OBJECTIVE: Studies have shown that expectations of alcohol-induced impairment can produce adaptive responses to alcohol that reduce the degree of behavioral impairment displayed. The present study tested psychomotor performance following combined caffeine and alcohol administration in 42 social drinkers (23 men). Subjects were led to expect either that caffeine would antagonize alcohol-induced impairment or that it would have no effect. The study tested the hypothesis that drinkers who expected an antagonist effect of caffeine would display greater alcohol impairment than those who expected no antagonist effect.
METHODS: Groups practiced a pursuit rotor task and received a moderate dose of alcohol (0.65 g/kg) combined with either 4.0 mg/kg caffeine or placebo caffeine. Some groups were led to expect that caffeine would counteract the impairing effect of alcohol and others were led to expect no counteracting effect. Psychomotor performance was then tested over a 3-hour period.
FINDINGS: In accord with the hypothesis, groups led to expect counteracting effects of caffeine displayed greater impairment than those led to expect no counteraction. Caffeine had no significant antagonist effect on alcohol impairment.
DISCUSSION: The findings suggest that compensation for alcohol impairment occurs when drinkers hold clear expectations that the drug will disrupt performance. When no such clear expectation exists, no compensatory response occurs and the impairing effects of alcohol are observed.
As a professional fire officer I read with interest the article and ongoing debate on the issue of free smoke detectors and the suggested outcomes from the research. (DiGuiseppi et al, available online Download Document). One element perhaps overlooked in the debate is ownership, which has two components.
The first is the gift of the smoke detector itself. Being given one doesn't bring with it the same sense of ownership as working for and buying one. It would not be appropriate to discuss the relative merits or otherwise of purchasing power, given the socioeconomic elements of the study, but the relative cost of these units through subsidized purchase might help to address concerns.
The second component is the ownership of risk, which is much more difficult to grapple with. In Dorset we have developed a multiagency community safety center, "Streetwise," in which visitors, mostly children, confront several safety related issues, fire being one.
Our messages are intended to provide a holistic safety message for each visitor. The overall intention is to provide every visitor with some of the underlying tools for life, which we hope will ensure that they recognize their personal responsibility to contribute to a safer environment for us all.
Research is ongoing on providing sprinklers for houses. My colleagues and I are hopeful that this will bring about an increase in active systems that will not only inform those in the property of a fire but tackle it as well. The long term aim is to ensure that sprinklers become as widely regarded as a must have in a new home as fitted carpets are now. The costs are about the same.
Undoubtedly the focus of installations will be mandated to premises at the highest risk. In many deaths and serious injuries caused by fire a high proportion of people are affected by drugs or alcohol, with the associated debilitating effects. Perhaps this is another area worthy of research.
Like many professionals, members of the fire service are working widely to promote fire prevention and reduce deaths and injuries, whose costs to health budgets are notable.2 I add my support to the humble smoke detector, which, if properly installed and maintained, has an important part to play in helping to create a safer society for us all.
Correspondence: Roderick McClure, Injury Prevention and Control (Australia) Ltd, School of Population Health, University of Queensland Medical School, Herston QLD 4006, AUSTRALIA; (email: r.mcclure@sph.uq.edu.au).
OBJECTIVE: This study aimed to identify the distribution of fall related injury in older people hospitalized for acute treatment of injury, in order to direct priorities for prevention.
SETTING: A follow up study was conducted in the Brisbane Metropolitan Region of Australia during 1998.
METHODS: Medical records of patients aged 65 years and over hospitalized with a fall related injury were reviewed. Demographic and injury data were analyzed and injury rates calculated using census data as the denominator for the population at risk.
FINDINGS: From age 65, hospitalized fall related injury rates increased exponentially for both males and females, with age adjusted incidence rates twice as high in women than men. Fractures accounted for 89% of admissions, with over half being to the hip. Males were significantly more likely than females to have fractured their skull, face, or ribs (p <0.01). While females were significantly more likely than males to have fractured their upper or lower limbs (p < 0.01), the difference between proportions of males and females fracturing their hip was not significant. Males were more likely than females (p < 0.01) to have fall related head injuries (13% of admissions). Compared with hip fractures, head injuries contributed significantly to the burden of injury in terms of severity, need for intensive care, and excess mortality.
