The number of bicycle-related injuries among Ontario children is declining, likely because of increased helmet use and parental diligence, the Canadian Institute for Health Information (CIHI) reports. It says there has been a 12.5% decrease in the number of hospitalizations due to bicycle-related injuries among Ontario children aged 5 to 19. During the same 5-year period, the number of bicycle-related head injuries in that age group dropped by 26%. The CIHI report, Injury Hospitalizations, states that this is related to the 1995 introduction of Ontario's bicycle helmet legislation, which requires children to wear a helmet while riding a bicycle. Alison Macpherson, an injury researcher at the Hospital for Sick Children in Toronto, says research has shown that this type of legislation is "an effective tool." She added that a recent study indicated that the number of children riding bicycles does not decrease because of mandatory helmet legislation (www.injuryprevention.com). Julian Martalog, a CIHI consultant, says British Columbia, Alberta, New Brunswick and Nova Scotia have helmet legislation similar to Ontario's. The report also notes an overall drop in the rate of hospitalization for the 5-19 age group in Ontario, from 28.6/100 000 in 1997/98 to 23.6/100 000 in 2001/02, but found little change in the data for other age groups. "We hope [the decrease] is because preventive strategies are having an impact," said Dr. Vincent Grant of the Children's Hospital of Eastern Ontario in Ottawa. Overall, the report shows that injury-related hospitalizations declined by 7.5 % in Ontario in the 5-year period. The report indicates that the leading cause of these hospitalizations remains unintentional falls, accounting for 61% of the total. This figure hasn't changed significantly over the last decade, said Martalog.
Work-related injuries in residential and drywall carpentry.
- Lipscomb HJ, Dement JM, Li L, Nolan J, Patterson D. Appl Occup Environ Hyg 2003; 18(6): 479-488.
Correspondence: Hester J Lipscomb, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA; (email:hester.lipscomb@duke.edu).
Findings are reported on the first two years of an active injury surveillance project designed to test the utility of active injury investigations in identifying causes of injury among a large cohort of carpenters who did residential building and drywall installation. Occupational Safety and Health Administration recordable injuries were reported by participating contractors. Injured union carpenters were interviewed by experienced journeymen trained in a standard questionnaire protocol. Enumeration of workers and hours worked were provided by the union. These data allowed the definition of a dynamic cohort of 4,429 carpenters, their hours worked, detailed information on the circumstances surrounding recordable injuries, and possible preventive measures from the perspectives of the injured worker and an experienced journeyman investigator. The overall estimated injury rate (16.9 per 200,000 hours worked) was considerably higher than recent Bureau of Labor Statistics rates despite less than complete ascertainment of injuries. Injuries most commonly involved being struck by or against something, manual materials handling injuries, and falls. Manual materials handling injuries often involved very heavy objects or tasks and were injuries carpenters most often reported needs for adequate help and coordinated team work to prevent. Falls from heights occurred from a variety of surfaces and were not just injuries of inexperience. Carpenters reported the need for more attention to common fall protection practices, such as the use of more toe boards and guardrails. Poor housekeeping was involved in the majority of same level falls, as well as some manual materials handling injuries.
This study was undertaken as a preliminary investigation to compare cycling errors and sudden stopping distance in secondary students traversing an obstacle course on their bicycle with and without a schoolbag, to determine if further studies of cycling accident aetiology amongst children were warranted. Twenty children cycled as fast as they could around an obstacle course. Each child undertook two separate trials, about an hour apart on a morning of the same day. The children traversed the course one at a time in turn using their own bicycle and wearing their own usual school clothes. For the first trial they did not carry a schoolbag. On the second trial they carried a schoolbag weighing 6 kg. There were no significant differences in the number of cycling errors made by the children when traversing the obstacle course with and without a schoolbag. However, the children generally took longer to complete the course when carrying the schoolbag and stopping distances were greater. It was not possible to be certain that these findings were genuine or whether the effect of carrying the schoolbag was reduced by increased familiarity with the course, since all of the children first traversed the course without a schoolbag and then with one. It is concluded that there is some justification for conducting further studies to explore the implications of carrying schoolbags on cycling accident aetiology amongst children.
Bicycle helmet effectiveness in preventing injury and death.
- Novick LF, Wojtowycz M, Morrow CB, Sutphen SM. Am J Prev Med 2003; 24(4 Suppl): 143-149.
Correspondence: Lloyd F. Novick, SUNY-Upstate Medical University, Syracuse, New York, USA; (email: PMP@upstate.edu).
