The concept of risk appears in a prominent way in the recently revised European Directive on General Product Safety (GPSD). Risk assessment is therefore an important tool for the success of the Directive; the question is how risk assessment should be carried out in a systematic manner in order to meet the aims of the Directive. In this paper, the references in the GPSD concerning the concept of risk are reviewed and compared with reported problems in European risk assessment. Existing guidelines for risk assessment are examined in order to determine what factors determine the consistency of the outcome. This leads to recommendations for a process that could be followed in order to make risk assessment successful in the context of the GPSD. On the basis of existing guidelines for risk assessment, criteria are formulated with which methods of risk assessment should comply. A stepwise process is proposed in order to develop a common method of risk assessment that can be applied in Europe to support the GPSD. The requirements for risk management in the new GPSD are rather abstract and lack specification, both for producers and for enforcement authorities. The Directive further refers to the need to develop non-binding guidelines in due course. Sources of different outcomes of the risk assessment process are outlined in this paper as well as possibilities to achieve a more consistent basis for decision, more uniformity and transparency. These are essential conditions if one wishes to avoid both undue trade barriers and unsafe products on the market. A leading role for the European Commission seems necessary to make sure that the intentions of the GPSD are accomplished.
A risk model for the prediction of recurrent falls in community-dwelling elderly. A prospective cohort study.
Correspondence: P. A. Stalenhoef, Department of General Practice, Maastricht University, Postbox 616, 6200 MD, Maastricht, THE NETHERLANDS; (email: p.stalenhoef@hag.unimaas.nl).
The object of this article was to determine the predictive value of risk factors for recurrent falls and the construction of a fall risk model as a contribution to a mobility assessment for the identification of community-dwelling elderly at risk for recurrent falling in general practice. The design was a prospective cohort study (n = 311). There were four primary health care centers. A sample stratified on previous falls, age, and gender of community-dwelling elderly persons aged 70 years or over (n = 311) was taken from the respondents to a mail questionnaire (n = 1660). They were visited at home to assess physical and mental health, balance and gait, mobility and strength. A 36-week follow-up with telephone calls every 6 weeks was conducted. Falls and fall injuries were measured. During follow-up 197 falls were reported by 33% of the participants: one fall by 17% and two or more falls by 16%. Injury due to a fall was reported by 45% of the fallers: 2% hip fractures, 4% other fractures, and 39% minor injuries. A fall risk model for the prediction of recurrent falls with an area under the curve (AUC) of 0.79, based on logistic regression analysis, showed that the main determinants for recurrent falls were: an abnormal postural sway (OR 3.9; 95% Cl 1.3-12.1), two or more falls in the previous year (OR 3.1; 95% Cl 1.5-6.7), low scores for hand grip strength (OR 3.1; 95% Cl 1.5-6.6), and a depressive state of mind (OR 2.2; 95% CI 1.1-4.5). To facilitate the use of the model for clinical practice, the model was converted to a "desk model" with three risk categories: low risk (0-1 predictor), moderate risk (two predictors), and high risk (>/=3 predictors). A fall risk model converted to a "desk model," consisting of the predictors postural sway, fall history, hand dynamometry, and depression, provides added value in the identification of community-dwelling elderly at risk for recurrent falling and facilitates the prediction of recurrent falls.
Does accident prevention education reduce the incidence of childhood accidents in the home?
This mini-review examines whether accident prevention education reduces the incidence of home accidents among children under the age of 5 years. The Cochrane Library, Medline, CINAHL and Embase databases were searched for randomized controlled studies (RCTs) and systematic reviews of RCTs that compared parents who received accident prevention education with those that did not. Only two RCTs met the inclusion criteria for analysis in this review. The results of these studies showed that there was no statistically significant difference in accidents between the two groups but the quality of the trials was low.
Correspondence: L. Clift, Applied Ergonomics Centre, Research School in Ergonomics and Human Factors, Loughborough University, Holywell Building, Holywell Way, Loughborough, Leicestershire, LE11 3UZ, U.K.; (email: L.clift@lboro.ac.uk).
Stepladder accidents continue to be a major cause of injury at home and at work. Despite this, few changes have been seen in their design or their labeling. Many of the accidents occurring appear to be whilst the stepladder is being utilized in a manner which the user considers reasonable, but the manufacturer considers abuse. This work, sponsored by the Health and Safety Executive, investigates whether this mismatch can be eliminated in order to improve safety. The research combines user profiling with dynamic trials to establish what behavior stepladders need to sustain. Through innovative measuring techniques, the demands on the stepladder system are quantified and the margin of safety calculated. Extensive dynamic trials generated data for over 4000 user, stepladder and task combinations. Individuals were given demanding tasks, but permitted to undertake them in a manner they considered reasonable and the resulting data can be considered as representative of the demands they would place on stepladders in everyday use. From this data, the stepladder and user system has been modeled, allowing manipulation of the stepladder parameters such that a virtual stepladder can be created which provides sufficient stability to tolerate all reasonably foreseeable use. In addition this model is used to generate predictive software which can determine the level of safety provided by real, or theoretical, stepladders. In conclusion, a specification for a simple test is given which could be routinely conducted to determine whether any given stepladder will offer the minimum level of stability considered necessary for safe use.