DISCUSSION: The frequency and impact of hip fractures warrants continued emphasis in falls program interventions for both males and females to prevent this injury. However, interventions that go beyond measures to slow and protect against bone loss are also needed to prevent fall related head injuries.
Lipid-lowering agents and the risk of hip fracture in a Medicaid population.
- Ray WA, Daugherty JR, Griffin MR. Inj Prev 2002; 8(4): 276-279.
Correspondence: Wayne Ray, Department of Preventive Medicine, Medical Center North, A-1124, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (wayne.ray@mcmail.vanderbilt.edu).
BACKGROUND: Three recent nested case-control studies conducted in automated databases suggest that users of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have a risk of hip and other osteoporotic fractures half that of non-users of any lipid-lowering drug. However, this comparison may be biased by unmeasured factors associated with treated hyperlipidemias.
OBJECTIVES: To compare the risk of hip fracture among users of statins and other lipid-lowering agents, which is less susceptible to bias than the comparisons performed in the previous studies.
DESIGN AND SETTING: Retrospective cohort study conducted in the Tennessee Medicaid program between 1 January 1989 through 31 December 1998.
SUBJECTS: New users of all lipid-lowering drugs and randomly selected non-user controls who at baseline were at least 50 years of age and did not have life threatening illness, nursing home residence, or diagnosed dementia or osteoporosis. There were 12,506 persons with new use of statins, 4,798 with new use of other lipid lowering drugs, and 17,280 non-user controls.
MAIN OUTCOME MEASURE: Fracture of the proximal femur (hip), excluding pathological fractures or those resulting from severe trauma.
FINDINGS: During 66,690 person years of follow up, there were 186 hip fractures (2.8 per 1000). Relative to non-users, the adjusted incidence rate ratios (95% confidence interval) were 0.62 (0.45 to 0.85) for statin users and 0.44 (0.26 to 0.95) for other lipid-lowering drugs. When compared directly with the other drugs, the adjusted incidence rate ratio for statins was 1.42 (0.83-2.43).
DISCUSSION: These data provide evidence that the previously observed protective effect of statins may be explained by unmeasured confounding factors.
This paper presents information on occupational choices and behaviors as described by the model of human occupation and the profession of occupational therapy. This project was designed to answer the research question, "Why do people choose to return to the same high-risk careers after sustaining a serious work-related injury?" Two firefighters from a New York metropolitan area were interviewed individually to explore their roles, especially the worker role, their injuries, and their decisions to return to the same high-risk type of work. The results indicate that a strong social support system from co-workers, and the motivation and enjoyment of the job were the common factors that influenced the two participants to return to their jobs.
Bright light, dark and melatonin can promote circadian adaptation in night shift workers.
- Burgess HJ, Sharkey KM, Eastman CI. Sleep Med Rev 2002; 6(5):407-420.
Correspondence: Charmane Eastman, Biological Rhythms Research Laboratory, Rush-Presbyterian-St Luke's-Medical Center, 1645 W. Jackson Blvd, Suite 425, Chicago IL 60612, USA; (email: ceastman@rush.edu).
The circadian rhythms of shift workers do not usually phase shift to adapt to working at night and sleeping during the day. This misalignment results in a multitude of negative symptoms including poor performance and reduced alertness during night work and poor daytime sleep at home. After an introduction to circadian principles, we discuss the efficacy of appropriately timed bright light exposure (natural and artificial) and exogenous melatonin administration for producing circadian adaptation to night work. Interventions that generate alternative 24h light/dark patterns that facilitate appropriate circadian phase shifting are discussed. Such interventions include minimizing night workers' exposure to the external light/dark cycle, and the use of intermittent and moving patterns of bright light at work. The efficacy of melatonin in phase shifting circadian rhythms in the field is also addressed and compared to that of bright light. We present sleep/light exposure schedules that could produce circadian adaptation in permanent night workers. We conclude this review by discussing the impact of individual differences on possible circadian interventions and issues associated with the use of bright light interventions in the field.
BACKGROUND: Poison control centers (PCCs) reduce health care costs for childhood poisonings by providing telephone advice for home management of most cases. Past research suggests that PCCs are underutilized by low-income minority and Spanish-speaking parents because of lack of knowledge and misconceptions about the PCC. A videotape intervention was designed to address these barriers to PCC use.