This case-bicycle helmet effectiveness-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine.This case examines the cost-effectiveness of three interventions to increase utilization of bicycle helmets to avert head injuries in individuals aged 18 years and under in Onondaga Count NY. Students are initially presented with data on head injuries, hospitalization, and death related to bicycle use. They then appraise a published study on the effectiveness of bicycle helmets in averting head injury. Finally, students work in groups to determine the cost-effectiveness of each intervention by calculating implementation costs and the specific number of head injuries averted associated with intervention. The three interventions are legislative, school, and community-based campaigns to increase helmet use. Students are provided with budget estimates and assumptions needed to complete the exercise. Cost-effectiveness analysis, cost-benefit analysis, and related concepts are discussed, including provider versus societal perspectives and importance of sensitivity analysis.
Apparently, fatal poisoning as cause of death are still rarely found in unnatural deaths investigated in the institutes of forensic medicine. In the Institute of Forensic Medicine at the University of Greifswald, 10-15% of the post-mortem autopsies displayed an intoxication during the last several decades with a possible decreasing tendency. Thirteen thousand eight hundred and nineteen autopsies were carried out in our institute-situated in a low populated rural area-during the last 50 years with the confirmed death cause intoxication in 1,589 times. In this study, especially the intoxication causes and the substance classes of the poisonous agents have been investigated. In addition, we analyzed the frequency of intoxications as well as sex and age of the deceased. Surprisingly, CO-intoxications were found most frequently with an incidence of 49% followed by alcohol intoxications with 21%. The latter was not unexpected taking into account the habits of the local population. Medical drugs and narcotics take only the third place, although the abuse of modern narcotics drugs is already visible even in the far east of Germany. The spectrum of substances which are abused, taken accidentally or deliberately is continuously changing, reflecting scientific progress in the pharmaceutical industry as well as fashion tendencies. Therapeutic use is almost always followed by abuse. Our results confirm prior experience concentrating mostly on other poisons like heavy metals or herbicides, etc. In addition, we could demonstrate the influence of political conditions on use and distribution of illegal drugs in Germany. Our study clearly demonstrates that insufficient equipment or analytical methods are no longer the reason for any problems uncovering lethal intoxications. They are rather due to insufficient investigations of the corpses (without considering the possibility of an intoxication as differential diagnosis) and to frequent mistakes of the prosecutor's office in death without signs of physical violence. These facts may explain the above mentioned decreasing tendency of intoxications, but they also clarify that this tendency probably does not correspond to reality.
- Capao Filipe JA, Fernandes VL, Barros H, Falcao-Reis F, Castro-Correia J. Arch Ophthalmol 2003; 121(5): 687-694.
Correspondence: Jo�o A. Cap�o Filipe, Sports Ophthalmology Unit, Department of Ophthalmology, University of Porto School of Medicine, S Jo�o Hospital, 4200-319 Porto, PORTUGAL; (email: jacapaofilipe@netcabo.pt).
OBJECTIVE: To outline the severity and long-term sequelae of eye injuries in soccer.
DESIGN: Prospective observational study of 163 patients who sustained soccer-related ocular injuries between April 1, 1992, and March 31, 2000 (8 years).
METHODS: Patients were observed at a sports ophthalmology unit located in the largest university hospital of the northern region of the country and central to all major soccer fields in town. The data were recorded using the United States Eye Injury Registry report forms for initial and follow-up observation.
MAIN OUTCOME MEASURES: (1) Self-reported history surrounding the ocular trauma, initial visual acuity, diagnosis, and operations and (2) final visual acuity, late diagnosis, and additional operations.
FINDINGS: Injuries occurred predominantly in young men (mean +/- SD age, 23.2 +/- 8.8 years) practicing indoor soccer (50.9%) or outdoor soccer (47.2%), and most resulted from a kicked ball (79.1%) near the goalpost (60.1%). Angle recession and peripheral vitreoretinal lesions were more likely to occur in the superotemporal quadrant (54.7%; 95% confidence interval, 44.2%-65.0%; and 57.6%; 95% confidence interval, 48.4%-66.4%; respectively). Vitreoretinal lesions were present in 42.2% (95% confidence interval, 33.1%-51.8%) of patients with "normal" visual acuity (>/=20/40) and in 50.0% (95% confidence interval, 38.1%-61.8%) of patients without hyphema. No significant association was found between severity of injury and age, sex, type of soccer, level of athletic expertise, or player position.
DISCUSSION: Severe ocular lesions can occur in soccer players without symptoms and at all skill levels. The development of laboratory models will be essential to explain the tendency for lesions to be in the superotemporal quadrant. The data support the need for protective eyewear designed specifically for soccer.
Using test dummy experiments to investigate pediatric injury risk in simulated short-distance falls.
