SafetyLit Update: 23 December 2002

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23 December 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.

No reports this week

No reports this week

Experimental evaluation of LPG tank explosion hazards.

Stawczyk J. J Hazard Mater 2003; 96(2-3): 189-200.

Correspondence: Jan Stawczyk, Faculty of Process and Environmental Engineering, Technical University of Lodz, ul. Wolczanska 215, 90-924, Lodz, POLAND; (email: stawczyk@wipos.p.lodz.pl).

Liquefied-pressure gases (LPG) are transported and stored in the liquid phase in closed tanks under sufficiently high pressure. In the case of an accident, an abrupt tank unsealing may release enormous quantity of evaporating gas and energy that has a destructive effect on the tank and its surroundings. In this paper, experiments with explosions of small LPG tanks are described. The data acquisition equipment applied in the tests provided a chance to learn dynamics of the process and determine hazard factors. The tests enabled a determination of temperature and pressure at which tanks containing LPG disrupt. The results enable a reconstruction of consecutive phases of the explosion and identification of hazards resulting from damage of the tanks. An explanation of the tank unsealing process with fluid parameters above critical point is given.

No reports this week

Fundamentals of safety conscious process design.

Pohjola VJ. Saf Sci 2002; 41(2-3): 181-218.

Correspondence: Veikko J. Pohjola, Department of Process and Environmental Engineering, University of Oulu, PO Box 4300, FIN-90014, Oulu, FINLAND; (email: veikko.pohjola@oulu.fi

An approach to safety conscious chemical process design is described and illustrated. It is taken for granted that the way the process is represented has a profound influence upon the way process design is done. Thus safety conscious process design can result only from a proper incorporation of safety into the process model. From this starting point a general purpose modeling language (the PSSP language) is introduced. The language is capable of unified object oriented representation of reality and of knowledge integration on that basis. Using the language chemical process is represented as an object having the generic list of four attributes: Purpose, Structure, State, and Performance. Safety is made an explicit property of process via Purpose, and environment is included as one of the structural parts of process via Structure. Finally Process object is associated with Design and Management activity objects to make up a mutually communicating set of the three objects called design cycle representing safety conscious process design. (Copyright © 2002, Elsevier Science)
Unsafe acts and unsafe outcomes in aircraft maintenance.

Hobbs A, Williamson A. Ergonomics 2002; 45(12):866-882.

Correspondence: Alan Hobbs, Bureau of Air Safety Investigation, Canberra, AUSTRALIA; (email: unavailable)

See also: http://www.atsb.gov.au/aviation/pdf/msurv.pdf

Road safety studies using the Driver Behaviour Questionnaire (DBQ) have provided support for a three-way distinction between violations, skill-based errors and mistakes, and have indicated that a tendency to commit driving violations is associated with an increased risk of accident involvement. The aims of this study were to examine whether the three-way distinction of unsafe acts is applicable in the context of aircraft maintenance, and whether involvement in maintenance safety occurrences can be predicted on the basis of self-reported unsafe acts. A Maintenance Behaviour Questionnaire (MBQ) was developed to explore patterns of unsafe acts committed by aircraft maintenance mechanics. The MBQ was completed anonymously by over 1300 Australian aviation mechanics, who also provided information on their involvement in workplace accidents and incidents. Four factors were identified: routine violations, skill-based errors, mistakes and exceptional violations. Violations and mistakes were related significantly to the occurrence of incidents that jeopardized the quality of aircraft maintenance, but were not related to workplace injuries. Skill-based errors, while not related to work quality incidents, were related to workplace injuries. The results are consistent with the three-way typology of unsafe acts described by Reason et al. (1990) and with the DBQ research indicating an association between self-reported violations and accidents. The current findings suggest that interventions addressed at maintenance quality incidents should take into account the role of violations and mistakes, and the factors that promote them. In contrast, interventions directed at reducing workplace injury are likely to require a focus on skill-based errors. (Copyright © 2002, Taylor & Francis)
Formalization of normative knowledge for safe design.

Blaise J, Lhoste P, Ciccotelli J. Saf Sci 2002; 41(2-3): 241-261.

Correspondence: Jean-Christophe Blaise, Research Centre for Automatic Control, University of Nancy, BP 239, F54 506, Vandoeuvre Les Nancy Cedex, FRANCE; (email: jean-christophe.blaise@inrs.fr.)

