be equally safe for pedestrians. When risks for pedestrians were calculated as the expected number of reported pedestrian accidents per pedestrian, risk decreased with increasing pedestrian flows and increased with increasing vehicle flow. As risk decreases with increasing pedestrian flows, promoting walking will have a positive effect on pedestrian risk at signalized intersections. (Copyright © 2002 Elsevier Science)
Pedestrian fatalities by race/ethnicity in Arizona, 1990-1996.

Campos-Outcalt D, Bay C, Dellapenna A, Cota MK. Am J Prev Med 2002; 23(2): 129-135.

Correspondence: Doug Campos-Outcalt, Maricopa County Department of Public Health, 1825 E. Roosevelt St., , Phoenix, AZ 85006, USA; (email:dougcampos@mail.maricopa.gov).

OBJECTIVES: To explore rates of pedestrian fatalities in Arizona, and how rates and circumstances of pedestrian deaths differ by race/ethnicity, urban or rural residence, age, and gender.

METHODS: Using the Fatality Analysis Reporting System and the National Center for Health Statistics' Multiple Cause of Death file, pedestrian fatalities in Arizona from 1990 through 1996 were classified by gender, race/ethnicity, and urban or rural residence. Age-adjusted rates were calculated and adjusted for the proportion of rural residence. Age analyses compared pedestrian fatality rates in 10-year age groups by race/ethnicity. Conditions associated with pedestrian deaths were examined, including the time and day of occurrence, alcohol involvement, and degree of pedestrian contribution to the crash.

FINDINGS: American Indians had rates of pedestrian deaths 6 to 13 times those of non-Hispanic whites. Elevated rates for American Indians were found in urban and rural areas, in both genders, in all age groups in men, and in five of nine age groups in women. American-Indian pedestrian death rates and relative risks (RRs) were higher in rural areas than in urban areas. Compared to non-Hispanic whites, urban Hispanic males had an elevated RR of 1.56, rural Hispanic females had an RR of 2.45, and urban African-American (AA) females had an RR of 2.33. However, significantly elevated rates, compared to non-Hispanic whites, were limited to Hispanic males aged <5 years and African-American females aged 65 to 74 years. In all race/ethnic groups, except rural Hispanics, men had higher rates than women, although American-Indian women had higher rates than non-Hispanic whites, African Americans, and Hispanic men. Rural residence accounted for 27% of the excess American-Indian pedestrian mortality. Sixty-one percent of urban, American-Indian pedestrian deaths occurred on weekends, compared to 29% among non-Hispanic whites and 46% among Hispanics. American Indians had six times the rate of alcohol-related pedestrian deaths as non-Hispanic whites in urban areas and 16 times that respective rate in rural areas. Hispanics had an alcohol- involvement RR of 1.82 in urban areas, but the RR was not elevated in rural areas. When blood alcohol was measured, the blood alcohol concentration was >0.20 g/dL in 64.4% of American Indians, 35% of Hispanics, and 29% of non-Hispanic whites.

DISCUSSION: A major disparity in pedestrian fatalities exists for both American-Indian men and women in urban and rural areas. Other racial/ethnic groups have elevated pedestrian fatality rates that are gender and residence specific, and are limited to specific age groups. Much of the American-Indian excess mortality is alcohol related and associated with residence in rural areas. (Copyright © 2002 Elsevier Science)

Development of a Chinese herbal medicine toxicology database.

Bensoussan A, Myers SP, Drew AK, Whyte IM, Dawson AH. J Toxicol Clin Toxicol 2002; 40(2):159-167.

Correspondence: Alan Bensoussan, Research Unit for Complementary Medicine, University of Western Sydney, NSW, AUSTRALIA; (email: a.bensoussan@uws.edu.au).

BACKGROUND: Use of Chinese herbal medicine has increased steadily in the West and adverse reactions have been reported. However, information is not readily available on the toxicity of the herbs and the management of poisoning. The goals of this project were to retrieve and evaluate scientific evidence on the toxicity of Chinese herbal medicine, to grade the toxicity of individual herbs, and to summarize relevant herb data via a searchable electronic database.

METHODS: English and Chinese primary studies were systematically retrieved via journal abstracting databases and key toxicity texts. Partial translation of published research was achieved via an audited process utilizing data extraction forms. Methods for grading herb toxicity (in therapeutic use or overdose) were developed based on a combination of the quality of reports, severity of adverse reaction, supporting animal studies, extrapolation from pharmacology and empirical evidence.

FINDINGS: Good quality studies on the toxicity of Chinese herbs are lacking. In some cases there is insufficient scientific evidence to create an evidence-based grading of the toxicity of individual herbs. Available data have been summarized into detailed monographs. Twelve herb monographs (with a full toxicity profile and grading) have been completed and summary data for all adequate quality papers used in the grading are linked to the monographs. CONCLUSIONS: The resultant database and monographs represent the first reviews specifically on the toxicity of individual Chinese herbs with toxicological grades based on the evidence of published studies. The database and monographs should assist in promoting the safe and effective use of Chinese herbal medicine. (Copyright © 2002 Marcel Dekker Publishing)

Karting Accidents.

Stam C. Inj Control Saf Promo 2002; 9(1): 58-60.

Correspondence: Christine Stam, Consumer Safety Institute, P.O. Box 75169, Amsterdam 1070 AD, THE NETHERLANDS, (email: c.stam@consafe.nl)

BACKGROUND: Karting, or go-karting, involves the driving of small. special purpose motorized vehicles. The following hazards are mentioned in the literature: impact injuries, entanglement (of hair, loose clothing, or body parts), burns, and exposure to chemicals.

METHODS: In our analysis of karting accidents, we used accident data from the Consumer Safety Institute's Dutch Injury Surveillance System (LIS). This contains details of accident victims treated at the A & E units of a representative sample of hospitals (with continually staffed A & E departments) in the Netherlands. The period 1989-1999 was analyzed.

FINDINGS: During the early 1990s, there were between 20 and 40 such treatments each year. By 1997, that number had risen to over 1000. For the year 1999, more males (68%, 900) than females (32%, 430) were injured in karting incidents. Sixty-five percent of the victims were aged 15-34 years old. About half (56%) of these injuries were superficial grazes or contusions. About ten percent of the injuries were serious enough to require hospitalization. This proportion is more than double that for sporting accidents as a whole. (Copyright © 2002 Swets & Zeitlinger )

Modeling young driver motor vehicle crashes: data with extra zeros.

Lee AH, Stevenson MR, Wang K, Yau KK. Accid Anal Prev 2002; 34(4): 515-521.

Correspondence: Mark R Stevenson, Road Accident Prevention Research Unit, Department of Public Health, The University of Western Australia, Nedlands, WA 6009, AUSTRALIA; (email: marks@dph.uwa.edu.au).