Changes in logging injury rates associated with use of feller-bunchers in West Virginia.
Correspondence: Jennifer L Bell, National Institute for Occupational Safety and Health, Division of Safety Research, Analysis and Field Evaluations Branch, 1095 Willowdale Road, MS-1181, 26505-2888, Morgantown, WV, USA; (email: Jbell@cdc.gov).
BACKGROUND: It is well documented that logging is one of the most dangerous occupations and industries in which to work, and trees fellers are at greatest risk of injury. The objective of this study was to determine whether West Virginia (WV) logging companies experienced a reduction in injuries after beginning to use feller-bunchers (tree cutting machines, which replace some of the work done with a chain saw) during harvesting operations.
METHODS: WV workers compensation claims and employment data from 1995 to 2000 were used to calculate injury rates. Injury trends in the rest of the WV logging industry, not using feller-bunchers, were also assessed.
FINDINGS: For 11 companies, the pre-feller-buncher injury claims rate was 19.4 per 100 workers and the post-feller-buncher rate was 5.2 per 100 workers. This was a significant difference, with an adjusted rate ratio of 2.8 (95% CI: 1.8-4.5) of pre to post claims. Struck by injuries also showed significant decline, with the pre-feller-buncher injury rate being 3.8 (95% CI: 1.8-8.2) times as great as post-feller-buncher rate. During the time of the study, the injury rate rose in the rest of the WV logging industry. The average cost of a workers compensation claim in the WV logging industry during the time of the study was approximately $10,400.
DISCUSSION: As mechanization of logging tasks becomes more widespread, the WV logging industry as a whole may see substantial injury declines and a reduction in the total cost of injury claims. Struck by injuries, the most common and potentially fatal of logging injury types, appear to be particularly affected. However, logging operations in areas of very steep terrain where it is not possible to use these machines may need to rely on strategies other than feller-bunchers to reduce injuries.
Occupational safety and health in Spain.
- Sesé A, Palmer AL, Cajal B, Montano JJ, Jimenez R, Llorens N. J Safety Res 2002; 33(4):511-525.
Correspondence: Albert Sesé Department of Psychology, Balearic Islands University, Guillem Cifre de Colonya Building, Ctra. de Valldemossa, km. 7'5, 07071, Palma de Mallorca, Spain; (email: albert.sese@uib.es).
Occupational Health and Safety in Spain has improved considerably over the last decade, most likely due to a new concept where an overall concept of safety culture is defined. Important changes in industrial safety, hygiene, and psychosocial factors present an optimistic panorama for the future of Spain. Despite this general improvement, according to the European Convergence Program, Spanish statistics still offer far from good safety results. In fact, according to 1997 official statistics, Spain had the highest incidence rate for nonfatal occupational accidents of all European Union (EU) countries, and occupied third place for fatal accidents. This paper summarizes the organizational structure of the Spanish National System of Health & Safety at Work, its effective health and safety laws, and statistics on the Spanish work environment obtained from III Spanish National Survey on Work Conditions (1997). The researchers hope that the findings of this work will have an impact on Spanish industry that will subsequently bring about improvements in work conditions and develop assessment and intervention models in occupational health and safety, from a theoretical position integrating environmental, human, and organizational factors.
INTRODUCTION: We wanted to examine the preventative effect of bicycle helmets on head injuries in youngsters aged 0-15 years treated after road traffic accidents (RTAs). The data were based on hospital records.
METHODS: We conducted a case-control study of all youngsters aged 0-15 years, who were treated at Odense University Hospital after RTAs on bicycles during the period 1993 to 1999. Bicyclists with injuries localized to the head or brain comprised the case group. The controls were all bicyclists with injuries to other body regions.
FINDINGS: Altogether 3285 persons were entered. Of these, 409 had injuries to the head or brain and 2876 had injuries to other body regions. Regression analysis showed that the use of helmets decreased the risk of head injury by a factor of 0.4 and the risk of concussion by a factor of 0.6. Only nine bicyclists with more severe brain injury were included in the study. Registered motor vehicles as the counterpart increased the risk of head injury in a given accident and no effect of the helmets could be shown in such accidents.
DISCUSSION: Helmets offer bicyclists aged 0-15 years protection against head injury. The effect could not be shown in accidents involving a motor vehicle as the counterpart.
Correspondence: David J. Chalmers, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, NEW ZEALAND; (email: david.chalmers@ipru.otago.ac.nz).
BACKGROUND: There is a saying in sport that "injury is just part of the game". In other words, injury in sport is seen as inevitable.
OBJECTIVE: To examine progress toward reaching the contrary position that "injury prevention is just part of the game".
