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21 October 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.
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The impact of later trading hours for Australian public houses (hotels) on levels of violence.
Chikritzhs T, Stockwell T. J Stud Alcohol 2002; 63(5): 591-599.
Correspondence: T. N. Chikritzhs, National Drug Research Institute, Curtin University of Technology, Perth, Western Australia, Australia. t.n.Chikritzhs@curtin.edu.au
OBJECTIVE: To examine the impact of later trading hours for licensed hotels (Australian public houses are usually known as "hotels") in Perth, Western Australia, on levels of violent assault on or near these premises.
METHOD: Data on assault offenses reported to police between July 1, 1991, and June 30, 1997, were examined to identify those offenses that occurred on or close to hotels. During this period, 45 (24%) of the 188 hotels meeting study criteria were granted an extended trading permit for 1AM closing ("ETP hotels"), whereas the rest continued to close at midnight ("non-ETP hotels"). A time-series analysis employing linear regression was used to test whether there was a relationship between the introduction of extended trading and monthly rates of assaults associated with ETP hotels, while controlling for the general trend in assault rates among normally trading hotels. Possible confounders and other variables of interest (e.g., levels of alcohol purchases) were also examined.
RESULTS: After controlling for the general trend in assaults occurring throughout Perth hotels, there was a significant increase in monthly assault rates for hotels with late trading following the introduction of extended trading permits. This relationship was largely accounted for by higher volumes of high alcohol content beer, wine and distilled spirits purchased by late trading hotels.
CONCLUSIONS: Late trading was associated with both increased violence in and around Perth hotels and increased levels of alcohol consumption during the study period. It is suggested that greater numbers of patrons and increased levels of intoxication contributed to the observed increase in violence and that systematic planning and evaluation of late trading licenses is required. (Copyright © 2002 Center of Alcohol Studies)
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Emergency medical assistance team response following Taiwan Chi-Chi earthquake.
Hsu EB, Ma M, Lin FY, VanRooyen MJ, Burkle FM Jr. Prehospital Disaster Med 2002; 17(1): 17-22.
Correspondence: Edbert Hsu, Center for International Emergency, Disaster and Refugee Studies, Departments of Emergency Medicine and International Health, Johns Hopkins University Medical Institutions, Baltimore, Maryland, USA; (email: unavailable).
BACKGROUND: On 21 September, 1999, an earthquake measuring 7.3 on the Richter scale, struck central Taiwan near the town of Chi-Chi. The event resulted in 2,405 deaths and 11,306 injuries. Ad hoc emergency medical assistance teams (EMATs) from Taiwan assumed the responsibility for initiating early assessments and providing medical care.
OBJECTIVE: To determine whether the EMATs served a key role in assisting critically injured patients through the assessment of number and level of hospitals responding, training background, timeliness of response, and acuity of patient encounters.
METHODS: Local and national health bureaus were contacted to identify hospitals that responded to the disaster. A comprehensive questionnaire was piloted and then, sent to those major medical centers that dispatched EMATs within the first 72 hours following the quake. In-depth interviews also were conducted with team leaders.
RESULTS: A total number of 104 hospitals/clinics responded to the disaster, including nine major medical centers and 12 regional hospitals. Each of the major medical centers/regional hospitals that dispatched EMATs during the first 72 hours following the quake were surveyed. Also, 20 individual team leaders were interviewed. Seventy-nine percent of the EMATs from the hospitals responded spontaneously to the scene, while only 21% were dispatched directly by national or local health authorities. Combining the phases of the disaster response, it is estimated that only 7% of EMATs were providing on-site care within the first 12 hours following the earthquake, 17% within < 18 hours, and 20% within < 24 hours. Thus, 80% of these EMATs required > 24 hours to respond to the site. Based on a ED I-IV triage system (Level-I, highest acuity; Level-IV, lowest acuity), the vast majority of patient encounters consisted of Level-III and Level-IV patients. Fewer than 16% of teams encountered > 10 Level-I patients, and < 28% of teams evaluated > 10 Level-II patients.
CONCLUSIONS: 1. The response from EMATs was impressive, but largely uncoordinated in the absence of a pre-existing dispatching mechanism. 2. Most of the EMATs required > 24 hours to reach the disaster sites, and generally, did not arrive in time of affect the outcome of victims with preventable deaths. Therefore, there is an urgent need to strengthen local prehospital care. 3. A central governmental body that ensures better horizontal and vertical integration, and a comprehensive emergency management system is required in order to improve future disaster response and mitigation efforts. (Copyright © 2002 Prehospital and Disaster Medicine)
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A reliability study of potential risk factors for acute traumatic occupational hand injuries.
Lombardi DA, Sorock GS, Lesch MF, Hauser R, Eisen EA, Herrick RF, Mittleman MA. Am J Ind Med 2002; 42(4):336-343.
Correspondence: David A. Lombardi,Liberty Mutual Research Center for Safety and Health, Hopkinton, MA, USA (email: david.lombardi@libertymutual.com).