Much of the data collected on motor vehicle crashes is count data. The standard Poisson regression approach used to model this type of data does not take into account the fact there are few crash events and hence, many observed zeros. In this paper, we applied the zero-inflated Poisson (ZIP) model (which adjusts for the many observed zeros) and the negative binomial (NB) model to analyze young driver motor vehicle crashes. The results of the ZIP regression model are comparable to those from fitting a NB regression model for general over-dispersion. The findings highlight that driver confidence/adventurousness and the frequency of driving prior to licensing are significant predictors of crash outcome in the first 12 months of driving. We encourage researchers, when analyzing motor vehicle crash data, to consider the empirical frequency distribution first and to apply the ZIP and NB models in the presence of extra zeros due, for example, to under-reporting. (Copyright © 2002 Elsevier Science)
The use of local accident and emergency injury surveillance to monitor the impact of a lay safety community programme.

Nicholson AJ, Duff S, Mullan C, O'Keefe B, Ryan M. Ir Med J 2002 May;95(5):143-145.

Correspondence: Alf J. Nicholson, CCAPP, Department of Public Health, Our Lady of Lourdes Hospital, Drogheda, Co Louth, IRELAND; (email: unavailable)

To study prospectively the injury patterns in under 14 year olds presenting to casualty. To use this information to assess the impact of a local Community Childhood Accident Prevention Project (CCAPP) Prospective injury surveillance was collected on all attendees under 14 years of age. Casualty attendance for the members of the Safety Club and matched controls were analyzed. Of the 4,267 attendees there was the expected male predominance. 2,261 (53%) of injuries occurred at home, 574 (13.5%) on the road, 553 (13%) at school with 202 (4.7%) during sports. Priority areas noted were high falls > 1 meter, road accidents, burns and poisonings. Those participating in the program demonstrated significantly (p-value < 0.05) reduced admission rates and head injury rates when compared to non-participants. The above database allows us to analyse injury patterns and to assess the success of an EU-sponsored local injury prevention campaign in areas of high social deprivation. (Copyright © 2002 Irish Medical Journal)
The role of ambient light level in fatal crashes: inferences from daylight saving time transitions.

Sullivan JM, Flannagan MJ. Accid Anal Prev 2002; 34(4): 487-498.

Correspondence: John M. Sullivan, University of Michigan Transportation Research Institute, 2901 Baxter Road, Ann Arbor, MI 48109-2150, USA; (email: jsully@umich.edu).

The purpose of this study was to estimate the size of the influence of ambient light level on fatal pedestrian and vehicle crashes in three scenarios. The scenarios were: fatal pedestrian crashes at intersections, fatal pedestrian crashes on dark rural roads, and fatal single-vehicle run-off-road crashes on dark, curved roads. Each scenario's sensitivity to light level was evaluated by comparing the number of fatal crashes across changes to and from daylight saving time, within daily time periods in which an abrupt change in light level occurs relative to official clock time. The analyses included 11 years of fatal crashes in the United States, between 1987 and 1997. Scenarios involving pedestrians were most sensitive to light level, in some cases showing up to seven times more risk at night over daytime. In contrast, single-vehicle run-off-road crashes showed little difference between light and dark time periods, suggesting factors other than light level play the dominant role in these crashes. These results are discussed in the context of the possible safety improvements offered by new developments in adaptive vehicle headlighting. (Copyright © 2002, Elsevier Science)
Road traffic accidents in the United Arab Emirates: trends of morbidity and mortality during 1977-1998.

El-Sadig M, Norman JN, Lloyd OL, Romilly P, Bener A. Accid Anal Prev 2002; 34(4): 465-476.

Correspondence: Mohammed El-Sadig, Department of Community Medicine, Faculty of Medicine and Health Sciences, UAE University, United Arab Emirates, PO Box 17666, Al Ain, UNITED ARAB EMIRATES (email: Msadig@uaeu.ac.ae).

High rates of serious road traffic accidents (RTAs) have been reported for several Arabian Gulf countries, including the United Arab Emirates (UAE). in recent years. This study aims to describe quantitatively the morbidity and mortality from RTAs in the UAE, to identify their trends during the period 1977-1998, to compare the results with those of developed countries, and to evaluate the information available on possible causes with a view to identifying the most useful direction for future research. Data were obtained from UAE's police and health sources and, for international comparison, from WHO Statistics reports and the published literature. Overall and cause-specific fatality and injury rates of RTAs were calculated. Estimates of trends were achieved by using linear regression. The characteristics of road users injured or killed were also analyzed. The results revealed that during the period 1977-1998, the rates of RTAs per 100,000 population and per 100,000 motor vehicles declined in the UAE by a trend component of -56.3 (P < 0.001: R2 = 0.69) and -521.8 (P < 0.001; R2=0.92), respectively. RTA fatality and injury rates based on the same denominators also declined by -1.1 (P < 0.001; R2 = 0.56) and -13.3 (P < 0.001; R2 = 0.47); and by -3.8 (P < 0.02; R2 = 0.23) and - 90.0 (P < 0.001; R2 = 0.59), respectively. Paradoxically, however, except for a short period (1977-1985), a steady increase in the risk of injury and death in each RTA accompanied these declines. Between 1985 and 1998 the severity rate (the ratio of fatalities and injuries per 1,000 RTAs) more than tripled in the UAE. The UAE's rates were high when compared with a number of selected countries. The cause for the increasing severity of RTAs is not clear but the most likely cause could lie in speeding, careless driving, the changing vehicle mix on the roads and the standard of immediate care available for victims. Further investigation is essential and will require close collaboration between police and health authorities. (Copyright © 2002 Elsevier Science)

Socioeconomic differences in injury risks in childhood and adolescence: a nation-wide study of intentional and unintentional injuries in Sweden.

Engstrom K, Diderichsen F, Laflamme L. Inj Prev 2002; 8(2): 137-142.

Correspondence: Karin Engstrom, Karolinska Institutet, Department of Public Health Sciences, Stockholm, SWEDEN; (email: karin.engstrom@phs.ki.se).

OBJECTIVE: To measure socioeconomic differences in injuries among different age groups of children and adolescents.

METHODS: Subjects-: Children under 20 living in Sweden between 1990 and 1994 (about 2.6 million). Design: A cross sectional study based on record linkage between 15 Swedish national registers. Children were divided into four age groups and allocated to four household socioeconomic status groups. Absolute and relative risks were compiled using children of high/intermediate level salaried employees as the comparison group. Four diagnostic groups were considered: fall, traffic, interpersonal violence, and self inflicted injuries.

FINDINGS: Injury incidences were relatively low and socioeconomic differences negligible in the 0-4 year olds. Thereafter, significant socioeconomic differences were observed in all diagnostic groups except falls. The highest absolute differences were in traffic injuries, especially among 15-19 year olds, and in self inflicted injuries among 15-19 year old girls. Relative differences were highest in both categories of intentional injuries for the age group 10-14. Social circumstances in the household other than family socioeconomic status affected the social pattern of intentional but not that of unintentional injuries.