METHODS: The four steps of van Mechelen's "sequence of prevention" model provide a structure for examining progress.
FINDINGS: Step 1 -- What is known about the size of the problem? Most is known about more serious injuries and about injuries in elite and professional sport. Least is known about less serious injuries, injury in community level and amateur sport, and injury occurring in recreational activities. Step 2 -- What is known about risk factors? Despite calls for analytic studies since the early 1980s, few such studies have been reported in the literature. Step 3 -- What is known about the effectiveness of preventive measures? Few randomized controlled trials have been reported in the literature. Step 4 -- Are there systems in place to monitor sports injury? Examples are given of systems in North America, Europe, and Australasia.
DISCUSSION: With a few exceptions, progress has not gone beyond step 1 in van Mechelen's model. Challenges for the future include: deciding where research efforts should be placed, standardization of definitions and methods of data collection and reporting, identification of risk factors and mechanisms of injury, and the evaluation of interventions. Finally, if the field of sports injury prevention is to advance, multidisciplinary collaboration will be required, along with the involvement of the sports community.
Implementation of a system of surveillance of childhood injuries involved in a Safe Community program: the example of Boulogne-Billancourt (France).
- Sznajder M, Chevallier B, Yacoubovitch J, Aegerter P, Auvert B. Inj Prev 2002; 8(4): 330-331.
Correspondence: Marc Sznajder, Service de Santé Publique et Information Médicale, Hôpital Ambroise Paré AP-HP, 9 avenue Charles de Gaulle, 92100 Boulogne, FRANCE; (email: marc.sznajder@apr.ap-hop-paris.fr)
OBJECTIVES: To provide precise information about child injuries, intended to promote preventive actions, in keeping with the general pattern of a Safe Community program implemented in Boulogne-Billancourt (France) since 1997.
METHODS: Information about children under 16 injured in the city of Boulogne-Billancourt and its surroundings, are extracted in a database.
DISCUSSION: The Boulogne-Billancourt database is the first permanent and specific childhood injury surveillance system in France integrated in a "Safe Community". It may constitute an "alarm system" by allowing rapid implementation of preventive action. The final evaluation of the collected data will be performed at the end of the program (after five years).
Drowning in Finland: "external cause" and "injury" codes.
- Lunetta P, Penttila A, Sajantila A. Inj Prev 2002; 8(4): 342-344.
Correspondence: Philippe Lunetta, Department of Forensic Medicine, University of Helsinki, PL 40 Kytösuontie 11, 00300 Helsinki, Finland; (email: philippe.lunetta@helsinki.fi).
BACKGROUND: The International Classification of Diseases (ICD) external codes (E codes) for drowning assist in determining the primary event leading to drowning, but do not alone allow the precise determination of the overall drowning rates. AIMS: To analyze the sensitivity of the ICD E codes for drowning. To describe the pattern and trend of drowning deaths that are classified with E codes other than for drowning.
SETTING: Finland, 1969-2000.
METHODS: Mortality files of Statistics Finland were searched electronically using the injury codes (I codes) and E codes for drowning. Cross analysis of I and E coded drownings was performed to determine the rate and pattern of drowning cases classified with E codes other than for drowning. Time trends were calculated using the Poisson regression model.
FINDINGS: Of 13 705 drowning deaths, 644 (4.7%) were not identified with the E codes for drowning. The great majority (n=547, 84.9%) of these cases were traffic accidents resulting in drowning. No significant time trends were found even after the introduction, in 1996, of the ICD 10th revision.
DISCUSSION: In Finland, underestimation of overall drowning rates using the E code alone is less pronounced than in countries where similar studies have been performed. The relatively high rate of transport accidents resulting in drowning indicates a specific target for preventive countermeasures.
Comparison of two fatal occupational injury surveillance systems in the United States.
- Biddle EA, Marsh SM. J Safety Res 2002; 33(3):337-354.
Correspondence: Elyce A. Biddle, Division of Safety Research, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, MS-1811, Morgantown, WV 26505, USA; (email: egb6@cdc.gov).
INTRODUCTION: Using different methods, two national systems compile fatal occupational injury data in the United States: the National Institute for Occupational Safety and Health (NIOSH) National Traumatic Occupational Fatalities (NTOF) surveillance system, and the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). The NTOF uses only death certificates, while CFOI uses multiple sources for case ascertainment.
METHODS: Through overall and case-by-case comparisons, this study compares these systems and evaluates counts for the nation and by state for worker and case characteristics.
FINDINGS: From 1992 through 1994, NTOF reported an average of 84% of the number of traumatic occupational fatalities reported in CFOI. This percentage changed somewhat when a case-by-case comparison was conducted--88% of the NTOF cases were matched directly to the CFOI cases. Although CFOI captured a larger number of fatalities annually, the additional fatalities did not follow a discernible pattern.
DISCUSSION: By understanding the distribution of fatalities, targeted efforts to reduce them will benefit all industries.