This paper presents a formal methodology for modeling knowledge included in safety standards. The use of the NIAM/ORM method addresses the problem of unprecise semantics and the misinterpretation introduced by the use of natural languages. It also allows for producing a formal model of the knowledge. This formalization is a necessary step in order to exploit the knowledge efficiently, but is not sufficient in itself. So, we propose to restructure the normative knowledge, basing this restructuring on a generic structure of engineering views. This multi-criterion approach allows the designer to use standards much easier in this form than in their current textual expression. Furthermore, the resulting formal model of a standard can be implemented. This implementation results in the production of a Computer Aided Safety Standards Application for design (CASSA) tool. This tool allows to analyse various application scenarios, all included in the safety knowledge model, through specific user-oriented interfaces depending on each user's objective. Nevertheless, the implemented model of the safety knowledge is independent and unique with regard to these scenarios. In so doing, our contribution can concern users other than machine designers, such as valuers, standardization experts or teachers, as well as relate to other areas dealing with standards such as the environment, toy industry, etc. (Copyright © 2002, Elsevier Science)
Occupational accidents in an oil refinery in Brazil

Souza CA, Freitas CM. Rev Saude Publica 2002; 36(5): 576-583.

Correspondence: Carlos Machado de Freitas, Av. Leopoldo Bulhões, 1480 Manguinhos, 21041-210 Rio de Janeiro, RJ, BRAZIL; (email: carlosmf@ensp.fiocruz.br).

OBJECTIVE: Work in oil refineries involves the risk of minor to major accidents. National data show the impact of accidents on this industry. A study was carried out to describe accident profile and evaluate the adequacy of accident reporting system.

METHODS: Data on all accidents reported in an oil refinery in the state of Rio de Janeiro for the year 1997 were organized and analyzed. The study population consisted of 153 injury cases, 83 hired and 69 contracted workers. The variables were: type of accident, operation mode and position of the worker injured.

FINDINGS: Among hired workers, minor accidents predominated (54.2%) and they occurred during regular operation activities (62.9%). Among contracted workers, there also predominated minor accidents (75.5%) in a higher percentage, but they occurred mainly during maintenance activities (96.8%).

CONCLUSIONS: The study results showed that there is a predominance of accidents in lower hierarchy workers, and these accidents occur mainly during maintenance activities. There is a need to improve the company's accident reporting system and accident investigation procedures. (Copyright © 2002, Faculdade de Saúde Pública da Universidade de São Paulo

Mobilizing for pedestrian safety: an experiment in community action.

Bergman AB, Gray B, Moffat JM, Simpson ES, Rivara FP. Inj Prev 2002; 8(4): 264-267.

Correspondence: Abraham B Bergman, Department of Pediatrics, Harborview Medical Center (MS 359774), 325 9th Avenue, Seattle, WA 98104, USA; (email: oscarb@u.washington.edu).

In contrast to the steady reduction in mortality and morbidity from collisions involving motor vehicle occupants, relatively little progress has been made in controlling motor vehicle/pedestrian collisions. Engineering modifications are the most effective means of reducing such collisions, but mainly because of their cost, and public apathy about pedestrian safety, are too rarely employed. A modest experiment in community action was undertaken by attempting to induce the authorities of 10 small cities to apply for state funds to create a single model pedestrian refuge in their respective communities. Our hope was that this model would later lead to more widespread improvements. The key elements of the campaign were organizing local pedestrian safety task forces, compiling local pedestrian injury statistics, and publicizing the stories of pedestrian injury victims. At the conclusion of the planning process, all 10 target communities submitted grant applications and all 10 received full grant funding. Five projects were completed as planned, two are under construction, and the plans for three were abandoned. Pedestrian safety is not an issue that captures public attention. To make progress, goals must be modest, and a dedicated constituency must be developed. "Victim advocacy" is a vital part of this process. Progress in injury control requires concerted community action. (Copyright © 2002 Injury Prevention - published by BMJ Publishing Group)
The spatial and temporal dimensions of child pedestrian injury in Edmonton.

Yiannakoulias N, Smoyer-Tomic KE, Hodgson J, Spady DW, Rowe BH, Voaklander DC. Can J Public Health 2002; 93(6): 447-451.

Correspondence: Nikolaos Yiannakoulias, Department of Earth and Atmospheric Sciences, 1-26 Earth Sciences Building, University of Alberta, Edmonton, AB T6G 2E3, CANADA; (email: nwy@ualberta.ca).

OBJECTIVES: This paper describes the temporal and spatial distribution of child pedestrian injury within Edmonton, Alberta for four fiscal years (1995-96 through 1998-99), and compares this pattern to temporal and spatial data on traffic volume.

METHODS: We used injury data obtained through an ongoing emergency department (ED) surveillance system involving all hospitals in Alberta's Capital Health Region. We identified peak times of injury occurrence and the location of high injury incidence as indicated by census tract of residence. Empirical Bayes estimation procedures were used to calculate stable injury incidence ratios. Cartographic and correlation analyses identified the relationship between traffic volume and injury incidence.