BACKGROUND: A reliability study of transient workplace exposures was conducted within a case-crossover study of acute traumatic occupational hand injuries. Exposures examined included features of work equipment (unusual performance of equipment or materials, glove use), work practices (performing an uncommon work task, using an unusual work method), and worker-related factors (being rushed, distracted, ill, or working overtime).
METHODS: Interviewers administered a follow-up questionnaire about exposure up to 4 days after the initial interview. The reliability of the usual frequency of exposure in the past month, exposure reported at the time of the injury, and the degree to which subjects had confidence in the accuracy of their memory for exposure was assessed.
RESULTS: The test-retest reliability for the estimated number of hours of exposure during the past month was high for six of the eight potential risk factors (intraclass correlation coefficients (ICC) ranging from 0.84-0.99). ICC for the frequency per month and minutes per exposure, used to calculate the estimated number of hours per month, ranged from 0.12-0.99 and 0.49-0.99, respectively. Agreement of reported exposure at the time of the injury, evaluated using the kappa statistic, ranged from substantial agreement to perfect agreement (0.65-1.0). However, for some factors, there was little or no reported exposure. Most subjects (74-100%) reported being "very confident" or "certain" in their memory for each exposure.
CONCLUSIONS: These findings suggest that the frequency and duration of unusual transient workplace exposures can be reliably recalled by subjects interviewed by telephone within 4 days of an injury. (Copyright © 2002 Wiley-Liss)
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Exposure to traffic among urban children injured as pedestrians.
Posner JC, Liao E, Winston FK, Cnaan A, Shaw KN, Durbin DR. Inj Prev 2002 Sep;8(3):231-235.
Correspondence: J. C. Posner, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia 19104, USA; (email: posner@email.chop.edu).
OBJECTIVES: To explore the immediate pre-crash activities and the routine traffic exposure (street crossing and play) in a sample of urban children struck by automobiles. In particular, the traffic exposure of children who were struck while playing was compared with that of those struck while crossing streets. DESIGN: Cross sectional survey.
SETTING: Urban pediatric emergency department.
PATIENTS: A total of 139 children ages 4-15 years evaluated for acute injuries resulting from pedestrian-motor vehicle collisions during a 14 month period.
MAIN OUTCOME MEASURES: Sites of outdoor play, daily time in outdoor play, weekly number of street crossings, pre-crash circumstance (play v walking).
RESULTS: Altogether 39% of the children routinely used the street and 64% routinely used the sidewalks as play areas. The median number of street crossings per week per child was 27. There were no differences in exposures for the 29% who were hit while playing compared with the 71% who were hit while walking. Although 84% of the children walked to or from school at least one day per week, only 15% of the children were struck while on the school walking trip. The remainder were injured either while playing outdoors or while walking to other places.
CONCLUSIONS: Urban children who are victims of pedestrian crashes have a high level of traffic exposure from a variety of circumstances related to their routine outdoor playing and street crossing activities. The distributions of traffic exposures were similar across the sample, indicating that the sample as a whole had high traffic exposure, regardless of the children's activity preceding the crash. Future pedestrian injury programs should address the pervasive nature of children's exposure to traffic during their routine outdoor activities. (Copyright © 2002 Injury Prevention)
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United Kingdom legislation on pack sizes of analgesics: background, rationale, and effects on suicide and deliberate self-harm.
Hawton K. Suicide Life Threat Behav 2002; 32(3):223-229.
Correspondence: Keith Hawton, Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3, UK; (email: keith.hawton@psych.ox.ac.uk).
Following increasing concern in the UK about the mortality and morbidity associated with self-poisoning with analgesics, especially paracetamol (Tylenol, acetaminophen), legislation was introduced in 1998 to modify packs sold over-the-counter. The most important change was a reduction in the maximum size of packs. In this paper the background to the legislation, the rationale behind it, and its early impact are reviewed. The changes have had significant positive initial benefits on the mortality and morbidity associated with self-poisoning with analgesics. (Copyright © 2002 American Association of Suicidology)
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Injury risk associated with playing actions during competitive soccer.
Rahnama N, Reilly T, Lees A. Br J Sports Med 2002 Oct;36(5):354-359.
Correspondence: Tom Reilly, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Henry Cotton Campus, Webster Street, Liverpool L3 2ET, UK; (email: t.p.reilly@Livjm.ac.uk).
OBJECTIVE: To assess the exposure of players to injury risk during English Premier League soccer matches in relation to selected factors.
METHODS: Injury risk was assessed by rating the injury potential of playing actions during competition with respect to (a) type of playing action, (b) period of the game, (c) zone of the pitch, and (d) playing either at home or away. In all, 10 games from the English Premier League 1999-2000 were chosen for analysis. A notation system was used whereby 16 soccer specific playing actions were classified into three categories: those inducing actual injury, those with a potential for injury (graded as mild, moderate, or high), and those deemed to have no potential for injury. The pitch was divided into 18 zones, and the position of each event was recorded along with time elapsed in the game, enabling six 15 minute periods to be defined.