OBJECTIVES: To evaluate the effectiveness of a videotape intervention (videotape, PCC pamphlet, and PCC stickers) in improving knowledge, attitudes, behaviors, and behavioral intention regarding use of the PCC in a low-income and predominantly Spanish-speaking population in Northern California.
METHODS: Two hundred eighty-nine parents of children <6 years of age, attending educational classes at 2 Women, Infant, and Children (WIC) clinics participated in a randomized, controlled trial. WIC classes were randomized to receive the video intervention (video group) or to attend the regularly scheduled WIC class (control group). Participants completed a baseline questionnaire and 2 to 4 weeks later, a follow-up telephone interview. Changes from baseline to posttest were compared in the treatment and control groups using analysis of variance.
FINDINGS: Compared with the control group, the video group showed an increase in knowledge about the PCC's function, its hours of operation, and staff qualifications; was more likely to feel confident in speaking with and carrying out recommendations made by the PCC; was less likely to believe the PCC would report a mother for neglect; was more likely to have the correct PCC phone number posted in their homes; and when presented with several hypothetical emergency scenarios, was more likely to correctly answer that calling the PCC was the best action to take in a poisoning situation.
DISCUSSION: This videotape intervention was highly effective in changing knowledge, attitudes, behaviors, and behavioral intentions concerning the PCC within this population. As a result, use of this video may help increase use of the PCC by low-income and Spanish-speaking families.
Objective: Winter sports continue to be a popular form of recreation, but few studies have focused on serious injuries. The objectives of this study were to evaluate the major morbidity associated with downhill skiing, snowboarding, and sledding and to determine the incidence of serious injuries sustained while downhill skiing and snowboarding.
Methods: State trauma registry data from the 1992-93 through 1998-99 ski seasons on all snow sports participants transported to tertiary trauma hospitals in Oregon were analyzed.
Findings: Of 132 patients, 80% were male and 20% were female, with a mean age of 30.4 ± 15.6 for skiers, 24.1 ± 10.5 for snowboarders, and 18.8 ± 11.9 for sledders. The mean Injury Severity Score was 12.3 ± 7.6 for skiers, 10.3 ± 7.4 for snowboarders, and 12.8 ± 8.5 for sledders. Head injuries accounted for 55% of sledding injuries and 39% of all injuries. Skiers and snowboarders were less likely to have head injuries than sledders (odds ratio [OR] = 0.45; 95% CI, 0.21 to 0.98). A higher proportion of injuries sustained by snowboarders were due to falls from heights (29%) compared with injuries sustained by skiers or sledders (OR = 4.8; 95% CI, 1.6 to 13.7). Sledders were more likely to be injured during collisions than were skiers or snowboarders (OR = 16.7; 95% CI, 5.8 to 47.6). The incidence of serious skiing and snowboarding injuries was 6.4 injuries per million visits. There were 4 deaths (3%), 1 each from snowboarding and skiing (head injuries) and 2 from sledding (1 from head and 1 from head and thoracic injuries).
Discussion: Serious snow sports injuries are rare but potentially debilitating. Head injuries account for the majority of deaths and functional impairment.
Overview of injuries in the young athlete.
- Adirim TA, Cheng TL. Sports Med 2003; 33(1): 75-81.
Correspondence: Terry A. Adirim, Division of Emergency Medicine, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA; (email: unavailable).
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; and proper equipment and field/surface playing conditions.
Standard analysis of matched-pair cohort data requires information only from pairs in which at least one had the study outcome. This can be useful in traffic fatality studies of characteristics that can vary among vehicle occupants, such as seat belt use, as crash databases often lack information about vehicles in which all survived. However, matching crash victims who were in the same vehicle does not necessarily eliminate confounding by vehicle or crash related factors, because the matched occupants must be in different seat positions. This paper reviews three methods for estimating relative risks in matched-pair crash data. The first, Mantel-Haenszel stratified methods, may produce biased estimates if seat position is associated with the outcome. The second, the double-pair comparison method, was designed to deal with confounding by seat position. If the effects of seat position vary according to some vehicle or crash characteristic which is associated with the study exposure, adjustment for this characteristic may be needed to produce unbiased estimates. Third, conditional Poisson regression and Cox proportional hazards regression can produce unbiased estimates, but may require model interaction terms between seat position and vehicle or crash characteristics. This paper reviews some of the strengths and limitations of each of these methods, and illustrates their use in simulated and real crash data.