DISCUSSION: Socioeconomic differences in injury risks are not necessarily constant over age. Inequalities are particularly high in absolute terms among adolescents 15-19 years old for traffic injuries and in relative terms among 10-14 year olds for intentional injuries. (Copyright © 2002 BMJ Publications)
Citywide trauma experience in Kampala, Uganda: a call for intervention.

Kobusingye OC, Guwatudde D, Owor G, Lett RR. Inj Prev 2002; 8(2): 133-136.

Correspondence: Olive Kobusingye, Department of Surgery, Faculty of Medicine, Makerere University and Injury Control Centre, Kampala, UGANDA; (email: olive@imul.com).

OBJECTIVES: To describe injuries and their emergency care at five city hospitals.

METHODS: Setting- Data were collected between January and December 1998 from casualty departments of the five largest hospitals of Kampala city, Uganda, with bed capacity ranging from 60 to 1200. Registry forms were completed on trauma patients. All patients with injuries were eligible. Outcome at two weeks was determined for admitted patients.

FINDINGS: Of the 4359 injury patients, 73% were males. Their mean age was 24.2 years, range 0.1-89, and a 5-95 centile of 5-50 years. Patients with injuries were 7% of all patients seen. Traffic crashes caused 50% of injuries, and were the leading cause for patients > or = 10 years. Fifty eight per cent of injuries occurred on the road, 29% at home, and 4% in a public building. Falls, assaults, and burns were the main causes in homes. Fourteen per cent of injuries were intentional. Injuries were severe in 24% as determined with the Kampala trauma score. One third of patients were admitted; two thirds arrived at the hospital within 30 minutes of injury, and 92% were attended within 20 minutes of arrival.

DISCUSSION: Injuries in Kampala are an important public health problem, predominantly in young adult males, mostly due to traffic. The majority of injuries are unintentional. Hospital response is rapid, but the majority of injuries are minor. Without pre-hospital care, it is likely that patients with serious injuries die before they access care. Preventive measures and a pre-hospital emergency service are urgently needed. (Copyright © 2002 BMJ Publications)

Strategies for dynamic stability during locomotion on a slippery surface: effects of prior experience and knowledge.

Marigold DS, Patla AE. J Neurophysiol 2002; 88(1): 339-353.

Correspondence: Aftab Patla, Gait and Posture Lab, Department of Kinesiology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; (email: patla@healthy.uwaterloo.ca).

Falls due to slips are prevalent in everyday life. The purpose of this study was to determine the reactive recovery responses used to maintain dynamic stability during an unexpected slip, establish the time course of response adaptation to repeated slip perturbations, and distinguish the proactive strategies for negotiating a slippery surface. Twelve young adults participated in the study in which a slip was generated following foot contact on a set of steel free-wheeling rollers. Surface electromyographic (EMG) data were collected from rectus femoris, biceps femoris, tibialis anterior, and the medial head of gastrocnemius on the perturbed limb. Whole body kinematics were recorded using an optical imaging system: from this the center of mass, foot angle, and medial-lateral stability margins were determined. In addition, braking/loading and accelerating/unloading impulses while in contact with the rollers and the rate of loading the rollers were determined from ground reaction forces. Results demonstrate that the reactive recovery response to the first slip consisted of a rapid onset of a flexor synergy (146-199 ms), a large arm elevation strategy, and a modified swing limb trajectory. With repeated exposure to the slip perturbation, the CNS rapidly adapts within one slip trial through global changes. These changes include the attenuation of muscle response magnitude, reduced braking impulse, landing more flat-footed, and elevating the center of mass. Individuals implement a "surfing strategy" while on the rollers when knowledge of the surface condition was available before hand. Furthermore, knowledge of a slip results in a reduced braking impulse and rate of loading, a shift in medial-lateral center of mass closer to the support limb at foot contact on the rollers and a more flat foot landing. In conclusion, prior experience with the perturbations allows subsequent modification and knowledge of the surface condition results in proactive adjustments to safely traverse the slippery surface. (Copyright © 2002 by the American Physiological Society)
Injury caused by baby walkers: the predicted outcomes of mandatory regulations.

Thompson PG. Med J Aust 2002; 177(3): 147-148.

Correspondence: Peter Thompson, Epidemiology Branch, South Australian Department of Human Services, PO Box 6, Rundle Mall, Adelaide, SA 5000, AUSTRALIA; (email: Peter.Thompson@dhs.sa.gov.au).

OBJECTIVE: To examine the potential of the New South Wales baby-walker regulation to reduce injury.

DESIGN: Injury surveillance data were used to reconstruct baby-walker injury incidents, which were examined in conjunction with the 2000 NSW baby-walker regulation, which requires a specified level of stability and a gripping mechanism to stop the walker at the edge of a step. SETTING AND PARTICIPANTS: Injury surveillance data on injuries to 381 babies collected from hospital emergency departments in South Australia and Victoria, 1986-2000. MAIN OUTCOME MEASURE: Injury events that would still have occurred with the regulation in place.

FINDINGS: About half (46%; 95% CI, 32.5%-59.8%) of the serious baby-walker injuries (ie, requiring admission to hospital) are caused by the walker enabling babies to reach hazards other than steps and stairs.

DISCUSSION: The New South Wales regulation has the potential to eliminate only about half the baby-walker injuries. Banning baby walkers altogether is preferable. (Copyright © 2002 Australian Medical Association)
Falls in African American and white community-dwelling elderly residents.

Hanlon JT, Landerman LR, Fillenbaum GG, Studenski S. J Gerontol A Biol Sci Med Sci 2002; 57(7): M473-478.

Correspondence: Joseph T. Hanlon, College of Pharmacy, 7–115 Weaver-Densford Hall, University of Minnesota, 308 Harvard Street S.E., Minneapolis, MN 55455, USA; (email: hanlo004@tc.umn.edu).

BACKGROUND: Few studies have examined the relationship of race to falls. This study evaluated the association between potential risk factors and falls in a representative sample of 1049 African American and 1947 white participants of the second in-person wave of the Duke Established Populations for Epidemiologic Studies of the Elderly.

METHODS: Information about sociodemographic characteristics, health-related behaviors, health status, visual function, and drug use was determined during baseline in-home interviews. Three years later, falls in the previous 12 months were assessed by self-report.

FINDINGS: One or more falls occurred in 22.2% of the participants. Nearly half the fallers reported more than one fall. Multivariable analysis revealed that African Americans were less likely than whites to have any fall (adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62-0.94). Increased age and education, arthritis, diabetes, and history of broken bones were also significant (p < .05) independent risk factors for any fall. In multivariable analyses comparing those with two or more falls to those with none, again, increased age and education, arthritis, and diabetes were significant (p < .05) independent risk factors while smoking was protective. Race was not a significant predictor of multiple falls (adjusted OR 0.90, 95% CI 0.64-1.26).