Development and evaluation of the Kids Count Farm Safety Lesson.
- Liller KD, Noland V, Rijal P, Pesce K, Gonzalez R. J Agric Saf Health 2002; 8(4): 411-421.
Correspondence: Karen Liller, Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, Florida 33612-3805, USA; (email: kliller@hsc.usf.edu).
The Kids Count Farm Safety Lesson was delivered to nearly 2,000 fifth-grade students in 15 rural schools in Hillsborough County, Florida. The lesson covered animal, machinery, water, and general safety topics applicable to farming in Florida. A staggered pretest-posttest study design was followed whereby five schools received a multiple-choice pretest and posttest and the remainder of the schools (N = 10) received the posttest only. Results of the study showed a significant increase in the mean number of correct answers on the posttests compared to the pretests. There was no significant difference in the mean number of correct answers of those students who received the pretest and those students who had not, eliminating a "pretest" effect. This study fills an important gap in the literature by evaluating a farm safety curriculum offered in the elementary school setting. It also included migrant schoolchildren in the study population. It is strongly recommended that agricultural safety information be included into the health education curriculum of these elementary schools.
Correspondence: Robert Goldney, Department of Psychiatry, Adelaide University, The Adelaide Clinic, 33 Park Terrace, Gilberton 5081 SA, AUSTRALIA; (email: robert.goldney@adelaide.edu.au).
Mental health literacy is the knowledge and beliefs about mental disorders that aid their recognition, management, or prevention, and is an important determinant of help seeking. This has relevance in suicide prevention, particularly for those with major depression, the clinical condition most frequently associated with suicidal behavior. In this study of a random and representative community sample, a vignette depicting classical features of major depression was presented to subjects along with questions related to mental health literacy. The responses of those with major depression, as delineated by the Primary Care Evaluation of Mental Disorders instrument, both with and without suicidal ideation, were compared to those of a third group of respondents. The results demonstrated that despite increased professional contact by those with major depression and suicidal ideation, there were few differences among the three groups on either open-ended or direct questions related to mental health literacy. This indicates that increased professional contact in itself was not related to increased mental health literacy, and suggests that more specific psychoeducational programs are required.
Studying suicide with psychological autopsy: social and cultural feasibilities of the methodology in China.
- Zhang J, Wieczorek WF, Jiang C, Zhou L, Jia S, Sun Y, Jin S, Conwell Y. Suicide Life Threat Behav 2002; 32(4): 370-379.
Correspondence: Jie Zhang, Department of Sociology, State University of New York College at Buffalo, 1300 Elmwood Avenue, Buffalo, NY 14222, USA; (email: zhangj@bscmail.buffalostate.edu).
As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides.
Ling's death: an ethnography of a Chinese woman's suicide.
Correspondence: Veronica Pearson, Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong, PEOPLE'S REPUBLIC OF CHINA; (email: vpearson@hkucc.hku.hk).
Over the past decade, great concern has been expressed about the high suicide rates in China, especially among women and young women in particular. However, most of the information that has been presented has considered macro-level data and speculated on why women are so vulnerable to self-harm. This article presents the detailed story of one village woman who killed herself and suggests that motives and behavior are more complex than the cultural script and statistics suggest. Although depression is said to be commonly present in people who kill themselves in Western countries, this may not be the case in China.
Drinking, other substance use and suicidal ideation in middle adolescence: a population study.
- Torikka A, Kaltiala-Heino R, Marttunen M, Rimpelä A, Rantanen P, Rimpela M. J Subst Use 2002; 7(4): 237-243.
Correspondence: Antti Torikka, Tampere School of Public Health, Tampere, FINLAND; (email: unavailable).
OBJECTIVES: To assess the relationship between self-reported suicidal ideation and alcohol and other substance use among 14-16-year-olds.
METHODS: A cross sectional school survey of 16 464 subjects aged 14-16 years in two Finnish regions.
FINDINGS: Alcohol use frequency and any use of substances other than alcohol were significantly associated with suicidal ideation. Of girls (boys) who reported drinking weekly, 8% (7%) reported severe suicidal ideation compared with 1% (0.7%) of those not drinking. Of girls (boys) who reported use of substances other than alcohol five times or more, 13% (21%) reported severe suicidal ideation, compared with 1.3% (1.1%) of those who had no use of substances other than possibly alcohol. These associations persisted in multivariate analyses controlling for depressive symptoms and sociodemographic background.
DISCUSSION: Frequent alcohol use and use of substances other than alcohol independently indicate a risk for adolescent suicidal ideation and may thus represent an early warning signal for attempted suicides. School and health service personnel should pay attention to adolescents who drink frequently or experiment with or use drugs to improve the identification of suicidality and the possibilities for early intervention.
Do hospital E-codes consistently capture suicidal behavior?
- Rhodes AE, Links PS, Streiner DL, Dawe I, Cass D, Janes S.Chronic Dis Can 2002; 23(4): 139-145.