FINDINGS: Child pedestrian injury occurred most frequently during morning (0700-0900 hrs) and late afternoon (1500-1800 hrs) which corresponds with peak periods of vehicular traffic flow. The highest incidence rates occurred in or near areas of high traffic volume, notably in the central and west-central parts of Edmonton.

DISCUSSION: These findings emphasize the importance of considering spatial and temporal patterns in pedestrian injury research, as well as the need to incorporate these patterns in prevention strategies. Changing the times that children attend school may reduce the convergence of pedestrian and vehicular traffic.

No reports this week

Overview of injuries in the young athlete.

Adirim TA, Cheng TL. Sports Med 2003; 33(1): 75-81.

Correspondence: Terry A. Adirim, Divisions of Emergency Medicine and Orthopedics and Sports Medicine, Children's National Medical Center, Washington, DC, USA; (email: tadirim@cnmc.org).

It is estimated that 30 million children in the US participate in organized sports programs. As more and more children participate in sports and recreational activities, there has been an increase in acute and overuse injuries. Emergency department visits are highest among the school-age to young adult population. Over one-third of school-age children will sustain an injury severe enough to be treated by a doctor or nurse. The yearly costs have been estimated to be as high as $US1.8 billion. There are physical and physiological differences between children and adults that may cause children to be more vulnerable to injury. Factors that contribute to this difference in vulnerability include: children have a larger surface area to mass ratio, children have larger heads proportionately, children may be too small for protective equipment, growing cartilage may be more vulnerable to stresses and children may not have the complex motor skills needed for certain sports until after puberty. The most commonly injured areas of the body include the ankle and knee followed by the hand, wrist, elbow, shin and calf, head, neck and clavicle. Contusions and strains are the most common injuries sustained by young athletes. In early adolescence, apophysitis or strains at the apophyses are common. The most common sites are at the knee (Osgood-Schlatter disease), at the heel (Sever's disease) and at the elbow (Little League Elbow). Non-traumatic knee pain is one of the most common complaints in the young athlete. Patellar Femoral Pain Syndrome (PFPS) has a constellation of causes that include overuse, poor tracking of the patellar, malalignment problems of the legs and foot problems, such as pes planus. In the child, hip pathology can present as knee pain so a careful hip exam is important in the child presenting with an insidious onset of knee pain. Other common injuries in young athletes discussed include anterior cruciate ligament injuries, ankle sprains and ankle fractures. Prevention of sports and recreation-related injuries is the ideal. There are six potential ways to prevent injuries in general:the pre-season physical examination;medical coverage at sporting events; proper coaching;adequate hydration; proper officiating; andproper equipment and field/surface playing conditions. (Copyright © 2002, Adis International - Wolters Kluwer)

ICD-10 External Cause of Injury Mortality Matrix

International Collaborative Effort (ICE) on Injury Statistics, APHA Injury Control and Emergency Health Section. Published Online.

Correspondence: Lois A. Fingerhut, National Center for Health Statistics, Hyattsville, MD 20782-2003, USA; (email: LFingerhut@cdc.gov).

The matrix and SAS input statements are available: HERE.

ICD-10 for mortality was implemented in the United States beginning with data year 1999.The ICD-10 injury mortality framework was developed to be as consistent as possible with the recommended framework developed based on the ICD-9 external cause of injury codes as published in Morbidity and Mortality Weekly Report, August 29, 1997, Vol. 46, No. RR-14. Colleagues in the ICE (International Collaborative Effort) on Injury Statistics as well as in the Injury Control and Emergency Health Services (ICEHS) section of APHA participated in its development. However, it must be recognized that ICD-10 external cause of injury mortality codes are very different, often more detailed and at times far less detailed than codes in ICD-9. Thus, NCHS has decided to finalize the matrix because of its logic and internal consistency rather than basing changes on final comparability ratios.