- Bertocci GE, Pierce MC, Deemer E, Aguel F, Janosky JE, Vogeley E. Arch Pediatr Adolesc Med 2003; 157(5): 480-486.
Correspondence: Gena E. Bertocci, Center for Injury Research & Control, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa, USA; (email:genaber@pitt.edu).
BACKGROUND: Short-distance falls, such as from a bed, are often falsely reported scenarios in child abuse. In attempting to differentiate between abusive and nonabusive injury, knowledge of factors that affect injury risk in falls could prove useful.
OBJECTIVES: To assess the biomechanics associated with simulated short-distance falls in children (one fall scenario, without attempting to maximize injury potential) and to investigate the effect of impact surface type on injury risk.
METHODS: Repeatable fall experiments from bed height (0.68 m) onto different surfaces were conducted using an instrumented side-lying Hybrid II 3-year-old test dummy. Biomechanical measures assessed in falls included head acceleration, pelvis acceleration, femur loading, and head injury criteria.
FINDINGS: Fall dynamics resulted in the pelvis or legs making first contact. Biomechanical measures assessed in simulated bed falls were below known head injury criteria and lower extremity injury thresholds. The impact surface type had a significant effect on head injury risk and lower extremity loading. Playground foam proved to have the lowest associated injury risk of all the tested surfaces.
DISCUSSION: The biomechanics of a child falling from a short distance, such as from a bed, were investigated using an experimental laboratory mock-up and an instrumented test dummy. Despite the impact surface having an effect on injury risk, rolling from a 0.68-m (27-in) horizontal surface from a side-lying posture presented low risk of contact-type head injury and leg injury on all tested impact surfaces.
BACKGROUND: The incidence of sudden infant death syndrome has decreased in the United States as the percentage of infants sleeping prone has decreased, but persisting concerns about the safety of supine sleeping likely contribute to prone sleeping prevalence rates that remain higher than 10%.
OBJECTIVE: To document health outcomes in infants aged 1 to 6 months in relation to sleep position.
DESIGN: Prospective cohort study.
SETTING: Massachusetts and Ohio, from February 21, 1995, to December 31, 1998.
Study PARTICIPANTS: A total of 3733 infants with consistent sleep positions at ages 1, 3, and 6 months.
MAIN OUTCOME MEASURES: Descriptive statistics and multiple logistic regression analysis relating sleep position at each follow-up age to symptoms in the prior week (fever, cough, wheezing, stuffy nose, trouble breathing or sleeping, diarrhea, vomiting, or spitting up) and outpatient visits in the prior month (ear infection, breathing problem, vomiting, spitting up, colic, seizure, accident, or injury).
FINDINGS: No symptoms or outpatient visits were significantly more common among infants sleeping on the side or supine than in infants sleeping prone, and 3 symptoms were less common: (1) fever at 1 month in infants sleeping in the supine (adjusted odds ratio [OR], 0.56; 95% confidence interval [CI], 0.34-0.93) and side positions (OR, 0.48; 95% CI, 0.28-0.82); (2) stuffy nose at 6 months in the supine (OR, 0.74; 95% CI, 0.61-0.89) and side positions (OR, 0.82; 95% CI, 0.68-0.99); and (3) trouble sleeping at 6 months in the supine (OR, 0.57; 95% CI, 0.44-0.73) and side positions (OR, 0.69; 95% CI, 0.53-0.89). Also, outpatient visits for ear infections were less common at 3 and 6 months in infants sleeping in the supine position (OR, 0.64; 95% CI, 0.46-0.88; and OR, 0.73; 95% CI, 0.58-0.92, respectively) and at 3 months in the side position (OR, 0.68; 95% CI, 0.49-0.96).
DISCUSSION: No identified symptom or illness was significantly increased among nonprone sleepers during the first 6 months of life. These reassuring results may contribute to increased use of the supine position for infant sleeping.
Preventing falls in older people: risk factors and primary prevention through physical activity.
Falls among older people represent a major public health issue, which can in part be tackled through an integrated falls service combining both primary and secondary prevention. Many falls can be prevented following comprehensive assessment to identify risk factors and to plan interventions to eliminate them or ameliorate their effect. Community nursing staff are well placed to undertake such risk assessments and can instigate programmes of primary prevention designed to reduce the likelihood of a person falling. Increased physical activity among older people represents one element of a prevention programme. While this is beneficial for the older person's general health and well-being, certain types of exercise can also be used to reduce falls in individuals with muscle weakness, reduced mobility and balance problems. With the exception of balance training the evidence base related to exercise and falls prevention is patchy; Carter et al (2001) suggest that as yet there is insufficient evidence to suggest an optimum exercise programme for falls prevention. Each person should therefore be individually assessed and the results used to identify what type of exercise they might benefit from in order to address a specific risk factor. Once an appropriate form of exercise has been identified, practitioners should put the older person in contact with a physical activity coordinator to assist them in accessing an exercise programme.