RESULTS: Close to 18 000 actions were notated. On average (mean (SD)), 1788 (73) events (one every three seconds), 767 (99) events with injury potential (one every six seconds), and 2 (1) injuries (one every 45 minutes) per game were recorded. An overall injury incidence of 53 per 1000 playing hours was calculated. Receiving a tackle, receiving a "charge", and making a tackle were categorised as having a substantial injury risk, and goal catch, goal punch, kicking the ball, shot on goal, set kick, and heading the ball were all categorised as having a significant injury risk. All other actions were deemed low in risk. The first 15 minutes of each half contained the highest number of actions with mild injury potential, the last 15 minutes having the highest number of actions with moderate injury potential (p < 0.01). The first and last 15 minutes of the game had the highest number of actions with high injury potential, although not significant. More actions with mild injury potential occurred in the goal area, and more actions with moderate and high injury potential occurred in the zone adjacent to the goal area (p < 0.001). There was no significant difference between home and away with regard to injury potential.
CONCLUSIONS: Playing actions with high injury risk were linked to contesting possession. Injury risk was highest in the first and last 15 minutes of the game, reflecting the intense engagements in the opening period and the possible effect of fatigue in the closing period. Injury risk was concentrated in the areas of the pitch where possession of the ball is most vigorously contested, which were specific attacking and defending zones close to the goal. Injury potential was no greater in away matches than at home.
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Cumulative effects of concussion in high school athletes.
Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Neurosurgery 2002; 51(5):1175-1181.
Michael W. Collins, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; (email: mwc973@pitt.edu).
OBJECTIVE: A common assumption in sports medicine is that a history of concussion is predictive of a lower threshold for, as well as a worse outcome after, subsequent concussive injury. The current study was conducted to investigate the relationship between concussion history in high school athletes and the on-field presentation of symptoms after subsequent concussion.
METHODS: One hundred seventy-three athletes who experienced sports-related concussion composed the initial study group. Binary groups were subsequently created on the basis of concussion history. Sixty athletes with no concussion history were compared with 28 athletes with a history of three or more concussions. The groups were compared in terms of the on-field presentation of symptoms after an in-study concussion. Dependent variables included the postinjury presence of loss of consciousness, anterograde amnesia, retrograde amnesia, and confusion.
RESULTS: Athletes with three or more prior concussions were more likely to experience on-field positive loss of consciousness (chi(2) = 8.0, P = 0.005), anterograde amnesia (chi(2) = 5.5, P = 0.019), and confusion (chi(2) = 5.1, P = 0.024) after a subsequent cerebral concussion. An odds ratio revealed that athletes with a history of three concussions were 9.3 times more likely than athletes with no history of concussion to demonstrate three to four abnormal on-field markers of concussion severity.
CONCLUSION: This study is the first to suggest a cumulative effect of concussion in high school athletes. A more severe on-field presentation of concussion markers is evidenced in high school athletes with a pronounced history of concussion. This study's findings highlight the need for more long-term outcome studies in high school athletes who sustain sports-related concussions. (Copyright © 2002 Congress of Neurological Surgeons)
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Trends in road injury hospitalisation rates for Aboriginal and non-Aboriginal people in Western Australia, 1971-97.
Cercarelli LR, Knuiman MW. Inj Prev 2002; 8(3): 211-215.
Rina Cercarelli, Injury Research Centre, Department of Public Health, University of Western Australia Department of Public Health, University of Western Australia, 35 Sterling Hwy, Crawley, WA 6009, AUSTRALIA; (email: rina@dph.uwa.edu.au).
OBJECTIVE: To examine trends in road injury hospitalisation rates for Aboriginal and non-Aboriginal people in Western Australia.
METHODS: Data from the Western Australian Hospital Morbidity Data System for the years between 1971 and 1997 were analysed. Poisson regression models were fitted to determine whether the trends were significant.
RESULTS: The rate of hospitalisation due to road injury for Aboriginal people (719.1 per 100 000 population per year) over the time period examined was almost twice as high as that for non-Aboriginal people (363.4 per 100 000 population per year). Overall, the results showed that while hospitalisations from road injury involving non-Aboriginal people have been decreasing by 6.7% per three year period since 1971, the rates of hospitalisation for Aboriginal people have been increasing by 2.6% per three year period. Both of these trends were statistically significant. The alarming increasing trend observed for Aboriginal people was more pronounced in males, those aged 0-14 years and over 45 years, and for those living in rural areas.
CONCLUSIONS: As the rates of road injury for Aboriginal people are higher than for non-Aboriginal people, and are also following an increasing trend, road safety issues involving Aboriginal people need to be addressed urgently by health and transport authorities. (Copyright © 2002 Injury Prevention - BMJ Publishing Group)
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Pediatric motor vehicle related injuries in the Navajo Nation: the impact of the 1988 child occupant restraint laws.