DISCUSSION: Similar sociodemographic characteristics and health problems appear to be important risk factors for any and multiple falls in community-dwelling African American and white elderly residents, with white elders at greater risk of one-time falls. (Copyright © 2002 Gerontological Society of America)

No reports this week

No reports this week

Physical activity, sports participation, and suicidal behavior among college students.

Brown DR, Blanton CJ. Med Sci Sports Exerc 2002; 34(7):1087-1096.

Correspondence: David R. Brown, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA; (email: drb8@CDC.GOV).

OBJECTIVES: To evaluate the relationship between physical activity, sports participation, and suicidal behavior among college students (N = 4,728).

METHODS: Data from the 1995 National College Health Risk Behavior Survey were analyzed. Students were classified as engaging in frequent vigorous activity 6-7 d.wk-1, vigorous activity 3-5 d.wk-1, moderate activity, low activity, or no activity. Sports participation was dichotomized into "yes" or "no" participation. Suicidal behavior was defined as thoughts about, plans for, or attempts at suicide during the 12 months before completing the survey. Data were stratified by sex and multivariable logistic regression modeling, calculated odds ratios (ORs) (adjusted for age, race/ethnicity, Body Mass Index/weight perception, cigarette smoking, episodic heavy alcohol use, drug use, and either activity level or sport participation) for suicidal behavior as associated with physical activity and sports participation.

FINDINGS: Adjusted ORs show that men in the "low activity" group were at almost half the odds (adjusted OR = 0.54; P < 0.015) of reporting suicidal behavior than men in the "not active" group. Women who engaged in moderate or frequent vigorous activity were at greater odds of reporting suicidal behavior compared with inactive women; OR = 1.76 (P < 0.035) and 1.99 (P < 0.034) respectively. Sports participation was protective against suicidal behavior. Adjusted ORs show that men who did not participate in sports were 2.5 times (P < 0.0003) more likely to report suicidal behavior than men who were sports participants. Women not participating in sports had 1.67 times the odds of reporting suicidal behavior than women sports participants (P < 0.05).

DISCUSSION: Associations were found between sports participation/selected patterns of physical activity and suicidal behavior. Causal factors mediating the relationships need to be identified. (Copyright © 2002 American College of Sports Medicine)
Sexual assault history and suicidal behavior in a national sample of women.

Ullman SE, Brecklin LR. Suicide Life Threat Behav 2002; 32(2): 117-130.

Correspondence: Sarah E. Ullman, Department of Criminal Justice, University of Illinois at Chicago 60607-7140, USA; (email: seullman@uic.edu).

This study examined demographic and psychosocial correlates of suicidal ideation and suicide attempts in women with histories of sexual assault in childhood and/or adulthood identified from a national sample of women. Multivariate analyses showed that women with histories of sexual assault in both childhood and adulthood reported significantly greater odds of lifetime suicide attempts, controlling for demographic factors and other psychosocial characteristics. As predicted, younger age (marginal), stressful life events (marginal), depression, PTSD, and alcohol dependence symptoms were also significantly associated with suicidal ideation. Furthermore, number of lifetime traumatic events and depression were each associated with lifetime odds of suicide attempts. Implications for studying the role of sexual trauma and other psychosocial factors in relation to women's suicidal behavior are discussed. (Copyright © 2002 American Association of Suicidology)
Suicidality after traumatic brain injury: demographic, injury and clinical correlates.

Simpson G, Tate R. Psychol Med 2002; 32(4): 687-697.

Correspondence: Correspondence: Grahame Simpson, Brain Injury Rehabilitation Unit, Liverpool Hospital, Locked Bag 7103, Liverpool BC, New South Wales 1871, AUSTRALIA; (email: unavailable).

BACKGROUND: In spite of the high frequency of emotional distress after traumatic brain injury (TBI), few investigations have examined the extreme of such distress, namely, suicidality, and no large scale surveys have been conducted. The current study examined both the prevalence and demographic, injury, and clinical correlates of hopelessness, suicidal ideation and suicide attempts after TBI.

METHODS: Out-patients (N = 172) with TBI were screened for suicidal ideation and hopelessness using the Beck Scale for Suicide Ideation and the Beck Hopelessness Scale. Data were also collected on demographic, injury, pre-morbid and post-injury psychosocial variables and included known risk factors for suicide.

FINDINGS: A substantial proportion of participants had clinically significant levels of hopelessness (35%) and suicide ideation (23%), and 18% had made a suicide attempt post-injury. There was a high degree of co-morbidity between suicide attempts and emotional/psychiatric disturbance. Results from regression analyses indicated that a high level of hopelessness was the most significant association of suicide ideation and a high level of suicide ideation, along with occurrence of post-injury emotional/psychiatric disturbance, were the most significant associations of post-injury suicide attempts. Neither injury severity nor the presence of pre-morbid suicide risk factors contributed to elevated levels of suicidality post-injury.

DISCUSSION: Suicidality is a common psychological reaction to TBI among out-patient populations. Management should involve careful history taking of previous post-injury suicidal behavior, assessment of post-injury adjustment to TBI with particular focus on the degree of emotional/psychiatric disturbance, and close monitoring of those individuals with high levels of hopelessness and suicide ideation. (Copyright © 2002 Cambridge University Press)
The occurrence of suicide in severe depression related to the months of the year and the days of the week.

Bradvik L. Eur Arch Psychiatry Clin Neurosci 2002; 252(1): 28-32.

Correspondence: Louise Bradvik, Department of Clinical Neuroscience, Lund University Hospital, SWEDEN; (email: louise.bradvik@telia.com).

The purpose of the present study was to investigate the distribution of suicide during the months of the year and the days of the week in severe depression. A total of 1206 in-patients rated at discharge from the Department of Psychiatry, Lund, Sweden, on a multiaxial diagnostic schedule received the diagnosis severe depression/melancholia between 1956 to 1969. When followed up to 1998, a total of 114 depressed patients had taken their own life. Out of these, 98 patients appeared to have a primary depression. The monthly distribution of suicides showed a significant peak in October/November for men (41 % of all male suicides). No correlation with the onset of depression could be detected. Furthermore, there was a preponderance of suicide on Sundays for both sexes (31 % of all suicides). (Copyright © 2002 Steinkopff Verlag)

Visual search while driving: skill and awareness during inspection of the scene.

Underwood G, Chapman P, Bowden K, Crundall D. Transp Res Traffic Psychol Behav 2002; 5(2): 87-97.

Correspondence: Geoffrey Underwood, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK; ( email: geoff.underwood@nottingham.ac.uk).