Several changes were made to the ICD-10 matrix that warrant attention:
1. Two rows have been added. The first is labeled "All transport" and it includes all transport related deaths that were classified as unintentional, suicide, homicide, intent undetermined and operations of war. In ICD-9, the codes for suicide and intent undetermined by crashing of a motor vehicle were included with motor vehicle traffic injuries. There is no indication in the actual codes that these are traffic deaths. The second row, "Other land transport" was added to accommodate new codes in ICD-10.
2. A change was made to the transportation and drowning categories. The ICD-10 codes for water transportation-related drowning, V90 and V92, are included with the "other transport" codes rather than with the drowning codes. In the ICD-9 version of the matrix, the comparable codes, E830 and E832, were included with drowning. This change was made to be consistent with the categorization of other mechanisms of injury (i.e., falls, fires, and machinery) involved with water transport-related injuries.
3. In the ICD-9 matrix, E846-E848 "vehicle accidents not elsewhere classifiable" were categorized with other codes into the category "Other specified and classifiable". However, with the additional transportation categories in ICD-10 and to be consistent with the NCHS 113 Cause-of-Death list, ICD-10 codes V98-V99, "Other and unspecified transport accident" are included with other transportation codes (including water transport and air and space transport related accidents) in a group V90-V99, making them part of all transportation related accidents.
4. The November 2002 version of the matrix shows a correction in the motor vehicle traffic category. Codes V81.1 and V82.1 were moved from the occupant codes to the other codes. In addition, codes X82 for suicide, Y03 homicide and Y32 intent undetermined for the crashing of a motor vehicle are included in the group, "other land transport" and code Y36.1 is included with "other transport." In the preliminary matrix, they were only included in the row for "All transportation."
5. The November 2002 version also includes the newly developed US ICD-10 codes for terrorism. Further, because substantial changes were made in the classification of transport-related injuries in ICD-10, a more detailed categorization of transport codes is being offered for those users who want more detail than this framework offers.

Outcomes and costs of acute treatment of traumatic brain injury.

McGarry LJ, Thompson D, Millham FH, Cowell L, Snyder PJ, Lenderking WR, Weinstein MC. J Trauma 2002; 53(6): 1152-1159.

Correspondence: David Thompson, PhD, Innovus Research, Inc., 10 Cabot Road, Suite 102, Medford, MA 02155, USA; (email: dthompson@innovus.com)

BACKGROUND Although there are nearly a quarter of a million hospitalizations for traumatic brain injury (TBI) in the United States each year, data on the outcomes and costs of TBI treatment in the acute-care setting are limited.

METHODS: Using a large, geographically diverse, multihospital database, we examined inpatient records for persons aged 16 years or older who were hospitalized for TBI between January 1, 1997, and June 30, 1999. Patients were stratified by TBI severity using an adaptation of the Abbreviated Injury Scale for administrative data (ICD/AIS), as follows: 2 = "moderate"; 3 = "serious"; 4 = "severe"; and 5 = "critical." Patient characteristics, patterns of treatment, and outcomes and costs were examined by injury severity and mechanism of injury.

FINDINGS: Of 8,717 study subjects identified, 12.5% had moderate, 44.8% had serious, 29.6% had severe, and 13.2% had critical TBI. Falls were the most common reported cause of injury (40.8%), followed by motor vehicle crashes (39.3%), blows to the head (11.3%), and gunshot wounds (2.4%). Average length of stay in hospital ranged from 6.7 days for moderate TBI to 17.5 days for critical TBI. The overall rate of death in hospital was relatively low among patients with moderate (1.3%), serious (5.7%), and severe (8.7%) TBIs, but much higher among the most critically injured patients (52.0%). Costs of hospitalization averaged $8,189 for moderate, $14,603 for serious, $16,788 for severe, and $33,537 for critical TBI. Costs also varied by injury type, averaging $20,084 for gunshot wounds, $20,522 for motor vehicle crashes, $15,860 for falls, and $19,949 for blows to the head.

DISCUSSION: The economic burden of TBI in the acute-care setting is substantial; treatment outcomes and costs vary considerably by TBI severity and mechanism of injury. (Copyright © 2002, Lippincott Williams & Wilkins)
Role of individual and contextual effects in injury mortality: new evidence from small area analysis.

Borrell C, Rodriguez M, Ferrando J, Brugal MT, Pasarin MI, Martinez V, Plasencia A. Inj Prev 2002; 8(4): 297-302.

Correspondence: Carme Borrell, Municipal Institute of Public Health, Plaça Lesseps 1, 08023 Barcelona, SPAIN; (email: cborrell@imsb.bcn.es).

OBJECTIVE: To analyse the role of individual and contextual variables in injury mortality inequalities from a small area analysis perspective, looking at the data for the city of Barcelona (Spain) for 1992-98.

SETTING: Barcelona (Spain).

METHODS: All injury deaths in residents older than 19, which occurred in the period 1992-98 were included (n=4393). Age and sex specific mortality rates were calculated for each educational level and each cause of death (traffic injuries, falls, drug overdose, suicide, other injuries). The contextual variables included were the proportion of men unemployed, and the proportion of men in jail, in each neighborhood. Multilevel Poisson regression models were fitted using data grouped by age, educational level, and neighborhood for each sex.

FINDINGS: Death rates were higher in males, at the extremes of the age distribution (under 44 and over 74 years), and for lower educational levels. The results of the Poisson multilevel models indicate that inequalities by educational level follow a gradient, with higher risks for the population with no schooling, after having adjusted for the contextual variables of the neighborhood. Such inequalities were more important in the youngest age group (20-34 years), as relative risk of 5.41 (95% confidence interval (CI) 3.9 to 7.4) for all injury causes in males and 4.38 (95% CI 2.3 to 8.4) in females. The highest relative risks were found for drug overdose. There was a contextual neighborhood effect (the higher the deprivation, the higher the mortality) after having taken into account individual variables.