Correspondence: Anne E. Rhodes, The Suicide Studies Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, CANADA; (email: rhodesa@smh.toronto.on.ca).
Hospital separation data are used to study suicidal behavior; however, there is little information about the appropriateness of these data for research and planning activities. The study purpose is to examine how consistently hospital separation E-code data reflect suicidal behaviors. Expert clinicians reviewed medical records of individuals who had a separation for self-poisoning to determine whether the self-poisoning was deliberate. Agreement among clinicians was evaluated and latent class analysis performed to derive a summary estimate of the prevalence of deliberate self-poisoning. This estimate was then compared to the prevalence of deliberate self-poisoning based on the external cause of injury (E-codes). Clinicians estimated the prevalence to be 63% higher than the E-code based prevalence. Much larger discrepancies were apparent among older age groups, those whose care was primarily medical in nature and those with a longer length of hospital stay. In acute care settings, self-poisonings among the elderly may not receive adequate attention and/or documentation. Estimating the prevalence of admissions for suicidal behavior using hospital separation data is of questionable validity, particularly among older age groups.
Correspondence: David J DeYoung, California Department of Motor Vehicles, Research and Development Branch, MS F 126, 2415 First Avenue, 95818, Sacramento, CA, USA; (email: ddeyoung@dmv.ca.gov).
PROBLEM: This study evaluates the degree to which courts have implemented California's ignition interlock program, and surveys judges and district/city attorneys to identify barriers to implementing a successful interlock program.
METHOD: There are three parts to the evaluation. In the first, a sample of drivers arrested for driving on a driving under the influence (DUI)-suspended driver license was examined to calculate the rate at which courts order interlocks for DUI-suspended drivers, as required by California law. The second part of the study used Department of Motor Vehicle (DMV) records to count the statewide rate of court-ignition interlock device (IID) orders across time and jurisdictions. The final part surveyed judges, district/city attorneys, and offenders installing an interlock to obtain information about their use of interlock, barriers to implementing an interlock program, and the effectiveness of the devices in preventing drinking and driving.
FINDINGS: It was found that conviction rates for driving while suspended are low; that judges order interlocks for only a fraction of the convicted driving-while-suspended (DWS) offenders who should receive such an order; and that the majority of offenders who are ordered by the court to install an ignition interlock in their vehicle do not do so.
DISCUSSION: Any successful interlock program will need to find a way to balance the inability of many offenders to pay for the devices, with the need for the industry to remain economically viable.
Relationship Between Theoretical Knowledge and Behavior in Traffic Planning: Implementation and Results of an Awareness Program for a Developing Country by a Nongovernmental Organization.
Correspondence: María Cristina Isoba, Road Safety Education and Research, Luchemos por la Vida, Buenos Aires, ARGENTINA; (email: info@luchemos.org.ar).
This report involves a diagnosis of the knowledge level of the adult population about traffic safety, and the way this is related to their behavior within the traffic system in Argentina. This is done in order to plan and be able to implement a traffic safety education for children, teenagers, and adults, the goal of which will be to have a positive influence for individual and general change so as to decrease the number of traffic accidents. A general description of the actions already taken within this safety program and their results are also included. Luchemos por la Vida is a nongovernmental organization which gathered information by means of a survey of adult users of public roads (drivers) about their knowledge on several key subjects like traffic lights, safety belts, drinking and driving, speeding, bike riding, helmet use for motorbike riders, and causes of accidents. This information was cross-related with the results of systematic observations of some specific behaviors in traffic. The results showed that there was a contradiction between the "theoretical" knowledge (which was superficial and not systematic) and the real behavior of road users. On the other hand, the study of the correlation between serious traffic violations committed and records taken by the enforcement authorities showed important deficiencies in the enforcement system. From the information, the conclusion was that the knowledge which most of the population has about traffic safety is superficial, fragmented, incomplete, and is not put into practice. This knowledge is not reflected in road use behavior. The serious lack of control and law enforcement aggravates the situation creating a virtual condition of "anarchy" where each individual is left to himself or herself, without clear directions, to determine how to behave in traffic.
Car size in U.K. crashes: the effects of user characteristics, impact configuration, and the patterns of injury.
- Thomas P, Frampton R.Traf Inj Prev 2002; 3(4): 275-282.
Correspondence: Pete Thomas, Vehicle Safety Research Centre, Loughborough University, Loughborough, Leicester LE11 3UZ, UK; (email: p.d.thomas@loboro.ac.uk).
Previous work examining the effect of vehicle mass has demonstrated the link with occupant injury severity. The principal factor has been related to Newtonian mechanics. This article analyses data from the U.K. Co-operative Crash Injury Study and identifies other factors associated with car size. The mass of the car is found to have a predominant effect on injury outcome in frontal collisions only where the effect is seen most in injuries to the head, face, and chest. Most fatal casualties in small cars occur when in collision with another car in front or side collisions while the key group for large cars is frontal collisions with roadside objects. There are several characteristics of small car occupants that differ from those in large cars including gender, age, and vehicle occupancy. New information in the analysis concerns the priorities in casualty reduction between small and large car occupants, and the article argues that vehicle design should take account of this variation to produce vehicles optimized for the complete range of crashes and car occupants.