Novice drivers tend to restrict their search of the road on dual-carriageways, relative to the scanning observed in experienced drivers. The present study determined whether the difference was the result of novices having limited mental capacity remaining after vehicle control had been maintained, or whether it resulted from an impoverished mental model of the events likely to occur on a dual-carriageway. Novice and experienced drivers watched video-recordings taken from a car traveling along a variety of roads, including dual-carriageways, and their eye movements were recorded to determine the scanning patterns as they followed instructions to indicate hazardous events. The experienced drivers showed more extensive scanning on the demanding sections of dual-carriageway in this task. This supports the hypothesis that the inspection of the roadway by novices is limited not because they have limited mental resources residual from the task of vehicle control, but that they have an impoverished mental model of what is likely to happen on dual-carriageways. (Copyright © 2002 Elsevier Science)
Change detection and occlusion modes in road-traffic scenarios.

Velichkovsky BM, Dornhoefera SM, Kopfb M, Helmerta J, Joosa M. Transp Res Traffic Psychol Behav 2002; 5(2): 99-109.

Correspondence: Boris M. Velichkovsky, Applied Cognitive Research Unit/Psychology III, Dresden University of Technology, 01062, Dresden, Germany; (email: velich@applied-cognition.org).

Change blindness phenomena are widely known in cognitive science, but their relation to driving is not quite clear. We report a study where subjects viewed color video stills of natural traffic while eye movements were recorded. A change could occur randomly in three different occlusion modes -- blinks, blanks and saccades -- or during a fixation (as control condition). These changes could be either relevant or irrelevant with respect to the traffic safety. We used deletions as well as insertions of objects. All occlusion modes were equivalent concerning detection rate and reaction time, deviating from the control condition only. The detection of relevant changes was both more likely and faster than that of irrelevant ones, particularly for relevant insertions, which approached the base line level. Even in this case, it took about 180 ms longer to react to changes when they occurred during a saccade, blink or blank. In a second study, relevant insertions and the blank occlusion were used in a driving simulator environment. We found a surprising effect in the dynamic setting: an advantage in change detection rate and time with blanks compared to the control condition. Change detection was also good during blinks, but not in saccades. Possible explanation of these effects and their practical implications are discussed. (Copyright © 2002 Elsevier Science)
Mental load and loss of control over speed in real driving: Towards a theory of attentional speed control.

Recarte MA, Nunes L. Transp Res Traffic Psychol Behav 2002; 5(2): 111-122.

Correspondence: Luis Nunes, Direccion General de Tráfico, Josefa Valcarcel 28, 28027, Madrid, SPAIN; (email: argos@dgt.es).

Relationships between attention and speed control are analyzed. The demands of speed control are derived from subjective appreciation of the traffic environment and from the need to adapt to legal restrictions. Drivers check the speedometer more or less frequently and also use their subjective speed perception while looking ahead. It is hypothesized that, in absence of specific speed restrictions, drivers choose an optimum preferred speed so that the attentional effort dedicated to speed control is minimized but with explicit speed restrictions additional resources are required to keep speed under control including more glances to the speedometer. If a secondary task needs attention the speed control is affected and the speed tends to return to the optimal preferred level. Twelve participants drove about 200 km in a Spanish highway under eight conditions: two speedometer states (visible/concealed) x two speed instructions (free/restricted between 90 and 100 km/h) x two workload states (normal driving/performing a mental task). The results demonstrated: (a) that under free speed the drivers choice was 11 km/h faster than in the restricted-speed condition, indicating that the speed instructions were effective and operated as a speed limit. (b) When a mental task was performed the speed increased independently of the speedometer availability under restricted speed but not in the free speed condition, what clearly supports the stated hypothesis. The role of the speedometer in speed control, its relations with endogenous distraction and its implications for driving are analyzed. (Copyright © 2002 Elsevier Science)
Cognitive demands of hands-free-phone conversation while driving.

Nunes L, Recarte MA. Transp Res Traffic Psychol Behav 2002; 5(2): 133-144.

Correspondence: Luis Nunes, Direccion General de Tráfico, Josefa Valcarcel 28, 28027, Madrid, SPAIN; (email: argos@dgt.es).

In four field experiments the participants drove an instrumented car provided with a hands-free phone and performed several cognitive tasks while driving including phone conversations. The study focussed the cognitive component of the conversations, excluding dialling. The cognitive demands of the conversations were varied and in two of the experiments the same tasks had two versions: by phone and in live conversation with the experimenter in the car. Several dependent measures like visual search behavior, driving speed, visual detection and response selection capacities and others were analyzed. Like in previous experiments of the same authors the more demanding cognitive tasks produced higher interference effects, but when the same tasks performed by phone were compared with its live versions no differences were observed. Once the manual phone operation has been technically suppressed the risk of phone conversations relies on the demands of the message content and its equivalent to talking to a passenger. Implications for safety are discussed. (Copyright © 2002 Elsevier Science)
Seat belt use among African Americans, Hispanics, and Whites.

Wells JK, Williams AF, Farmer CM. Accid Anal Prev 2002; 34(4): 523-529.

Correspondence: JoAnn K. Wells, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201-4751, USA; (email: jwells@iihs.org).

OBJECTIVES: This study investigated seat belt use among White, Black, and Hispanic drivers, in cities in which standard enforcement of the belt use law is permitted (primary enforcement) and in cities in which a motorist has to be first cited for another offense (secondary enforcement). Socioeconomic and gender differences in belt use were also studied.

METHODS: Belt use observations were obtained at gas stations in Boston, Chicago, Houston, and New York City. In short interviews with drivers, information on race/ethnicity and education was obtained.

FINDINGS: Belt use was higher in primary enforcement cities, among women, and among those with at least a college degree. In primary law cities there were no clear differences in belt use by race/ethnicity; in secondary cities African Americans were less likely than Whites or Hispanics to be belted, among populations both with and without college degrees. This is consistent with data from other studies indicating that African Americans are more sensitive than Whites to the enforcement of primary laws and are more likely to increase belt use when states shift from secondary to primary. There has been no evidence of enforcement bias against African Americans--increases in citations generally have been greater among Whites than African Americans once primary enforcement is implemented.

DISCUSSION: More widespread application of primary laws -- standard throughout the world but in only 17 US states and the District of Columbia -- would increase belt use for all drivers, especially African Americans. (Copyright © 2002 Elsevier Science)
Driving life expectancy of persons aged 70 years and older in the United States.

Foley DJ, Heimovitz HK, Guralnik JM, Brock DB. Am J Public Health 2002; 92(8): 1284-1289.

Correspondence: Daniel J. Foley, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, 7201 Wisconsin Avenue, Bethesda, MD 20892, USA; (email: foleyd@qw.nia.nih.gov).

OBJECTIVES: We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older.

METHODS: Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey.

FINDINGS: Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies.