Health-health analysis-an alternative method for economic appraisal of health policy and safety regulation. Some empirical Swedish estimates.
- Hjalte K, Norinder A, Persson U, Maraste P. Accid Anal Prev 2003; 35(1): 37-46.
Correspondence: Krister Hjalte Department of Economics, Lund University, P.O. Box 7082, SE-22007, Lund, Sweden; (email: krister.hjalte@nek.lu.se).
Health-health analysis (HHA) focuses on statistical lives themselves as a numeraire. The underlying principle is that the expected gains in health and safety of reduced risks in one area may result in increasing risks somewhere else in society. By reducing one risk other risks may increase due to changed individual behavior. In addition to this direct effect, another indirect effect will also be present. Expenditure on a particular health policy or safety regulation must be financed in one way or another, which will result in an opportunity cost or income effect leaving less resources for other health and safety promoting activities in society. Thus, we will have an effect that reduces safety and health benefits induced by that income loss. Whether the total net health effect from a specific safety regulation or health policy is positive or negative must be empirically analyzed. One way of estimating the income loss that induces one death, which we call the value of an induced death (VOID), is to estimate it as a multiple of the traditional value to avert a statistical death, also named the value of a statistical life (VOSL).A contingent valuation (CV) study eliciting the willingness-to-pay (WTP) for reducing the overall risk of dying was performed as a postal questionnaire in Sweden in 1998. By use of data from this study, it was possible to estimate the VOID and the VOSL in Sweden amounting to SEK116 and SEK20.8 million respectively, indicating that the net health result confined to mortality effects, will be negative (more lives will be lost than saved) if a health policy or safety regulation will cost more than SEK116 million per life saved.
Mode effects for collecting alcohol and other drug use data: Web and U.S. mail.
- McCabe SE, Boyd CJ, Couper MP, Crawford S, D'Arcy H. J Stud Alcohol 2002; 63(6): 755-761.
Correspondence: Sean Esteban McCabe, University of Michigan Substance Abuse Research Center, 47S Market Place, Suite D, Ann Arbor, Michigan 48108-1649, USA; (email: plius@umich.edu).
OBJECTIVE: The present study examined mode effects for collecting alcohol and other drug use data using a Web-based survey mode and a U.S. mail-based survey mode for comparison.
METHOD: A survey regarding alcohol and other drugs was administered to a randomly selected sample of 7,000 undergraduate students attending a large Midwestern research university in the spring of 2001. The sample was randomly assigned to either a Web-based survey mode (n = 3,500) or a U.S. mail-based mode (n = 3,500).
FINDINGS: The Web survey mode of administration resulted in a final sample that more closely matched the target sample in gender mix than did the U.S. mail survey mode. The response rate for the Web survey mode was significantly higher than for the U.S. mail survey mode. Chi-square results indicated there were significant differences in response propensity by several sample characteristics including sex, race, class year and academic credit hours. Multivariate logistic regression results revealed significant racial and gender differences in the response propensity between and within modes. After controlling for design discrepancies, there were no significant differences between modes in data quality or substantive responses to substance-use variables.
DISCUSSION: The findings of the present study provide strong evidence that Web surveys can be used as an effective mode for collecting alcohol and other drug use data among certain populations who have access to the Internet and high rates of use. Web surveys provide promise for enhancing survey research methodology among undergraduate college students.
Correspondence: E.O. Orjo, Department of Obstetrics, Gyaencology and Perinatology, Obafemi Awolowo University Teaching Ile-Ife, NIGERIA; (email: unavailable).