How Do Euro NCAP Results Correlate with Real-Life Injury Risks? A Paired Comparison Study of Car-to-Car Crashes.
- Lie A, Tingvall C Traf Inj Prev 2002; 3(4): 288-293.
Correspondence: Anders Lie, Swedish National Road Administration, Borlänge, SWEDEN; (email: unavailable).
The European New Car Assessment Program (Euro NCAP) is a resource for consumers regarding vehicle crash safety. The program promotes safety developments, and credits car manufacturers for focusing on safety. This study was based on real-life car-to-car crashes and results show that the overall indication of the safety level, provided by the Euro NCAP crash testing, is a valid prediction when considering severe or fatal injuries. No significant injury risk differences were seen for minor injury crashes. In car-to-car collisions, cars with three or four stars were found to be approximately 30% safer when compared with two-star cars or cars without a Euro NCAP score. The strong correlation between injury risk and Euro NCAP scores is not necessarily similarly good for individual car models. Pedestrian safety and child occupant protection were not considered in the present study.
Compliance and Comprehension of the Yellow Signal Indication: A Case Study from Jordan.
Correspondence: Mohammed S. Tarawneh, Department of Civil Engineering, University of Jordan, Shmeisani, P.O. Box 926269, Amman 11110, JORDAN; (email: arabass@go.com.jo).
The main objective if this study was to observe drivers' reactions at the onset of the yellow signal indication at signalized intersections in Jordan, assess drivers' understanding of the meaning of the signal, and assess drivers' perceived severity of punishment as a result of violating it. An observational field study, in which nearly 4,164 drivers' responses to the yellow signal indication at 20 signalized intersections, were observed, was aimed at assessing drivers' compliance with the signal in Jordan. A survey questionnaire study, in which 1,048 driver responses were obtained, was aimed at assessing drivers' understanding of the meaning of the yellow signal indication and the penalties associated with violating it. Based on the results of both studies, several conclusions were reached. The overall compliance rate was nearly 13%. Female drivers were significantly more compliant than male drivers. Age significantly contributed to compliance, with young male drivers having the worst compliance rate. The survey revealed that 73% of all respondents knew the correct meaning of the yellow signal indication. However, only 21% knew the correct penalties associated with violating it. Regarding the meaning of yellow signal indication, and the awareness of penalties associated with violating it, the survey revealed that older age, female gender, higher education, longer driving experience, and private license classification were all significantly associated with better understanding. Young male drivers particularly were the least aware of the meaning of the yellow signal indication and penalties associated with violating it.
Decision aid for allocation of transportation funds to guard rails.
Correspondence: James H. Lambert, Department of Systems and Information Engineering, Center for Risk Management of Engineering Systems, University of Virginia, 22904, Charlottesville, VA, USA; (email:lambert@virginia.edu).
We address the need for allocation of resources to run-off-road and fixed-object hazards on immense secondary road systems. In Virginia, there are 95,000km of roadway with uncharacterized hazards in need of guardrail upgrade, installation, or related warning signs or other protection. A decision aid is developed to assist the planner in guardrail resource allocation by accounting for the potential crash severities, traffic exposures, costs of treatment, and other factors. A premise is that no single benefit-cost ratio or selection criterion applies across all localities. The decision aid enables the planner to interpret the variety of benefits and costs in their own units, emphasizing the needs and preferences of individual localities. The paper describes: (1) archiving and comparison of protected and unprotected hazards; (2) regional screening of hazardous corridors and (3) multicriteria benefit-cost analyses of guardrail sites. A case study of guardrail selection is presented.
The impact of hands-free message reception/response on driving task performance.
- Cooper PJ, Zheng Y, Richard C, Vavrik J, Heinrichs B, Siegmund G. Accid Anal Prev 2003; 35(1): 23-35.
Correspondence: Peter Cooper, Insurance Corporation of British Columbia, Suite 415, 375 Water Street, BC, V6B 5C6, Vancouver, Canada; (email: peter.cooper@icbc.com.
A series of closed-course driving experiments were conducted in which 41 drivers ranging in age from 19 to 70 were put through a series of increasingly challenging driving performance tasks both in the presence and absence of audible messages. The messages required specific responses and these, along with driving performance measures based on driver/vehicle response characteristics, were recorded. The results clearly showed a negative impact of the message task on driver decision-making performance when this involved the more complex tasks of weaving and especially left-turning. Such decision-making decrements in the presence of the messages were exacerbated by adverse pavement surface conditions.
The effect of seatbelt use on injury patterns, disposition, and hospital charges for elders.