Phelan KJ, Khoury J, Grossman DC, Hu D, Wallace LJ, Bill N, Kalkwarf H. Inj Prev 2002; 8(3):216-220.
Correspondence: Kieran J. Phelan, Divisions of Health Policy and Clinical Effectiveness and General and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA; (email: kj.phelan@chmcc.org).
BACKGROUND: Navajo motor vehicle mortality is the highest among the 12 Indian Health Service (IHS) administrative areas. In July 1988, the Navajo Nation enacted a primary enforcement safety belt use and a child restraint law. OBJECTIVE: Assess the impact of the laws on the rate and severity of pediatric (0-19 years) motor vehicle injury resulting in hospitalizations in the Navajo Nation.
METHODS: Hospitalizations associated with motor vehicle related injury discharges were identified by International Classification of Diseases, 9th revision, CM E codes, 810-825 (.0,.1) from the Navajo IHS hospital discharge database. Age specific rates for the period before the law, 1983-88, were compared with those after enactment and enforcement, 1991-95. Severity of injury, measured by the abbreviated injury scale (AIS) score and new injury severity score (NISS), was determined with ICDMAP-90 software. Wilcoxon rank sum and chi(2) tests were used for analysis.
RESULTS: Discharge rates (SE) for motor vehicle injury (per 100 000) decreased significantly in all age groups: 0-4 years (62 (7) to 28 (4)), 5-11 years (55.3 (6) to 26 (4)), and 15-19 years (139 (14) to 68 (7)); p=0.0001. In children 0-4 years, the median AIS score decreased from 1.5 (1,3) (25th, 75th centile) to 1 (1,2), p=0.06, and the median NISS decreased from 3.5 (1,9) to 2 (1,5), p=0.07. The proportion of children with NISS scores >4 decreased significantly for the 0-4 year age group (p=0.03).
CONCLUSIONS: Concurrent with enactment of the Navajo Nation occupant and child restraint laws there was a reduction in the rate of motor vehicle related hospital discharges for children. Severity of injury declined in very young Navajo children. The effect of enactment and enforcement of this Native American child occupant restraint law may serve as an example of an effective injury control effort directed at Native American children. (Copyright © 2002 Injury Prevention - BMJ Publishing Group)
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Autopsy features relevant for discrimination between suicidal and homicidal gunshot injuries.
Karger B, Billeb E, Koops E, Brinkmann B. Int J Legal Med 2002 Oct;116(5):273-278.
Correspondence: B.Karger, Institute of Legal Medicine, University of Munster, Rontgenstrasse 23, 48149 Munster, GERMANY; (email: karger@uni-muenster.de).
A total of 624 consecutive gunshot autopsies from the Institutes of Legal Medicine in Munster and Hamburg was investigated retrospectively. In a subsample of 284 suicides and 293 homicides ( n=577), a large variety of features such as firearm, ammunition, number and site of entrance wounds, shooting distance and direction of the internal bullet path were recorded and binary logistic regression analysis performed in the case of bullet paths. Females constituted 26.3% of the homicide victims and 10.6% of the suicides. Short-barrelled firearms outnumbered long arms in homicides by 6:1 and in suicides by 2:1. More than 1 gunshot injury was found in 5.6% of the suicides (maximum 5 gunshots) and in 53.9% of the homicides (maximum 23 gunshots). The suicidal gunshots were fired from contact or near contact range in 89% while this was the case in only 7.5% of the homicides. The typical entrance wound sites in suicides were the temple (36%), mouth (20%), forehead (11%) and left chest (15%) but uncommon entrance wound sites such as the eye, ear, and back of the neck and head were also encountered. In suicidal gunshots to the right temple ( n=107), only 6% of the bullet paths were directed downwards and only 4% were directed from back-to-front. In gunshots to the left chest ( n=130), bullet paths running right-to-left or parallel occurred frequently in suicides (75%) and infrequently in homicide victims (19%). From 61 suicides who fired the gun inside their mouth, only 1 pointed the gun downwards. Consequently, some bullet path directions cannot be considered indicative of suicide: downwards and back-to-front in gunshots to the temple, left-to-right in gunshots to the left chest and downwards in mouth shots. The isolated autopsy findings can only be indicative of suicide or homicide but the combined analysis of several findings can be associated with a high probability.
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Mental health professionals' determinations of adolescent suicide attempts.
Wagner BM, Wong SA, Jobes DA. Suicide Life Threat Behav 2002; 32(3): 284-300.
Department of Psychology, Catholic University of America, Washington, DC 20064, USA. wagnerb@cua.edu
The degree of ambiguity in the term suicide attempt was examined among 14 expert suicidologists, and 59 general mental health clinicians who either did or did not receive a standard definition of the term. The participants judged whether each of ten vignettes of actual adolescent self-harm behaviors was a suicide attempt. Low levels of agreement were found within each group, although agreement was better for the most and least serious cases. Possible explanations were examined, including how professionals weight suicidal intent and medical lethality in their suicide attempt decisions, and the use of a "fuzzy," natural language conceptualization of suicide attempts was proposed.