A 21-year (1980-2000) retrospective review of 84 pregnant women involved in road traffic accidents in Southwest Nigeria was conducted. Case notes of these 84 pregnant women treated at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, were studied. Pregnant women formed 0.3% of all individuals involved in accidents during the study period compared to 7% reported in developed countries. The fetal death rate of 3.6% and maternal death rate of 2.4% in this study were lower than the fetal death rates of 57% and maternal death rate of 8-16% reported in developed countries. There was no obvious injury in 23.8%, while in 76.2% there were serious maternal injuries ranging from limb fractures, pelvic bone fracture, quadriplegia, uterine rupture, abruption placenta, lacerations, etc. Fetal tachycardia was observed in 11.9%. Despite these injuries, the majority (80.9%) achieved spontaneous vaginal deliveries; 16.7% were lost to follow-up, while 2.4% had an emergency caesarean section for reasons unrelated to the accidents. Preventive measures such as proper screening of drivers before issuing driving licenses, separation of vehicular and pedestrian traffic, installation and enforcement of the use of seat belts, restrictions of alcohol ingestion while driving, use of a crash helmet by cyclists would drastically reduce the incidence of these accidents.
Electrical injuries.
- Koumbourlis AC. Crit Care Med 2002; 30(11 Suppl): S424-s430.
Correspondence: Anastassios C. Koumbourlis, Division of Pediatric Critical Care, College of Physicians and Surgeons of Columbia University, Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA; (email:ack6@columbia.edu).
Electrical injury is a relatively infrequent but potentially devastating form of multisystem injury with high morbidity and mortality. Most electrical injuries in adults occur in the work-place, whereas children are exposed primarily at home. In nature, electrical injury occurs due to lightning, which also carries the highest mortality. The severity of the injury depends on the intensity of the electrical current (determined by the voltage of the source and the resistance of the victim), the pathway it follows through the victim's body, and the duration of the contact with the source of the current. Immediate death may occur either from current-induced ventricular fibrillation or asystole or from respiratory arrest secondary to paralysis of the central respiratory control system or due to paralysis of the respiratory muscles. Presence of severe burns (common in high-voltage electrical injury), myocardial necrosis, the level of central nervous system injury, and the secondary multiple system organ failure determine the subsequent morbidity and long-term prognosis. There is no specific therapy for electrical injury, and the management is symptomatic. Although advances in the intensive care unit, and especially in burn care, have improved the outcome, prevention remains the best way to minimize the prevalence and severity of electrical injury.
This study was carried out with three goals: (1) to determine the prevalence of suicidal ideation and suicide attempts among the homeless; (2) to determine what aspects of homelessness predict suicidality, and (3) to determine which aspects remain predictive after controlling for key covariates, such as mental illness. A sample of 330 homeless adults were interviewed. Sixty-one percent of the study sample reported suicidal ideation and 34% had attempted suicide. Fifty-six percent of the men and 78% of the women reported prior suicidal ideation, while 28 percent of the men and 57% of the women had attempted suicide. Childhood homelessness of at least 1 week without family members and periods of homelessness longer than 6 months were found to be associated with suicidal ideation. Psychiatric diagnoses were also associated with suicidality in this sample.
Does writing about suicidal thoughts and feelings reduce them?
Correspondence: Lillian M. Range, Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406-5025, USA; (email: l.range@usm.edu).
To assess whether writing with cognitive change or exposure instructions reduces depression or suicidality, 121 undergraduates screened for suicidality wrote for 20 minutes on 4 days over 2 weeks. They were randomly assigned to reinterpret or to write and rewrite traumatic events/emotions, or to write about innocuous topics. The three groups (N = 98) who completed pre-, post-, and 6-week follow-up were not different on suicidality or depression. All subjects reported fewer automatic negative thoughts over the 2 weeks; they also reported higher self-regard but more health center visits at follow-up. Suicidal thoughts may be more resistant than physical health to writing interventions.
BACKGROUND: Medical conditions may adversely affect driving ability. Many North American jurisdictions provide restricted driving licenses that permit people with certain medical conditions to drive under limited conditions, but the effectiveness of such programs has not yet been determined. The objectives of this study were to evaluate the rates of crashes and traffic violations among drivers with a restricted licence, compared with the rates in the general driving population, and to compare the crash and traffic violation rates before and after driving restrictions were imposed.
METHODS: We retrospectively analyzed a cohort of all licensed Saskatchewan drivers registered from Jan. 1, 1992, to Apr. 19, 1999. The cohort was divided into those with a restricted licence and those with an unrestricted general licence. We used multivariate Poisson regression to calculate incidence rate ratios (IRRs) for at-fault crashes and traffic violations, adjusting for age, sex and residence (urban v. rural). We used interventional time series analysis to compare rates of crashes and traffic violations before and after the imposition of driving restrictions.