- Coley A, Partridge R, Kaylor C, Shapiro M. Acad Emerg Med 2002; 9(12):1411-1416.
Correspondence: Robert Partridge, Department of Emergency Medicine, Injury Prevention Center, Samuels Building 2nd Floor, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA; (email: rpartridge@lifespan.org.).
OBJECTIVE: To study the relationships between seatbelt use and injury patterns, hospital charges, morbidity, and mortality in elder motor vehicle crash victims.
METHODS: A retrospective review of individuals at least 65 years old presenting to an urban emergency department (ED) after a motor vehicle crash.
FINDINGS: Over a two-year period, 339 patients had documentation of seatbelt use or non-use at the time of the crash. Of these, 241 (71%) patients had been wearing a seatbelt and 98 (29%) had not. Elders not using seatbelts were more likely to require hospitalization (29% unbelted vs. 17% belted) and had a higher mortality rate. Injury patterns were different in the two groups. Emergency department charges were significantly different between belted and unbelted elders ($351 vs. $451, p = 0.01) and head computed tomography (CT) utilization was higher in the unbelted group (25.6% vs 12.7%, p = 0.005).
DISCUSSION: Improved seatbelt compliance in elders can reduce injuries, hospitalization rates, ED charges, and mortality resulting from motor vehicle crashes.
Age and visual impairment decrease driving performance as measured on a closed-road circuit.
In this study the effects of visual impairment and age on driving were investigated and related to visual function. Participants were 139 licensed drivers (young, middle-aged, and older participants with normal vision, and older participants with ocular disease). Driving performance was assessed during the daytime on a closed-road driving circuit. Visual performance was assessed using a vision testing battery. Age and visual impairment had a significant detrimental effect on recognition tasks (detection and recognition of signs and hazards), time to complete driving tasks (overall course time, reversing, and maneuvering), maneuvering ability, divided attention, and an overall driving performance index. All vision measures were significantly affected by group membership. A combination of motion sensitivity, useful field of view (UFOV), Pelli-Robson letter contrast sensitivity, and dynamic acuity could predict 50% of the variance in overall driving scores. These results indicate that older drivers with either normal vision or visual impairment had poorer driving performance compared with younger or middle-aged drivers with normal vision. The inclusion of tests such as motion sensitivity and the UFOV significantly improve the predictive power of vision tests for driving performance. Although such measures may not be practical for widespread screening, their application in selected cases should be considered.
Correspondence: Richard E. Tremblay, GRIP, University of Montreal, 3050 Edouard-Montpetit, Suite A-210, Montreal, Quebec H3T 1J7, CANADA; (email: gripret@ere.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.
The security of urban women: practice, research, and partnerships.
- Michaud A, Paquin S. Inj Prev 2002; 8(Suppl 4): iv15-iv16.
Correspondence: Sophie Paquin, Université du Québec à Montréal, Département d'études urbaines et touristiques, Case postale 8888, succ Centre-ville, Montréal, Québec H3C 3P8, CANADA; (email: paquin.sophie@ugam.ca).
All public bodies whose mandate includes responsibility for the quality of urban life cannot ignore the question of security. On a global level, it is agreed that action needs to be taken locally, with the input of everyone involved. Since women have more at stake where safety issues are concerned, it is logical that security plans be drawn up that prioritize them. The interaction of public bodies, community organizations, and individual women is in itself innovative, enriching everyone involved, despite the inherent drawbacks and demands. International information networks on women's security are expanding and can help the new partnerships refine their working methods, to the benefit of all, regardless of gender. Still, the transfer of knowledge between partners and among the population is fundamental and demanding. The same applies to the need to develop methods and criteria of evaluation that are adapted to the specific realities of the partnership for prevention of crime and violence towards women.
Domestic violence screening and referral can be effective.
- Krasnoff M, Moscati R. Ann Emerg Med 2002; 40(5):485-492.
Correspondence: Ronald Moscati, Department of Emergency Medicine, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA; (email: moscati@acsu.buffalo.edu).
OBJECTIVE: We provide a targeted intervention in the emergency department for intimate partner violence (IPV) victims and to facilitate follow-up care from a professional case manager.
METHODS: This observational case study was conducted in an urban ED from July 1, 1997, through December 31, 1999. The targeted population consisted of all English-speaking women between the ages of 18 and 65 years presenting 24 hours a day, 7 days a week. There were 3 components to the study. The first consisted of an effort to improve the screening for IPV of female patients seen in the ED. The primary outcome for this component was the correlation of increased screening rates with increased violence detection. Universal screening of all women for IPV regardless of their chief complaint was encouraged through an IPV script and a new reporting area on the nursing note. The second component was an on-site IPV advocacy intervention. Once IPV was identified by means of screening or self-disclosure, the nurse notified a volunteer advocate from a local human service agency, who came to the ED within 30 minutes, conducted a crisis intervention, and encouraged the patient to follow-up with the case manager. The outcomes were patient cooperation with the ED intervention and subsequent follow-up with the community-based agency. The third phase was telephone-based counseling by an IPV case manager to help the client reduce her exposure to additional violence. The outcome was the client's self-report of a life free of violence.