DISCUSSION: Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70. (Copyright © 2002 American Public Health Association)
Transport safety for older people: A study of their experiences, perceptions and management needs.

Peel N, Westmoreland J, Steinberg M. Inj Control Saf Promo 2002; 9(1): 19-24.

Correspondence: Nancye Peel, University of Queensland Medical School, School of Population Health, Herston QLD 4006, AUSTRALIA (email: n.peel@sph.uq.edu.au)

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.

The present study aimed to identify transport options and licensing issues for a group of older people in an Australian community. 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.

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. 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)
A study to measure the incidence of driving under suspension in the Greater Moncton area.

Malenfant JE, Van Houten R, Jonah B. Accid Anal Prev 2002; 34(4): 439-447.

Correspondence: Ron Van Houten, Mount Saint Vincent University, 266 Bedford Highway, Halifax, Nova Scotia, B3M 2J6 CANADA; email: (rvh@cers-safety.com).

Roadside checkpoints were used to determine the percentage of motorists driving while suspended (DWS) during various times of the day. These data showed that the percentage of motorists DWS was 57% of the expected value relative to their representation among all drivers. Data also showed that suspended drivers make up a higher percentage of drivers on the road after midnight. Results also indicated that 90% of suspended drivers stopped in this study produced a driving permit even though they are required to surrender it when suspended. In order to compare data collected at roadside checkpoints with self-report data. a questionnaire was administered to 456 persons taking a re-education course for first offenders and 68 participants taking a re-education course for second offenders. The results indicated that participants under-represented their own incidence of DWS. However, when asked about the driving behavior of other suspended drivers, their estimates were much closer to the data obtained with the roadside survey. (Copyright © 2002 Elsevier Science)
Predicted effect of automatic crash notification on traffic mortality.

Clark DE, Cushing BM. Accid Anal Prev 2002; 34(4): 507-513.

Correspondence: David E. Clark, Department of Surgery, Maine Medical Center, 887 Congress Street, Suite 210, Portland, ME 04102, USA; (email: clarkd@mail.mmc.org).

OBJECTIVE: To estimate the reduction in traffic mortality in the United States that would result from an automatic crash notification (ACN) system.

METHODS: 1997 Fatality Analysis Reporting System (FARS) data from 30,875 cases of incapacitating or fatal injury with complete information on emergency medical services (EMS) notification and arrival times were analyzed considering cases at any time to be in one of four states: (1) alive prior to notification; (2) alive after notification; (3) alive after EMS arrival; and (4) dead. For each minute after the crash, transition probabilities were calculated for each possible change of state. These data were used to construct models with (1) number of incapacitating injuries ranging from FARS cases up to an estimated total for the US in 1997; (2) deaths equal to FARS total; (3) transitions to death from other states proportional to FARS totals and rates and (4) other state transitions equal to FARS rates. The outcomes from these models were compared to outcomes from otherwise identical models in which all notification times were set to 1 min.

FINDINGS: FARS data estimated 12,823 deaths prior to notification, 1800 after notification, and 14,015 between EMS arrival and 6 h. If notification times were all set to 1 min, a model using FARS data only predicted 10,703 deaths prior to notification, 2,306 after notification, and 15,208 after EMS arrival, while a model using an estimated total number of incapacitating injuries for the US predicted 9,569 deaths prior to notification, 2,261 after notification, and 15,134 after arrival. In the first model, overall mortality was reduced from 28,638 to 28,217 (421 per year. or 1.5%), while in the second model mortality was reduced to 26,964 (1,674 per year, or 6%).

DISCUSSION: Modest but important reduction in traffic mortality should be expected from a fully functional ACN system. Imperfect systems would be less effective. (Copyright © 2002 Elsevier Science)
Emergency medical service rescue times in Riyadh.

Al-Ghamdi AS. Accid Anal Prev 2002; 34(4): 499-505.

Correspondence: Ali S. Al-Ghamdi, College of Engineering, King Saud University, P.O. Box 800, Riyadh 11421, Saudi Arabia; (email: asghamdi@ksu.edu.sa).

The emergency medical service (EMS) in Saudi Arabia is managed by each hospital through the Saudi Red Crescent Society (SRCS). There are approximately 165 ambulance stations in the country, each with two ambulances. The SRCS collects data on EMS requests and ambulance arrival times at the accident scene. Each emergency incident has its own implications (accident, fire, injury, etc.) and must be dealt with individually. The aims of this study are to evaluate ambulance rescue time, which includes response time, in the city of Riyadh, the capital of Saudi Arabia; to analyze this time for road traffic accidents; and to compare the response time in Riyadh with corresponding times in other countries. A sample of 874 emergency calls was collected during 1999. Ambulance rescue time consists of three components: response time, time at the scene and travel time to the hospital. Data analysis showed that rescue time is, on average, 35.84 min (S.D. = 6.43 min). Within this time, the average response time is 10.23 min (S.D. = 5.66 min). Other service components (e.g. ambulance time at the accident scene and travel time to the hospital) are analyzed and detailed statistics are given. Ambulance speed to the accident averages approximately 55.05 km/h (S.D. = 27.42 km/h). One primary finding is that there is room for improvement in the rescue time in Riyadh, which would save more lives, through an increase in the efficiency of ambulance team performance. A test statistic is developed in this study to carry out a simple hypothesis testing for percentiles. This test statistic, which is generic and can be used for other applications, is used to compare EMS response time in Riyadh with that in other parts of the world. (Copyright © 2002 Elsevier Science)
Injury to the spinal cord in motor vehicle traffic crashes.

O'Connor P. Accid Anal Prev 2002; 34(4): 477-485.

Correspondence: Peter O'Connor, Australian Spinal Cord Injury Register, AIHW National Injury Surveillance Unit, Flinders University Research Centre for Injury Studies, Mark Oliphant Building, Laffer Drive, Bedford Park, 5042, AUSTRALIA; (email: peter.oconnor@nisu.flinders.edu.au).

Motor vehicle traffic crashes (MVTCs) are the leading cause of traumatic spinal cord injury. Evidence of putative risk factors for this type of injury comes largely from descriptive studies. This study is the first case-control study of risk factors for spinal cord injury specifically in car crashes. Cases of occupant spinal cord injury in South Australia were identified from the Australian Spinal Cord Injury Register (ASCIR) which provides full coverage of the adult population. The comparison group was other seriously injured car occupants. In single vehicle car crashes in the country, the likelihood of spinal cord injury was five times higher for occupants of non-sedan type cars compared with sedans. The likelihood of spinal cord injury was especially high in non-sedan type cars involved in rollover crashes; ten times higher than sedans. The implications of the findings for prevention are highlighted. Concern is expressed over the increasing proportion of four wheel drive passenger vehicles (sport utility vehicles) in the car fleet in Australia, and in the USA, as they are more prone to rollover. (Copyright © 2002 Elsevier Science)
Self-reports of aberrant behaviour on the roads: errors and violations in a sample of Greek drivers.