FINDINGS: Of the 703,758 drivers in the study, 23,185 (3.3%) had a restricted licence. Restricted licence holders had a higher crash rate than drivers without restrictions (adjusted IRR 1.13, 95% confidence interval [CI] 1.11-1.17). However, this rate was lower than that among male drivers (adjusted IRR 2.01, 95% CI 1.99-2.02) and urban drivers (adjusted IRR 1.38, 95% CI 1.37-1.39). Drivers with restricted licenses had a lower traffic violation rate than those without restrictions (adjusted IRR 0.93, 95% CI 0.91-0.95). At-fault crash rates decreased by 12.8% (95% CI 2.4%-23.2%) and adjusted traffic violation rates decreased by 10.0% (95% CI 4.4%-15.7%) after restrictions were imposed. During the study period, licence restrictions likely averted up to 816 crashes and 751 traffic violations.
DISCUSSION: Province-wide population data suggest that a restricted licensing program appears to provide a significant decrease in the rates of crashes and traffic violations.
Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities.
- Freund B, Szinovacz M. Gerontologist 2002; 42(5): 621-333.
Correspondence: BM Freund, The Glennan Center for Geriatrics and Gerontology, Eastern Virginia Medical School, Norfolk, 23507, USA; (email: freundbm@evms.edu).
OBJECTIVES: This study explored the impact of cognition and the availability of other drivers on driving restriction and cessation among older adults.
METHODS: Survey data from the first wave of the Asset and Health Dynamics Among the Oldest Old data were analyzed, using multinomial logistic regressions.
FINDINGS: Cognitive impairment is associated with driving restriction and cessation, although a noteworthy minority of mildly and severely cognitively impaired individuals continue to drive. Partner's driving and involvement and presence of other drivers in the household moderated the effect of cognition on driving restriction and cessation.
DISCUSSION: The decision processes surrounding an individual's restricting or stopping driving are complex and may include consideration not only of competence, but also of sense of self-worth and relationship with a partner.
Road Traffic Accidents with Two-Wheeled Motor Vehicles During a Five-Year Period in Odense, Denmark.
Correspondence: Tamás Barsi, Accident Analysis Group, Department of Orthopaedic Surgery, Odense University Hospital, DK-5000 Odense, DENMARK; (email: barsi@dadlnet.dk).
A new type of two-wheeled motor vehicle was introduced in Denmark in 1994. This "scooter-45" has become very popular and is sold in large numbers. The aim of this study was to examine the consequences of the introduction of the scooter-45 in the number of road traffic injuries. All patients treated at the Odense University Hospital during 1996 to 2000 following road traffic accidents with two-wheeled motor vehicles were included in this study. Injuries were graded according to the Abbreviated Injury Scale. A significant rise in the annual incidence rate for traffic injuries was observed in the study period for both mopeds and scooter-45s (p < .05). For both scooter-45s and motorcycles, the highest incidence rate of road traffic accidents was observed in the age group of 20 to 29 years. For mopeds, the highest incidence rate was seen in the age group of 10 to 19 years. We found an increase in the annual incidence rate of injuries following road traffic accidents with mopeds and scooter-45s. Single accidents were the most common accidents.
The Effect of Increasing Rural Interstate Speed Limits in the United States.
Within a year of the repeal of the National Maximum Speed Limit in the United States, 23 states had raised their rural interstate speed limits to 70 or 75 mph. The effect on rural interstate fatalities was examined by modeling fatalities between 1992 and 1999 against the size of the new speed limit (no change, 70 mph, and 75 mph), the period before and after the speed limit change (1992 to 1995 vs. 1996 to 1999), and their interaction. Fatalities in the groups of states that raised their speed limits to 75 mph and 70 mph were 38% and 35%, respectively, higher than expected based on fatalities in the states that did not change their speed limits. Furthermore, the states that raised their speed limits to 75 mph had a higher rural interstate fatality rate before the speed limit was changed than the other groups of states.
Effectiveness of Ford's belt reminder system in increasing seat belt use.
- Williams AF, Wells JK, Farmer CM. Inj Prev 2002; 8(4): 293-296.