FINDINGS: Of the 528 women identified as IPV victims, 475 (84%) agreed to speak to the advocate, and 258 (54% of those seen by the advocate) accepted case management follow-up. After the case management process, lasting 3 to 6 weeks, 127 women reported that they no longer believed they were at risk for violence from their abuser.
DISCUSSION: Through a coordinated effort by the medical staff and the volunteer advocates, 258 of 528 IPV victims seen in the ED received ongoing community-based services to address their experience of IPV.
"Between me and the computer": increased detection of intimate partner violence using a computer questionnaire.
- Rhodes KV, Lauderdale DS, He T, Howes DS, Levinson W. Ann Emerg Med 2002; 40(5): 476-484.
Correspondence: Karin V. Rhodes, Department of Medicine, Section of Emergency Medicine, the University of Chicago, 5841 South Maryland Avenue, MC 5068, Room L545, Chicago, IL 60637, USA; (email: krhodes@medicine.bsd.uchicago.edu).
OBJECTIVE: The emergency department is a problem-focused environment in which routine screening for intimate partner violence (IPV) is difficult. We hypothesized that screening for IPV during computer-based health-risk assessment would be acceptable to patients and improve detection.
METHODS: We performed a descriptive study of IPV data collected during a controlled trial of computer-based health promotion in an urban hospital ED. Patients received computer-generated health advice, and physicians received patient risk summaries. Outcomes were patient disclosure and physician documentation of IPV and associated risks.
FINDINGS: Two hundred forty-eight patients (69% female, 90% black, mean age 39 years) participated in a clinical trial of computer-based health promotion in the ED. Of 170 women, 53 (33%) disclosed emotional abuse, and 25 (15%) disclosed physical abuse. Of 78 men, 22 (29%) disclosed emotional abuse, and 5 (6%) disclosed physical abuse. Patients were also willing to self-report a history or concern of hurting someone close to them. This was true for 21 (14%) women and 15 (22%) men. Controlling for demographic factors, disclosures of victimization and perpetration were associated with multiple psychosocial risks. Computer screening resulted in chart documentation in 19 of 83 potential cases of IPV compared with 1 case documented in the group that received usual care.
DISCUSSION: Providing an opportunity for patients to confidentially self-disclose IPV has the potential to supplement current screening efforts and to allow providers to focus on assessment, counseling, and referral for those at risk. However, further measures will be needed to ensure that information gathered through computer screening is adequately addressed during the acute care or follow-up visit.
Threats and violence in Swedish care and welfare - magnitude of the problem and impact on municipal personnel.
The problem of threats and violence at work has received increasing attention in Sweden in recent years. Exposure is especially high among health-care personnel in social services. A nationwide survey of prevalence, work environment and risk situations was conducted. A questionnaire was sent to a stratified sample of 2800 local government employees in the care and welfare sector, working mainly with the elderly or persons with developmental impairments. Seven occupational groups, including supervisors, specialists and other categories of carers, were included, and represented a population of more than 170 000 employees. The response rate was 85%. The results indicated that as many as 51% of the population had been affected by threats/violence, either verbally or physically, over the previous year. Moreover, the results suggest that over 9% of the employees in the care sector experienced acts of violence or threats on a daily basis, and several times a month by 67%. The most vulnerable groups were assistant nurses and direct carers. Verbal threats appear more common (79%), but 66% appear to have experienced physical assaults. Stratified estimates suggest that feelings of anger (41%) and helplessness (31%), but also minor physical injuries (18%), are frequent reactions. Organizational change in the workplace and high workload entailed increased risk. Threats and violence in health-care settings are a major work-environment issue. Greater knowledge of consequences for organization, work situation and health of personnel is needed.
Brain injury and violent crime.
- Turkstra L, Jones D, Toler L. Brain Inj 2003; 17(1): 39-47.
Correspondence: Lyn S. Turkstra, Case Western Reserve University, Cleveland, OH, USA; (email: lst2@po.cwru.edu).
OBJECTIVES: To test the hypothesis that TBI is associated with violent crime, the prevalence and characteristics of traumatic brain injury (TBI) were compared between men convicted of domestic violence and a matched comparison group.
METHODS: Participants were 20 African American men convicted of domestic violence and 20 African American men without criminal convictions matched for age and socioeconomic status. Participants completed a questionnaire regarding health and behavior history.
FINDINGS: More than half of the participants in both groups had sustained a TBI, although injuries in the offender group were significantly more severe. There were significantly more reports of problems with anger management in the offender group.
DISCUSSION: Published epidemiological data regarding TBI may underestimate the prevalence in urban populations, which may have confounded earlier studies of TBI and domestic violence. The reported prevalence in this sample of defendants suggests implications for the justice system.