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Supervision of children aged two through six years.
Pollack-Nelson C, Drago DA. Inj Ctl Saf Promo 2002; 9(2): 121-126.
Carol Pollack-Nelson Independent Safety Consulting, 13713 Valley Dr., Rockville, MD 20850, USA; (email: pollacknel@comcast.net).
Manufacturers of household products - including appliances, exercise equipment, and even some children's toys - expect consumers to supervise their children to prevent product-related injuries. This approach to hazard prevention places the burden of safety on parents and caretakers. This study examined actual supervision practices of parents of children between the ages of two and six years. 59 parents, aged 31 to 40 years, residing in Montgomery County, Maryland, completed a 24-item self-administered questionnaire, consisting of multiple choice and open-ended questions.
Nearly all respondents reported that there are times when their children are in a different room from them. When the children are out of sight, parents reported checking on their children periodically, with increasingly longer periods between observations, as the child gets older. Nearly half of the children got out of bed in the morning always or often before a parent. Ninety-five percent of parents perceived that their child was at no risk or slight risk of injury when getting up in the morning before them.
In conclusion, it can be said that many parents supervise their children by being close-by and on-hand as needed, rather than being directly involved in the child's activities. Manufacturers are encouraged to employ passive measures and sound designs, rather than rely on close parental supervision for injury prevention. (Copyright © 2002 Swets & Zeitlinger)
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Central Nervous System-Active Medications and Risk for Falls in Older Women.
Ensrud KE, Blackwell TL, Mangione CM, Bowman PJ, Whooley MA, Bauer DC, Schwartz AV, Hanlon JT, Nevitt MC; The Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 2002; 50(10): 1629-1637.
Correspondence: Kristine E. Ensrud, General Internal Medicine (111-0), Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA; (email: ensru001@tc.umn.edu).
OBJECTIVES: To determine whether current use of central nervous system (CNS)-active medications, including benzodiazepines, antidepressants, anticonvulsants, and narcotics, increases the risk for subsequent falls.
DESIGN: Prospective cohort study.
SETTING: Four clinical centers in Baltimore, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania.
PARTICIPANTS: Eight thousand one hundred twenty-seven women aged 65 and older participating in the fourth examination of the Study of Osteoporotic Fractures between 1992 and 1994.
MEASUREMENTS: Current use of CNS-active medications was assessed with an interviewer-administered questionnaire with verification of use from medication containers. A computerized dictionary was used to categorize type of medication from product brand and generic names. Incident falls were reported every 4 months for 1 year after the fourth examination.
RESULTS: During an average follow-up of 12 months, 2,241 women (28%) reported falling at least once, including 917 women (11%) who experienced two or more (frequent) falls. Compared with nonusers, women using benzodiazepines (multivariate odds ratio (MOR) = 1.51, 95% confidence interval (CI) = 1.14-2.01), those taking antidepressants (MOR = 1.54, 95% CI = 1.14-2.07), and those using anticonvulsants (MOR = 2.56, 95% CI = 1.49-4.41) were at increased risk of experiencing frequent falls during the subsequent year. We found no evidence of an independent association between narcotic use and falls (MOR = 0.99 for frequent falling, 95% CI = 0.68-1.43). Among benzodiazepine users, both women using short-acting benzodiazepines (MOR = 1.42, 95% CI = 0.98-2.04) and those using long-acting benzodiazepines (MOR = 1.56, 95% CI = 1.00-2.43) appeared to be at greater risk of frequent falls than nonusers, although the CIs overlapped 1.0. We found no evidence to suggest that women using selective serotonin-reuptake inhibitors (MOR = 3.45, 95% CI = 1.89-6.30) had a lower risk of frequent falls than those using tricyclic antidepressants (MOR 1.28, 95% CI = 0.90-1.84).
CONCLUSIONS: Community-dwelling older women taking CNS-active medications, including those taking benzodiazepines, antidepressants, and anticonvulsants, are at increased risk of frequent falls. Minimizing use of these CNS-active medications may decrease risk of future falls. Our results suggest that fall risk in women taking benzodiazepines is at best marginally decreased by use of short-acting preparations. Similarly, our findings indicate that preferential use of selective serotonin-reuptake inhibitors is unlikely to reduce fall risk in older women taking antidepressants. (Copyright © 2002 American Geriatrics Society published by Blackwell Science)
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Mortality and morbidity in agriculture in the United States.
Rautiainen RH, Reynolds SJ. J Agric Saf Health 2002; 8(3): 259-276.
Correspondence: Risto H. Rautiainen, Great Plains Center for Agricultural Health, University of Iowa, Iowa City 52242-5000, USA; (email: risto-rautiainen@uiowa.edu).