Correspondence: Allan F Williams, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, Virginia 22201-4751, USA; (email: awilliams@iihs.org).
OBJECTIVES: The study investigated the effectiveness in increasing seat belt use of Ford's belt reminder system, a supplementary system that provides intermittent flashing lights and chimes for five minutes if drivers are not belted.
METHODS: Seat belt use of drivers in relatively new cars with and without the reminder system was unobtrusively observed as vehicles were brought to dealerships for service.
FINDINGS: Overall use rates were estimated at 71% for drivers in vehicles without the reminder system and 76% for drivers in vehicles with belt reminders (p < 0.01).
DISCUSSION: Seat belt use is relatively low in the United States. The present study showed that vehicle based reminder systems can be at least modestly effective in increasing belt use, which may encourage further development of such systems.
In-vehicle communication systems: the safety aspect.
Communication and information technology are developing very rapidly at present. At the same time, the number of older drivers is increasing. When designing systems for elderly drivers, it has been shown that: (1) simplifying a task reduces performance differences between old and young; and (2) the optimization of onboard systems (better legibility and intelligibility of the information, simplified dialogue) in relation to the abilities of elderly drivers benefits the rest of the user population. Elderly people do not automatically reject new information and assistance technologies especially when the systems are user friendly. However, the ergonomics of these new technologies must be studied, with particular attention to the specific needs of the elderly, in order not to marginalize them.
Fragility versus excessive crash involvement as determinants of high death rates per vehicle-mile of travel among older drivers.
- Li G, Braver ER, Chen LH. Accid Anal Prev 2003; 35(2): 227-235.
Correspondence: Guohua Li, Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, 21205, Baltimore, MD, USA;(email: ghli@jhmi.edu).
Using multiple national data systems, the roles of fragility (susceptibility to injury) versus excessive crash involvement in the increased fatality risk of older drivers per vehicle-mile of travel (VMT) were estimated. For each age and gender group, deaths per driver involved in a crash (a marker of fragility) and drivers involved in crashes per VMT (a marker of excessive crash involvement) were computed. Compared with drivers ages 30-59, those younger than 20 and those 75 or older both had much higher driver death rates per VMT. The highest death rates per mile driven, 13-fold increases, were observed among drivers age 80 or older, who also had the highest death rates per crash. Fragility began to increase at ages 60-64 and increased steadily with advancing age, accounting for about 60-95% of the excess death rates per VMT in older drivers, depending on age group and gender. Among older drivers, marked excesses in crash involvement did not begin until age 75, but explained no more than about 30-45% of the elevated risk in this group of drivers; excessive crashes explained less of the risk among drivers ages 60-74. In contrast, crash over-involvement was the major factor contributing to the high risk of death among drivers younger than 20, accounting for more than 95% of their elevated death rates per VMT. Although both fragility and crash over-involvement contributed to the excess death rates among older drivers per VMT, fragility appeared to be of over-riding importance. These findings suggest that measures to improve the protection of older vehicle occupants in crashes should be vigorously pursued.
Alcohol is the Main Factor in Excess Traffic Accident Fatalities in France.
- Reynaud M, Le Breton P, Gilot B, Vervialle And F, Falissard B. Alcohol Clin Exp Res 2002; 26(12): 1833-1839.
Correspondence: Michel Reynaud, MD, PhD, Psychiatry Department, Paul Brousse Hospital, 12 Avenue Paul Vaillant-Couturier, 94804 Villejuif Cedex, FRANCE; (email: michel.reynaud@pbr.ap-hop-paris.fr).
BACKGROUND: The aim of this study was to better evaluate the role of alcohol drinking in fatalities linked to road traffic accidents.
METHODS The data of accidents were collected by a French official agency from police records, including many variables, among which was a blood alcohol test. They were analyzed in a descriptive way and toward a logistic regression. This exhaustive database comprised all of the 500,961 accidents with casualties that involved less than three vehicles (28,506 fatal accidents) recorded in France during a 52 month period (September 1995 to December 1999). The results of the alcohol tests were known in 78.7 of the drivers.