DISCUSSION: The findings underscore the need to implement injury prevention strategies not only at the individual level taking into account socioeconomic position, but also at the neighborhood level. (Copyright © 2002, Injury Prevention - Published by BMJ Publishing)
Adolescent injury mortality in New Zealand and opportunities for prevention.

Kypri K, Chalmers DJ, Langley JD. Int J Adolesc Med Health 2002; 14(1): 27-41.

Correspondence: Kypros Kypri, Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin, NEW ZEALAND; (email: kypros.kypri@ipru.otago.ac.nz).

Injury is recognised internationally as the major threat to adolescent health. The purpose of this study was to describe the epidemiology of adolescent fatal injury in New Zealand, and to examine opportunities for prevention. National mortality data were searched to identify all 15-19 year-olds, who died from injuries in the period 1986-1995. Leading causes of injury were reviewed in light of known risk factors, injury mortality rates in other industrialised countries, and available prevention strategies. The results showed that injury accounted for 2,095 deaths (72.8 per 100,000 person years). Males comprised 77% of victims (110.6 per 100,000 person years), and there was a three-fold increase in mortality from age 15 (35.3 per 100,000 person years) to 19 years (106.4 per 100,000 person years). The leading causes of death were road traffic crashes (42.6 per 100,000 person years), suicide (16.4 per 100,000 person years), and unintentional drowning (3.6 per 100,000 person years). The Graduated Driver Licensing System addresses a range of risk factors for adolescent road traffic crashes. Despite inadequate enforcement, early indications are that it has yielded modest reductions in injury. Hazardous drinking is implicated in the high rates of road traffic crashes and drownings, and given recent liberalization of supply-side policies, proactive identification of hazardous drinkers followed by brief intervention holds promise as a prevention measure. Suicide accounts for an increasing rate of adolescent deaths in New Zealand. The effect of national policies to address a range of suicide risk factors remains to be fully evaluated. (Copyright © 2002, Freund Publishing)

No reports this week

Injury prevention for children with disabilities.

Gaebler-Spira D, Thornton LS. Phys Med Rehabil Clin N Am 2002; 13(4): 891-906.

Northwestern University, Feinberg School of Medicine, Pediatric Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, IL, USA; (email: dgaebler@rehabchicago.org).

Little injury data exists for children who have disabilities. There is an urgent need to address injury prevention and to improve safety standards for this group. Understanding the epidemiology of injuries will allow clinicians to accurately advise patients and their families on individual risks and counsel them in steps to take to reduce those risks. Safety information must be tailored to consider each child's functional impairments.

All children who have disabilities are at risk for maltreatment. Open discussion of this problem is warranted given the immensity of the problem. Identifying parental concerns and supporting parents in the use of respite resources are appropriate. For children who have problems in mobility, falls are the number one concern.

Collaboration with reliable vendors and therapists that adhere to standards for safe seating is essential for reducing the risk of wheelchair tips and falls. In addition, therapists should be directed to provide mobility training for activities from safe transfers to street crossing in a community setting. Parents should be counseled to approach their child's injury risk based on the child's cognitive and behavioral level rather than their chronological level.

Knowledge of the child's developmental quotient or intelligence quotient will also allow the clinician to accurately formulate an injury prevention plan. Many children will always need supervision for tasks that put them in situations of injury risk (i.e., swimming, street crossing, bathing).

Sensorineural deficits such as blindness or deafness create significant alterations in negotiating the environment and an increased risk of injury. Awareness of the special needs for fire risk reduction and street safety are critical in this population.

The collection of injury data is critical to define the scope of the problem and to influence changes in policy and the development of technical standards. Educational efforts focused on safety should include pediatricians, rehabilitative therapists, social workers, teachers, parents, and--most importantly--the empowerment of children as they age injury-free into adults.

SUGGESTED STRATEGIES: A national injury surveillance system for children who have disabilities should be developed to identify injury risk factors for children with disabilities. Children with disabilities should be monitored as a separate risk group in data collection regarding injuries. Parents should be aware of the cognitive level of their child and its influence on their injury risk. Crash testing on passenger restraints should include crash dummies whose physical characteristics resemble those of children who have disabilities. Families should have an emergency evacuation plan with specific consideration of their disabled child in the event of an emergency. Risk of burns to insensate skin and risks of thermal and friction trauma should be discussed when appropriate. The fire department and the police department should be notified of the presence of a child who has a disability in the home. Parents must be aware of the risk of falls to children who are mobile but cognitively impaired and to those in wheelchairs regardless of cognitive ability. Hospitals must have Child Protective Services teams with specific training in abuse to children with disabilities. Discussion of maltreatment risk should be addressed during routine office visits and appropriate resources should be made available to provide support to families. Educational programs should be developed to alert providers to the risks of abuse of children who have disabilities. (Copyright © 2002, Elsevier Science)

Effects of socioeconomic factors on suicide from 1980 through 1999 in Osaka Prefecture, Japan.