This article summarizes the trends in agricultural injuries and illnesses in the past decade, as well as the needs for surveillance in the future. Agriculture is one of the most hazardous industries in the U.S. The fatality rate in agriculture remained high (about 22/100,000 workers) through the 1990s. and tractors remained the leading source of death, causing approximately 300 fatalities each year. Non-fatal injuries and illnesses decreased in the employed agricultural worker population. There are no adequate injury and illness data for self-employed farmers and family members to show trends over time. The reported injury rates have been 0.5 to 16.6/100 workers, based on the source of information. Many studies have shown high rates of respiratory and musculoskeletal symptoms, hearing loss, and skin disorders in agriculture. The overall cancer rate is lower; however, certain cancers are elevated in farmers. Surveillance information has not improved significantly in the past decade; however, many studies have provided more insight into the prevalence, incidence, and risk factors for injury and illness. Further efforts are needed to better define the populations at risk, including farmers and ranchers, family members, workers, migrant and seasonal workers, and others exposed to farm hazards. Fatalities are well documented, and it is important to continue existing surveillance in the future. Surveillance systems should be developed to collect information on agriculture-related non-fatal injuries and illnesses. (Copyright © 2002 American Society of Agricultural Engineers)
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Tractor-related deaths among west virginia farmers.
Helmkamp JC, Lundstrom WJ. Ann Epidemiol 2002; 12(7): 510.
Correspondence: James C. Helmkamp, Center for Rural Emergency Medicine, West Virginia University, Morgantown, WV, USA; (email: jhelmkamp@hsc.wvu.edu).
PURPOSE: The agriculture industry has a high number of occupational deaths and a significantly high death rate compared to other industrial sectors. From 1995 to 2000, the US Bureau of Labor Statistics' Census of Fatal Occupation Injuries has shown that about 8% (550) of all annual work-related deaths (WRDs) were in agricultural production (farming). About one-third of these deaths were attributed to tractor incidents. Approximately three-quarters of these incidents involved rollover, overturn, or run over events. The purpose of this study was to describe tractor-related deaths among West Virginia farmers.
METHODS: Data from the West Virginia Fatality Assessment and Control Evaluation (FACE) Program was reviewed to identify specific cases from January 1997 through January 2002.
RESULTS: During the 61-month period, West Virginia experienced 276 WRDs, of which 4% (11) were in farming occupations. Nine of the eleven deaths involved machine-related (tractor; E-code 919.0) incidents: rollover (7), overturn (1), and run over (1). Three of the victims were livestock farmers (SIC 0219), three were beef and cattle farmers (SIC 0212), two were dairy farmers (SIC 0241), and one was a crop farmer (SIC 0191). The average age at death was 56 with a range from 38 to 82. All victims were male. Of the 4 cases investigated, none of the tractors were equipped with roll over protective structures (ROPS) or seat belts.
CONCLUSIONS: ROPS are the single best method of preventing tractor-related deaths, yet only about one-third of tractors on US farms are equipped with ROPS. The estimated cost (approximately $900) of retrofitting older tractors is a major factor impacting the increased use of ROPS. (Copyright © 2002 Elsevier Science)
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Attack on America: Children's reactions and parents' responses.
Beauchesne MA, Kelley BR, Patsdaughter CA, Pickard J. J Pediatr Health Care 2002; 16(5):213-21.
Correspondence: Michelle A. Beauchesne, School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA; (email: m.beauchesne@neu.edu).
INTRODUCTION: When disaster strikes, as it did September 11, 2001, children react to both the actual event and their parents' distress. The purpose of this study was to find out how children were affected by these recent events and how parents responded to their children's concerns. This study is a sequel to a previous study on parents' and children's perceptions to the President Clinton situation and the Starr Report.
METHOD: Eighty-eight school-aged children and 51 parents were recruited for this descriptive, qualitative study that used community-based snowball sampling. Parents and children were asked a series of questions about the attacks on the World Trade Center and Pentagon, including how they heard about it and how it made them feel.
RESULTS: Children's responses indicated feelings of fear about their safety and their future; wanting to take revenge; feeling sad and disappointed; and empathy for the victims. Parents realized they had to comfort their children in spite of their own feelings of dismay. Many parents reported difficulty in reacting to their child's concerns regarding fairness and justice.
DISCUSSION: Pediatric nurse practitioners need to understand parents' and children's responses to such events in order to provide optimal health care, support, and counseling within the context of normal growth and development. (Copyright © 2002 The National Association of Pediatric Nurse Practitioners)
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Perceptions of service provision for clients who self-injure in the absence of expressed suicidal intent.
Smith SE. J Psychiatr Ment Health Nurs 2002; 9(5): 595-601.
Correspondence: S.E. Smith, Adult Mental Health Services, Leicestershire and Rutland Health Care Trust, Leicester, UK; (email: unavailable).