Kontogiannis T, Kossiavelou Z, Marmaras N. Accid Anal Prev 2002; 34(3):381-399.

Correspondence: Tom Kontogiannis, Department of Production Engineering and Management, Technical University of Crete, University Campus, Crete, Chania GR 73100, GREECE; (email: konto@dpem.tuc.gr).

Recent studies have shown that unsafe driver acts can be classified into two distinct categories (i.e. errors and violations) entailing different measures for reducing road traffic accidents. A survey of over 1,400 drivers in Greece is reported in which a variety of aberrant driving behaviors have been identified. The present study has confirmed the results of earlier studies in the driving populations of Britain. Australia and Sweden that errors and violations are the major determinants in the factor structure of aberrant behaviors. Three types of violations were identified including, highway code-, aggressive- and parking-violations (or situational violations). Mistakes and lapses were two major forms of errors. The factor analysis identified another two classes of behavior that could not be accounted for very well by the error-violation distinction. One class of behaviors referred to a state of low preparedness and negligence while the other class referred to communication errors and 'social disregard' for the other road users. Each class of behavior was found to have different demographic correlates. Finally, accident liability was predicted by self-reported tendency to commit highway-code violations, but not by tendency to make errors due to failures of judgment (i.e.. mistakes) or lapses. Aggressive violations were significantly related to involvement in speeding convictions and law-breaking whilst highway-code violations were related to speeding convictions only. (Copyright © 2002 Elsevier Science)
Effects of road geometry and traffic volumes on rural roadway accident rates.

Karlaftis MG, Golias I. Accid Anal Prev 2002; 34(3): 357-365.

Correspondence: Matthew G. Karlaftis, Department of Transportation Planning and Engineering, Faculty of Civil Engineering, National Technical University of Athens, 5 Iroon Polytechnion Street, 157 93 Zografon, Athens, GREECE; (email: mgk@central.ntua.gr).

This paper revisits the question of the relationship between rural road geometric characteristics, accident rates and their prediction, using a rigorous non-parametric statistical methodology known as hierarchical tree-based regression. The goal of this paper is twofold: first, it develops a methodology that quantitatively assesses the effects of various highway geometric characteristics on accident rates and, second, it provides a straightforward, yet fundamentally and mathematically sound way of predicting accident rates on rural roads. The results show that although the importance of isolated variables differs between two-lane and multilane roads, 'geometric design' variables and pavement condition' variables are the two most important factors affecting accident rates. Further, the methodology used in this paper allows for the explicit prediction of accident rates for given highway sections, as soon as the profile of a road section is given. (Copyright © 2002 Elsevier Science)
Is the claim that 'variance kills' an ecological fallacy?

Davis GA. Accid Anal Prev 2002; 34(3): 343-346.

Correspondence: Gary A. Davis, Department of Civil Engineering, University of Minnesota, 122 CivE, 500 Pillsbury Drive SE, Minneapolis, MN 55455, USA; (email: drtrips@tc.umn.edu).

Over the past 15 years, a number of studies have reported positive correlations between estimated traffic crash rate and the dispersion of vehicle speeds. These correlations have on occasion been interpreted as supporting the view that slower and/or faster drivers have higher crash risks, or that speed variance itself is a causal factor for individual crash risk. This paper points out first that such positive correlations can be expected in situations where individual crash risk is either an increasing, or a decreasing, or a U-shaped function of speed, and so the correlations in themselves provide no evidence concerning the relation between speed and crash risk for individuals. Second, since such correlations can be expected in circumstances where individual risk is independent of speed variance, observation of these correlations provides no support for the hypothesis that increases in speed variance increase individual risk. (Copyright © 2002 Elsevier Science)
Driver response to variable message sign information in London.

K. Chatterjee K, Hounsell NB, Firmin PE, Bonsall PW. Transp Res Emerg Technol 2002; 149-169.

Correspondence: Kiron Chatterjee, Department of Civil and Environmental Engineering, Transportation Research Group, University of Southampton, Southampton SO17 1BJ, UK (email: k.chatterjee@soton.ac.uk).

Variable message signs (VMS) have been installed in London to notify motorists of planned events and current network problems. To guide investment and operational decisions an understanding is required of the impacts of VMS information. This paper presents the results of a study of driver response to VMS information. The study employed questionnaires to investigate the effect of different messages on route choice. A statistical analysis of stated intention questionnaire data enabled logistic regression models to be developed relating the probability of route diversion to driver, journey and message characteristics. The resultant models indicate that the location of the incident and the message content are important factors influencing the probability of diversion. A survey of drivers' actual responses to a message activation showed that only one third of drivers saw the information presented to them and few of these drivers diverted, although many found the information useful. Only one-fifth of the number of drivers diverted compared to that expected from the results of the stated intention questionnaire. It is thought that the low response rate achieved for the stated intention survey will have exaggerated drivers' responsiveness to VMS messages. Interestingly, survey data for another UK city with a newly installed VMS system showed that the number of drivers diverting due to VMS information was very similar to that expected from the results of the stated intention questionnaire. It is suggested that the use of London's VMS signs to display warnings of disruptions expected on future dates may be reducing their effectiveness as a channel for more urgent warnings. (Copyright © 2002 Elsevier Science)

Civil protection orders and risk of subsequent police-reported violence.

Holt VL, Kernic MA, Lumley T, Wolf ME, Rivara FP. JAMA 2002; 288(5): 589-594.

Correspondence: Victoria Holt, Department of Epidemiology, University of Washington, Box 358080 (MP474), Seattle, WA 98195-8080, USA; (email: vholt@u.washington.edu).

BACKGROUND: Approximately 1.5 million US women experience intimate partner violence annually. Approximately 20% of these women obtain civil protection orders, but the effectiveness of such orders in preventing future violence is unclear.

OBJECTIVE: To assess associations between obtaining a protection order and risk of subsequent police-reported intimate partner violence.

DESIGN, SETTING, AND SUBJECTS: Retrospective cohort study of 2691 adult female residents of Seattle, Wash, with an incident of male intimate partner violence reported to the Seattle Police Department between August 1, 1998, and December 31, 1999.

MAIN OUTCOME MEASURE: Relative risk (RR) of police-reported physical and psychological abuse in the 12 months following the index incident according to protection order status (temporary protection order, usually in effect for 2 weeks; permanent protection order, usually in effect for 12 months; or no protection order).

FINDINGS: Overall rates of police-reported physical and psychological abuse in the 12 months of follow-up were 13.5 per 100 person-years and 12.3 per 100 person-years, respectively. After controlling for cohabitation at time of index incident and index incident offense type, women with temporary protection orders in effect were more likely than women without protection orders to be psychologically abused (RR in the first 6 months after the index incident, 4.0; 95% confidence interval [CI], 2.2-7.2; RR in the entire 12 months after the index incident, 4.9; 95% CI, 2.8-8.6), while women with permanent protection orders in effect were less likely than those without orders to be physically abused (RR in the first 6 months, 0.4; 95% CI, 0.1-1.1; RR in the entire 12 months, 0.2; 95% CI, 0.1-0.8).