Aihara H, Iki M. J Epidemiol 2002; 12(6): 439-449.

Correspondence: H. Aihara, Department of Public Health, Kinki University School of Medicine, Osaka-Sayama, Osaka, JAPAN; (email: unavailable)

Suicide rate in Japan surged in 1998. Although the standardized mortality ratios (SMRs) of suicide in Osaka Prefecture, Japan had been mostly lower than the national SMRs of suicide between 1980 and 1997, they surpassed the increased national SMR of suicide in 1998 and 1999. We investigated whether the suicide rates for 1980-97 and the recent increased suicide rates in Osaka Prefecture were associated with socioeconomic factors. Time-series regression analyses of the suicide rate and socioeconomic factors were performed on respective data for five sub-areas in Osaka Prefecture. The suicide rates of young people and middle-aged men were more strongly associated with the job application and divorce rates for 1980-99 than for 1980-97. Some relations between the suicide rate and public assistance rate were found. The suicide rate was negatively associated with the marriage rate in some areas. The suicide rate of elderly women was strongly associated with the number of persons per household. The notable relation was found between the suicide rate of middle-aged men and the job application rate for 1980-99. The inverse relation between the suicide rate of elderly women and the number of persons per household was noteworthy. (Copyright © 2002, Japan Epidemiology Association)
Suicidality, impulsivity and aggression-is there a link to 5HIAA concentration in the cerebrospinal fluid?

Roggenbach J, Muller-Oerlinghausen B, Franke L. Psychiatry Res 2002; 113(1-2): 193-206.

Bruno Müller-Oerlinghausen, Former Research Group Clinical Psychopharmacology, Freie Universität Berlin, 14050, Berlin, GERMANY; (email: bmoe@zedat.fu-berlin.de).

In biological suicide research, low cerebrospinal fluid-5-hydroxyindolacetic acid (CSF-5HIAA) concentrations have been associated with suicidality, aggression and impulsivity. However, it frequently appears that the interpretation of existing study results is flawed. The analysis of various published findings suggests that contaminating factors like impulsivity or depressive symptoms in suicide attempters are often not taken into consideration at the time of suicide. The seemingly 'robust' association of low CSF-5HIAA concentration with 'suicidality' and 'aggression' is in fact rather weak. Reported associations of subgroups of suicidal behavior (e.g. violent suicide attempts) with low CSF-5HIAA concentrations are likely to represent somewhat premature translations of findings from studies that have flaws in methodology. Furthermore, the perception of 'suicidal behavior' as autoaggressive behavior or inwardly directed aggression in the view of the authors may not be useful in biological suicide research. The construct of aggressivity is insufficiently defined, resulting in difficulties to interpret empirical data. Some evidence exists, however, that reduced CSF-5HIAA concentrations might be related to certain depressive symptoms and changes in impulsivity. More carefully designed studies are required to overcome the existing methodological shortcomings. (Copyright © 2002, Elsevier Science)
Media coverage as a risk factor in suicide.

Stack S. Inj Prev 2002; 8(Suppl 4): iv30-iv32.

Correspondence:Steven John Stack, Department of Criminal Justice, Wayne State University, Detroit, MI 48202, USA; (email: aa1051@wayne.edu).

A total of 293 findings from 42 studies on the impact of publicized suicide stories in the media on the incidence of suicide in the real world were analyzed by logistic regression analysis. Studies measuring the effect of either an entertainment or political celebrity suicide story were 14.3 times more likely to find a copycat effect than studies that did not. Studies based on a real as opposed to fictional story were 4.03 times more likely to uncover a copycat effect. Research based on televised stories was 82% less likely to report a copycat effect than research based on newspapers. A review of recent events in Austria and Switzerland indicates that suicide prevention organizations can successfully convince the media to change the frequency and content of their suicide coverage in an effort to reduce copycat effects. (Copyright © 2002, Injury Prevention - Published by BMJ Publishing Group)

Driving as night falls. The contribution of retinal flow and visual direction to the control of steering.

Wilkie RM, Wann JP. Curr Biol 2002; 12(23): 2014-2017.

Correspondence: John P. Wann, School of Psychology, University of Reading, 3 Earley Gate, RG6 6AL, Reading, UK; (email: j.p.wann@rdg.ac.uk).