This research involved interviewing three people who had experienced self-injury. They were accessed from the voluntary sector as I felt that if I had accessed them from the National Health Service their views might not be honest, due to their possible perceptions of threats to their care. It was not intended that the views of these people would be representative, my aim was that their views, as well as areas highlighted in the literature, would inform me of areas pertinent to the topic, when seeking staff views. The views of staff, of which there were 15 self-selecting clinicians, formed the main focus of the study. The aims of the research were designed to highlight potentially contrasting perceptions of self-injury as a means of illuminating a current clinical problem. The results showed that staff on the whole agreed with the perceptions of people who have experienced self-injury; that they are often viewed negatively, though this is changing. It was recognized that care was dependent on where the person entered the service. Staff recognized that the service is under pressure and provision may not be available in the voluntary sector for these clients. (Copyright © 2002 Blackwell Science)
Children in motor vehicle collisions: analysis of injury by restraint use and seat location.
Sweitzer RE, Rink RD, Corey T, Goldsmith J. J Forensic Sci 2002; 47(5): 1049-1054.
Correspondence: Rebecca E. Sweitzer, Department of Anatomical Sciences and Neurobiology, University of Louisville, School of Medicine, KY, USA; (email: rebecca.sweitzer@louisville.edu).
This study was a retrospective chart review of hospital records and autopsy reports of 499 children nine years old or younger involved in motor vehicle collisions from 1994 to 1998. The objective was to evaluate the frequency and severity of injuries as a function of age, restraint use, and seat position. We found that 33% of the children were unrestrained and 20% were improperly restrained. Unrestrained children had the highest mean Maximum Abbreviated Injury Scores (MAIS) and Injury Severity Scores (ISS), accounted for 70% of the fatalities, and had the highest incidence of head injuries. Although most of the head injuries were superficial, 80% of the fatalities were the result of a head injury. Improperly restrained children had the highest frequency of abdominal injuries. Regardless of restraint use, the back seat was associated with fewer head injuries and lower mean MAIS and ISS scores compared to the front seat. Also, properly restrained children in the front seat had lower mean MAIS and ISS scores than unrestrained children in the back seat, suggesting that restraint use is more beneficial than seat position. (Copyright © 2002 American Academy of Forensic Sciences)
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Prevalence and risk of hospitalized pregnant occupants in car crashes.
Weiss HB, Lawrence B, Miller T. Annu Proc Assoc Adv Automot Med Conf 2002; 46: 355-366.
Correspondence: Hank B. Weiss, Center for Injury Research and Control, University of Pittsburgh, Pittsburgh, PA, USA; (email: ).
Hospitalized maternal injuries pose a serious threat to the fetus, therefore understanding their burden is important. In addition, this study examined whether the risk of serious injury from crashes changes during pregnancy. Using 1997 hospital discharge data from 19 states, injuries to younger women were classified as motor-vehicle related with and without pregnancy-associated diagnoses. The pregnancy screen identified 1,488 motor-vehicle occupant injury discharges (rate=129/100,000 person-years, rate-ratio=1.88, 95% CI=1.49, 1.98). Pregnancy-associated cases were younger, their median charge-per-visit and mean ISS were lower and their average length-of-stay was shorter. Once adjusted for severity, the age-specific rate-ratios were not significantly different than one. (Copyright © 2002 Association for the Advancement of Automotive Medicine)
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Deceleration energy and change in velocity on impact: key factors in fatal versus potentially survivable motor vehicle crash (mvc) aortic injuries (AI): the role of associated injuries as determinants of outcome.
Siegel JH, Smith JA, Tenenbaum N, McCammon L, Siddiqi SQ, Presswalla F, Pierre-Louis P, Williams W, Zaretski L, Hutchins K, Perez L, Shaikh J, Natarajan G. Annu Proc Assoc Adv Automot Med Conf 2002; 46: 315-338.
Correspondenc: John H. Siegel, CIREN - NHTSA, New Jersey Medical School-UMDNJ, Newark, NJ; USA; (email: siegeljh@umdnj.edu).
OBJECTIVE: To examine the difference in force mechanisms between fatal and potentially survivable MVC aortic injuries (AI) compared to non-AI severe thoracic injuries (ST).
METHODS: Of 324 autopsied MVC driver or front seat passenger fatalities (1997-2000), there were 43 fatal AI (36 scene deaths, 7 hospital deaths) and 5 additional AI survivors.
RESULTS: Of the 48 AI, there was only a 42% survival for those reaching hospital alive. 80% of AI survivors had isthmus lesions and all had no or minimal brain injury (GCS >= 13), no cardiac injury and only 20% ribs 1-4 fx or shock; of AI non-survivors reaching hospital alive, 67% had GCS <= 12, 50% cardiac injury, 83% ribs 1-4 fx and 83% shock; AI scene deaths had 78% severe brain injury, 56% cardiac injury, 69% lung injury and 78% ribs 1-4 fx. Quantifying forces in AI scene mortality: the Instantaneous Velocity on Impact of the subject vehicle (delta V1) and the Impact Energy Dissipated (IE) on the subject vehicle (V1) in joules demonstrated a linear regression in fatal car MVC AIs: Energy dissipated (joules) = -56.65 x (delta V1)(2) + 15972 x delta V1 - 454661, r(2) = 0.83. However, for 27 patients with non-AI but severe thoracic (ST) injury (AIS >=3), the relationship of IE to delta V1 had a linear regression of Energy dissipated (joules) = -5.0787 x (delta V1)(2) + 4282.1 x delta V1 - 57182 1, r(2) = 0.84, with the slope difference between the regression for AI scene deaths and that of ST and AI survivors being significant (p < 0.05). Based on these relationships, a Critical Zone limited by MVC Impact Energy level of 336,000 joules and a delta V1 of 64 kph appears to be the limit of potential survivability in MVCs producing aortic injuries. All AI above these thresholds died. In contrast, ST had greater use of seatbelts (AI 10% vs all ST 60%) and airbags (AI 50% vs all ST 72%), and an 83% survival.