DISCUSSION: Permanent, but not temporary, protection orders are associated with a significant decrease in risk of police-reported violence against women by their male intimate partners. (Copyright © 2002 American Medical Association)
Should health professionals screen women for domestic violence? Systematic review.

Ramsay J, Richardson J, Carter YH, Davidson LL, Feder G. BMJ 2002; 325: 314-327.

Correspondence: Gene Feder, National Perinatal Epidemiology Unit, Institute of Health Sciences, Oxford OX3 7LF England, UK; (email: g.s.feder@qmul.ac.uk).

OBJECTIVE: To assess the evidence for the acceptability and effectiveness of screening women for domestic violence in health care settings.

METHODS: Design- Systematic review of published quantitative studies. Search strategy- Three electronic databases (Medline, Embase, and CINAHL) were searched for articles published in the English language up to February 2001. Included studies- Surveys that elicited the attitudes of women and health professionals on the screening of women in health settings; comparative studies conducted in health care settings that measured rates of identification of domestic violence in the presence and absence of screening; studies measuring outcomes of interventions for women identified in health settings who experience abuse from a male partner or ex-partner compared with abused women not receiving an intervention.

FINDINGS: 20 papers met the inclusion criteria. In four surveys, 43-85% of women respondents found screening in health care settings acceptable. Two surveys of health professionals' views found that two thirds of physicians and almost half of emergency department nurses were not in favor of screening. In nine studies of screening compared with no screening, most detected a greater proportion of abused women identified by health care professionals. Six studies of interventions used weak study designs and gave inconsistent results. Other than increased referral to outside agencies, little evidence exists for changes in important outcomes such as decreased exposure to violence. No studies measured quality of life, mental health outcomes, or potential harm to women from screening programs.

DISCUSSION: Although domestic violence is a common problem with major health consequences for women, implementation of screening programs in health care settings cannot be justified. Evidence of the benefit of specific interventions and lack of harm from screening is needed. (Copyright © 2002 BMJ Publications)
Age patterns of suicide and homicide mortality rates in high-income nations.

Pampel FC, Williamson JB. Social Forces2001; 80(1): 251-282.

Correspondence: Fred C. Pampel, Department of Sociology, University of Colorado, 219 Ketchum Hall, UCB 327, Boulder, CO 80309, USA; (email: Fred.Pampel@Colorado.edu).

In most nations, suicide rates tend to increase and homicide victimization rates tend to decrease with age, but the degree of increase and decrease varies over time and across nations. In particular, some nations more than others show a worsening of youth lethal violence relative to older age groups. This age variation across nations and time in both forms of lethal violence may result from (1) the sizes of youth and elderly age groups, and the disadvantages and advantages, respectively, that size brings; (2) family changes that most harm younger, more recent cohorts; and (3) sociopolitical dimensions of equality that smooth the transition to adulthood. Using aggregate data on 18 nations over the period from 1955 to 1994, the analysis examines how these determinants affect measures of suicide and homicide rates among the young relative to older ages. In support of the theoretical arguments, the results show that deviations from the general increase in suicide with age and decrease in homicide with age relate as predicted to measures of demographic, family, and sociopolitical institutions. (Copyright © 2002 Southern Sociological Society and University of North Carolina Press)
Black-White Differentials in Adult Homicide Mortality in the United States.

Rogers RG, Rosenblatt R, Hummer RA, Krueger PM. Soc Sci Q 2001; 82(3): 435-452.

Correspondence: Richard G. Rogers, Department of Sociology, University of Colorado, 219 Ketchum Hall, UCB 327, Boulder, CO 80309, USA; (email: Richard.Rogers@Colorado.edu).

BACKGROUND: Homicide is a major social problem and a central cause of preventable death in the United States. A homicide not only claims one life prematurely but can also devastate a family, friends, and a neighboring community.

METHODS: We link eight consecutive years of the National Health Interview Survey (1987-94) to the Multiple Cause of Death file through the National Death Index (1987-97), and use Cox proportional hazard models to examine the role of social factors in black-white homicide mortality in the United States.

FINDINGS: We find that individual level sociodemographic characteristics—age, sex, marital status, education, employment status, and geographic factors—explain almost 35 percent of the racial differences in homicide mortality.

DISCUSSION: These results demonstrate the contributions that National Center for Health Statistics data can make to criminological literature and reveal the mechanisms through which blacks experience higher homicide mortality than whites. Such illumination may lead to a reduction in the fourth leading preventable cause of death in the United States. (Copyright © 2001 Blackwell Publishing and Southwestern Social Science Association)
Best laid plans: Effects of goals on accessibility bias and cognitive control in race-based misperceptions of weapons.

Payne BK, Lambert AJ, Jacoby LL.J Exp Soc Psychol 2002; 38(3): 384-396

Correspondence: B. Keith Payne. Department of Psychology, Washington University, One Brookings Drive, Campus Box 1125, St. Louis, MO 63130, USA; (email: bkpayne@artsci.wustl.edu).

This study applied process dissociation (PD) to investigate the role of conscious goals in controlling automatic influences of stereotypes. A priming procedure was used to show that the presence of Black (vs. White) faces caused stereotypical misidentifications of objects. Specifically, Black primes caused lures to be misidentified as weapons, whereas White primes caused weapons to be misidentified as non-threatening objects. By manipulating the goals with which participants completed the experiment, we demonstrated that the stereotype bias was invariant across conscious goals to avoid vs. use the influence of race. PD analysis provided three major insights. First, the impact of race was mediated solely through an unintentional accessibility bias. Second, requiring participants to respond rapidly increased the impact of stereotypes, an effect that was mediated by a reduction in controlled discrimination among stimuli. Finally, calling attention to race increased the stereotype accessibility bias, regardless of whether race was made salient with the intention to use, or the intention to avoid the influence of race. (Copyright © 2002 Academic Press)

The criteria for selecting report for inclusion are simple. If the answer to any of the following questions is "yes", then the report is likely to be included: 1. Do the SafetyLit reviewers find the report interesting? 2. Are SafetyLit readers likely to hear of a report from a colleague? 3. Are SafetyLit readers likely to be questioned about the report from a member of the population they serve? 4. Does the report contain findings that are likely to be used by an adversary to oppose the actions or recommendations of a SafetyLit reader?

If you know of a journal article or a report that you believe should be included in a SafetyLit update, please: Send SafetyLit.org an E-mail Message.

Back to "SafetyLit Update" Menu

Rev. 11-Aug-2002 at 23:16 hours.