We have the ability to locomote at high speeds, and we usually negotiate bends safely, even when visual information is degraded, for example, when driving at night. There are three sources of visual information that could support successful steering. An observer fixating a steering target that is eccentric to the current heading must rotate their gaze. The gaze rotation may be detected by using head and eye movement signals (extra-retinal direction: ERD) or their retinal counterpart, visual direction (VD). The gaze rotation also transforms the global retinal flow (RF) field, which may enable direct steering judgments. In this study, we manipulate VD and RF to determine their contribution toward steering a curved path in the presence of ERD. The results suggest a model that uses a weighted combination of all three information sources, but results also suggest that this weighting may change in reduced visibility, such as in low-light conditions. (Copyright © 2002, Elsevier Science)
Impact of lower speed limits in South Australia.

Woolley JE, Dyson CB, Taylor MAP, Zito R, Stazic B. IATSS Res 2002; 26(2): 6-17.

Correspondence: Jeremy Woolley, Transport Systems Centre, University of South Australia, Adelaide SA 5000, AUSTRALIA; (email: jeremy.woolley@unisa.edu.au).

Australia has recently undergone a change of urban speed limits in most of its jurisdictions. The political and social shift in attitudes required for this change is significant in a country that has a strong reliance on the use of the private motor vehicle. At present five states and one territory have lowered the speed limit in urban areas from 60km/h to 50km/h. Of the remaining two states and territories, one has already implemented lower speed limits (40km/h) in small areas within cities. In the majority of cases, the only criterion for judging the success of such schemes is an observed reduction in both speeds and crash numbers.

This paper reports on a more holistic assessment of such schemes taking into account factors in addition to speed and crashes including: traffic volume displacement, physical road network characteristics, environmental factors, community ownership and acceptance, enforcement effort and impact on travel times. The research work has included the analysis of extensive traffic data, community surveys and focus groups, the collection of environmental and travel time data from an instrumented probe vehicle and the computer modeling of road networks. The work reported is based on over 10 years of working with a 40km/h lower urban speed limit area in South Australia. The paper expands the notion of using speed and crash outcomes as the only criteria for measuring the success of lower speed limit schemes. (Copyright © 2002, International Association of Traffic and Safety Sciences)
Research into raising the maximum speed limit for light motor vehicles and motorcycles on national expressways.

Sumida S. IATSS Res 2002; 26(2): 6-17.

Correspondence: Shunsuke Sumida, Research Department, Japan Safe Driving Center, Tokyo, JAPAN; (email: unavailable).

Until recently, the maximum speed limit for light motor vehicles and motorcycles traveling on national expressways in Japan was 80km/h, a speed lower than the 100km/h limit for large-sized, regular and most other motor vehicles. However, recent changes in the traffic environment such as improved vehicular performance and the implementation of traffic restrictions for tractor-trailers traveling on national expressways made it necessary to consider raising the speed limit while balancing the benefits of consistency with the need to ensure safety. To this end we analyzed a number of factors including driver and vehicular behavior during driving tests as well as statistical data for traffic accidents.

Our research found nothing to suggest that operating light motor vehicles and motorcycles at a maximum speed limit of 100km/h would create problems in terms of vehicle performance, driver physiology and psychology or vehicular behavior. We did confirm that increased speed tends to lead to increased damage in the event of a traffic accident on a national expressway regardless of vehicle type. At the same time, we also concluded that raising the speed limit for light motor vehicles and motorcycles would likely have a positive preventative effect given that a more consistent traffic flow could be expected to reduce the incidence of passing and other such potential accident triggers. On the basis of our research, the Enforcement Orders of Road Traffic Law were revised and the maximum speed limit for light motor vehicles and motorcycles traveling on national expressways was raised to 100km/h on 1 October 2000. (Copyright © 2002, International Association of Traffic and Safety Sciences)

Accidental firearm fatalities: Forensic and preventive implications.

Karger B, Billeb E, Koops E. Int J Legal Med 2002; 116(6): 350-353.

Correspondence: Bernd Karger, Institute of Legal Medicine, University of Munster, Rontgenstrasse 23, 48149 Munster, GERMANY; (email: karger@uni-muenster.de).