CONCLUSION: The data suggest different mechanisms of force delivery and injury patterns in fatal vs potentially survivable AI, and vs ST MVCs. They suggest that an approach to improving vehicle safety measures for AI may involve better safety devices and mechanisms for reducing that fraction of Impact Energy dissipated on V1 for a given delta V1 which is focused on the upper portion of the subject's thoracic cage between the levels of ribs1-8. (Copyright © 2002 Association for the Advancement of Automotive Medicine)
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Validation of the urgency algorithm for near-side crashes.
Augenstein J, Perdeck E, Stratton J, Digges K, Steps J, Bahouth G. Annu Proc Assoc Adv Automot Med Conf 2002; 46: 305-314.
Correspondence:Jeffrey S. Augenstein, The William Lehman Injury Research Center, University of Miami School Of Medicine, Miami, FL, USA; (email: j.augenstein@miami.edu )
The URGENCY algorithm uses vehicle crash sensor data in Automatic Crash Notification (ACN) systems to assist in instantly identifying crashes that are most likely to have time critical injuries. The algorithm also provides the capability of improving injury identification, using data obtained from the scene. The prime purpose of the algorithm is to automatically provide emergency medical responders with objective information on crash severity to assist in detecting the approximately 1% of crashes with serious injuries needing the most urgent medical care. The algorithm calculates the risk of a MAIS 3+ injury being present in the crashed vehicle, instantly at the time of the crash. The prediction can be subsequently updated as more information becomes available. The algorithm was based on a multiple regression analysis using data from the National Accident Sampling System/Crashworthiness Data System, (NASS/CDS) years 1988-95. In this paper, the accuracy of the algorithm was evaluated for near side crashes by applying it retrospectively to the population of injured occupants in NASS 1997-2000. URGENCY was applied to the population of injured occupants in near side crashes. Using an injury risk criterion of 50%, URGENCY identified 69% of the crashes with MAIS 3+ injuries. By lowering injury risk criterion to 40%, URGENCY identified 78% of the crashes with MAIS 3+ injuries. Vehicle side intrusion was found to be a highly influential variable. By changing side intrusion from a binary to a continuous variable, the correctly identified crashes increased from 69% to 81%. Examination of the consequence of missing variables found that unknown values of occupant height and weight had a negligible effect on the ability to capture the MAIS 3+ injured. However, lack of knowledge of these variables did increase the magnitude of the false positives. (Copyright © 2002 Association for the Advancement of Automotive Medicine)
See abstract under Alcohol and Other Drugs -
The different faces of intimate violence: implications for assessment and treatment.
Greene K, Bogo M. J Marital Fam Ther 2002; 28(4): 455-466.
Correspondence: Kelly Greene, Peel Children's Centre, 85A Aventura Court, Mississauga, Ontario L5T 2Y6, CANADA; (email: kelly.greene@utoronto.ca).
Current research about violence in intimate relationships suggests that at least two qualitatively distinct types of violence exist. This new knowledge challenges the dominant conceptualization of intimate violence as solely a manifestation of patriarchal male dominance. Following a review of the research and analysis of illustrative clinical examples, a conceptual framework is presented that assists couple therapists in answering three salient questions: What type of violence am I most likely to be working with? How can I assess the differences between types of violence? And how might I proceed with treatment for different types of violence?
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A Domestic Violence Screening Program in a public health department.
Shattuck SR. J Community Health Nurs 2002; 19(3):121-132.
Correspondence: Susan R. Shattuck, Center For Women in Transition, 411 Butternut Drive, Holland, MI 49424, USA.
Domestic Violence (DV) is a public health problem with far-reaching effects for society. Local public health departments typically serve high-risk populations and have a unique opportunity to provide routine DV screening to all clients receiving services. This project piloted a DV screening program in the family planning clinic of a local public health department. Two interventions were required; the first was a 2-hr inservice program for family planning clinic staff. The second intervention consisted of development and implementation of the screening program. A comprehensive DV curriculum was developed and carried out at an inservice prior to the implementation of the screening program. Screening was evaluated over a 4-week period in the health department. Of the 182 women who were screened for DV, 21 (11.5%) screened positive for DV.
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