FINDINGS: The blood alcohol concentration was over the legal limit (0.50 g/L in France) in 9.8% of the accidents with casualties overall. Considering only fatal accidents, the rate of positive alcohol test in drivers was approximately 31.5%. This rate varied depending on the period and the type of accident, raising up to 71.2% in single-vehicle accidents (loss of control) at night during the weekend. The percentage of positive alcohol tests also dramatically increased following the number of fatalities per accident (87.5% in single-vehicle accidents during weekend nights involving three or more killed). The logistic regression in single-vehicle accident shows that the higher odds ratios concern the positive blood alcohol test (OR = 4.19), clearly overwhelming the other precipitating factors of accidents (age of driver, meteorological conditions, time of day, and other factors).
DISCUSSION: Drinking alcohol before driving is a well known factor of accidents. We clearly demonstrate here that it is the main factor leading to deaths linked to road traffic accidents in France. The results are strengthened, and some analyses are allowed, by the exceptional features of our database. The authors emphasize the need for prevention measures.
The problem of violence at work has received considerable attention in recent years. According to Swedish statistics, personnel in the health-care sector are the most affected. The purpose of this paper is to present a framework or model for studies of workplace violence, and to demonstrate its application to the analysis of violence in health-care settings. The model treats violence as a process comprising of several stages/sub-events, and shows how this process is influenced by underlying structural (rather permanent) and situational (generally temporary) risk factors. Understanding the diversity in the process provides a basis for analysis of connections between interacting factors at different stages. Risk management (hazard identification, risk analysis, and preventive counter-measures) should be integrated into the work situation and operations of an organization.
Correspondence: Tina L. Cheng, Department of General Pediatrics and Adolescent Medicine, Johns Hopkins University, 600 North Wolfe Street, Park 392, Baltimore, MD 21287, USA; (email: tcheng2@jhmi.edu).
OBJECTIVE: Toy gun play has been associated with aggressive behavior, and it has been suggested that child health professionals counsel families on limiting exposure. Effective violence prevention counseling requires an understanding of norms regarding parental attitudes, practices, and influencing factors. Both theories of reasoned action and planned behavior emphasize that subjective norms and attitudes affect people's perceptions and intended behavior. Few normative data exist on this issue from a cross-section of families. By establishing behavioral norms and understanding the spectrum of parental attitudes, community-sensitive and community-specific interventions for violence prevention can be developed. The objective of this study was to assess community norms on the topic of toy gun play from the perspective of parents.
METHODS: An anonymous self-report assisted survey was administered to a convenience sample of parents/guardians who visited child health providers at 3 sites: an urban children's hospital clinic, an urban managed care clinic, and a suburban private practice. The parent questionnaire included questions on child rearing attitudes, practice, and sociodemographic information.
FINDINGS: A total of 1004 eligible participants were recruited for the study; 922 surveys were completed (participation rate 92%). The 830 (90%) respondents who were parents and had complete child data were the focus of additional analysis. Regarding toy guns, 67% of parents believed that it was never "OK for a child to play with toy guns," and 66% stated that they never let their children play with toy guns. Parents who thought that it was okay for children to play with toy guns and allowed them to play with toy guns were more likely to be male parents, have male children, and be white.
DISCUSSION: There is variability in norms regarding toy gun play among parents, with most discouraging toy gun play. Norms varied based on gender of the child, gender of the parent, and race. Understanding norms is a first step in designing effective community-sensitive interventions.
Developing a framework for identifying individual and organizational risk factors for the prevention of violence in the health-care sector.
- Viitasara E, Menckel E. Work 2002; 19(2): 117-123.
Correspondence: Eija Viitasara, National Institute for Working Life,
112 79 Stockholm, SWEDEN; (email: eija.viitasara@niwl.se).
(Copyright 2002; IOS Press)
The problem of violence at work has received considerable attention in recent years. According to Swedish statistics, personnel in the health-care sector are the most affected. The purpose of this paper is to present a framework or model for studies of workplace violence, and to demonstrate its application to the analysis of violence in health-care settings. The model treats violence as a process comprising of several stages/sub-events, and shows how this process is influenced by underlying structural (rather permanent) and situational (generally temporary) risk factors. Understanding the diversity in the process provides a basis for analysis of connections between interacting factors at different stages. Risk management (hazard identification, risk analysis, and preventive counter-measures) should be integrated into the work situation and operations of an organization.