Out of a total of 624 consecutive gunshot autopsies from Munster and Hamburg, Germany, 32 cases (5.1%) were accidental. The accidents were self-inflicted in 3 cases while another person fired the gun in the remaining 29 cases. More than half of the victims were younger than 25 years and 75% were male. A single gunshot injury was present in all cases and the head was struck in 47% but a detailed analysis of the entrance wound sites did not show any preferential anatomical sites. A surprising finding was the presence of five contact or near contact gunshots (16%). The reasons for these and most other accidents were extreme carelessness when handling a firearm, the involvement of children or adolescents or a foolish behavior with a gun intended to impress others. Gun-cleaning accidents occurred rarely and there were no major technical defects of the weapons. Preventive measures should concentrate on strict inaccessibility of guns to children and on increased educational efforts to subgroups at risk such as hunters and members of the armed forces. A single non-contact gunshot injury from a long-barrelled firearm can be considered typical for an accident but the great variety and the possible presence of "disguised" suicides and homicides requires a careful forensic investigation including inspection of the scene and reconstruction of the events. It is recommended that a case should always be considered to be non-accidental in the beginning of an investigation. (Copyright © 2002, Springer Publishing)
Association of rates of household handgun ownership, lifetime major depression, and serious suicidal thoughts with rates of suicide across US census regions.

Hemenway D, Miller M. Inj Prev 2002; 8(4): 313-316.

Correspondence: David Hemenway, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; (email: hemenway@hsph.harvard.edu).

OBJECTIVE: Cross sectional studies in the United States often find a significant positive association between levels of household firearm ownership and suicide rates. This study investigates whether the association can be explained by differences in levels of mental health.

METHODS: The relationship between household handgun ownership and overall suicide rates across United States regions after accounting for two mental health variables-lifetime prevalence of major depression and serious suicidal thoughts-were examined. Analyses also add another control variable (urbanization, education, unemployment, or alcohol consumption). Data on mental health variables come from the National Comorbidity Study, conducted in the early 1990s. Data on household handgun ownership come from the General Social Surveys.

FINDINGS: Across the nine regions for the early 1990s (n = 9), household handgun ownership rates are positively correlated with the suicide rate (r = 0.59) and are not correlated with either the lifetime prevalence of major depression or suicidal thoughts. After controlling for major depression and suicidal thoughts (and any of the four additional control variables), handgun ownership rates remain significantly associated with the overall suicide rate.

DISCUSSION: In United States regions with higher levels of household handgun ownership, there are higher suicide rates. This relationship cannot be explained by differences in the prevalence of two mental health indicators-lifetime rates of either major depression or suicidal thoughts. (Copyright © 2002, Injury Prevention - Published by BMJ Publishing Group)
Prevention of injury by early socialization of aggressive behavior.

Tremblay RE. Inj Prev 2002; 8(Suppl 4): iv17-iv21.

Correspondence: R E Tremblay, GRIP, University of Montreal, 3050 Edouard-Montpetit, Suite A-210, Montreal, Quebec, H3T 1J7, CANADA; (email: grip@umontreal.ca).

Frequent use of physical aggression by humans appears to reach its peak between 2 and 3 years of age. In the following years most children learn alternatives to physical aggression. Approximately 4% of children have high levels of physical aggression from early childhood to late adolescence. These children can be considered to show chronic physical aggression. They are at high risk of causing injuries to others and to themselves. They are also at high risk of many other co-morbid mental health conditions, school failure, substance abuse, depression, unemployment, spouse abuse, child abuse, and suicide. There is some evidence that, because of their risky style of behavior, they are also at high risk of many other medical conditions such as cardiovascular problems, cancer, and brain damage. Socialization of aggressive behavior during the preschool years should help prevent injuries throughout the life span. (Copyright © 2002, Injury Prevention - Published by BMJ Publishing Group)
Injuries inflicted on homicide victims: A longitudinal victiminologic study of lethal violence.

Ericsson A, Thiblin I. Forensic Sci Int 2002; 130(2-3): 133-139.

Correspondence: Ingemar Thiblin, Department of Forensic Medicine, Karolinska Institute, S-171 26, Stockholm, SWEDEN; (email: ingemar.thiblin@rmv.se).

For the purpose of studying homicidal violence from a victiminologic point of view, we have examined the number and nature of injuries inflicted on homicide victims examined at the Department of Forensic Medicine in Stockholm during the periods 1976-1978, 1986-1988 and 1996-1998. Evaluation of the total number of injuries (both lethal and non-lethal) revealed a break in the earlier trend during the last of these periods, which demonstrated a clear increase in the number of injuries probably caused by intense and prolonged violence. Thus, there were 14 victims with 40 or more injuries (the maximum being 101 injuries) in the 1996-1998 period, whereas there was only one such victim in each of the two earlier periods. Furthermore, the proportion of victims exhibiting multiple lethal injuries was greater during the last period than during the two preceding periods. These findings indicate a general enhancement in the level of aggression exerted by violent offenders, as well as an increase in the number homicide victims with injuries apparently inflicted by acts of aggression characterized by outrage. (Copyright © 2002 Elsevier Science)

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Rev. 17 Nov 2002