Spinal cord injuries in Ilorin, Nigeria.
- Solagberu BA. West Afr J Med. 2002; 21(3): 230-232.
Correspondence: B.A. Solagberu, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin,Nigeria, P.O. Box 4377, Ilorin, NIGERIA; (email: basolagberu@yahoo.com).
BACKGROUND: Spinal Cord Injuries (SCI) usually result from road traffic accidents (RTA), falls, sports and some misadventures. This study was carried out to examine the aetiology of SCI in Ilorin, Nigeria; factors contributory to morbidity and mortality and to suggest measures for reducing them.
METHODS: Age, sex, mechanism of injury, complications, duration of treatment and eventual outcome of patients admitted for SCI from 1995 to 1999 were restrospectively studied.
FINDINGS: Thirty-nine patients, age 19 to 60 years (mean 37.3), 36 males and three females were seen. Cervical spine injuries accounted for 46.2% of the cases. Road traffic accidents caused 67% and falls 23%. Accidents involving passengers in open lorries are associated with SCI when the goods fall on passengers as seen in five of the 26 RTA's (19.2%). More falls from kola-nut (44%) than from palm tree (11%) were observed. Limb paralysis and bladder dysfunction were the commonest complications. Ten patients died, 70% of them had cervical spine injuries. Nine of the ten deaths had multiple transfers to different centres before admission.
DISCUSSION: This pattern of SCI in Ilorin, Nigeria showed that RTA has surpassed falls from trees, as the most common cause of SCI in Ilorin and probably in Nigeria. Indeed, the predominant tree implicated in this study has been kola nut tree unlike the palm tree in earlier reports. Imperative measures to improve morbidity and mortality include health education on passenger and load carriage, use of manual or motorised wheel barrow as against bearing heavy load on the head, principles of moving spinal Injured patients taught every road traveller and establishment of spinal centres and training of specialised personnel.
Pediatric spinal cord injury in Sweden: incidence, etiology and outcome.
- Augutis M, Levi R. Spinal Cord 2003; 41(6): 328-336.
Correspondence: M. Augutis, FoU, Sundsvall Hospital, Sundsvall, SWEDEN; (email: unavailable).
OBJECTIVES: To assess incidence, causes and early outcome of traumatic spinal cord injury (SCI) among children in Sweden, thereby identifying high-risk groups and situations as a basis for preventative measures and improved care.
METHODS: Data from population registers, County Habilitation Centers as well as from informal sources were used to estimate the incidence of SCI in Sweden during the years 1985-1996 among children aged 0-15 years. Contacts with the treating hospitals, reviews of medical records and/or personal interviews were used to verify primary data. In total, 92 children were thus identified.
FINDINGS: The incidence was found to be 4.6/million children/year (95% CI 3.6-5.5). When excluding prehospital fatalities, the incidence was 2.4 (95% CI 1.8-3.1). The main cause of injury among fatalities was traffic accidents. Associated injuries occurred in 41% of the children. Among survivors (10-15 years), sports-related injuries (43%) were as common a cause as traffic accidents (39%). The survivors were treated in 18 different hospitals.
DISCUSSION: Pediatric SCI in Sweden is rare, presumably because of effective primary prevention. Preventative measures should be further differentiated for each age group of children in accordance with their differing risk profiles. In contrast to the effective preventative measures that have been implemented in Sweden, care of these patients is still too fractionated and decentralized for sufficient specialization to emerge.
Injury and illness among youth working on farms are important problems. The types of farm tasks performed by children and the ages at which they begin these activities have not been well characterized. This cross-sectional study characterized agricultural work performed by adolescents in a rural Iowa county to better understand the patterns and extent of exposures to agricultural risk factors. This information will help to develop prevention strategies for agriculture-related injury and illnesses for children working on farms. The Keokuk County Rural Health Study is a prospective cohort study of randomly selected households in Iowa. In Round 2, all youth, aged 12 to 17 years participating in this population-based study, were asked about their use of farm machinery, work with livestock, pesticide handling, and other farm activities. The age at which they actually began these activities, the age they believed youth should start these activities, and sources of health and safety training they received were also ascertained. Adults in the study were asked the same questions about youth. Matched parental reports and opinions were compared to their children's reports and opinions using McNemar's chi-square tests. A total of 143 youth and 684 adults with farming experience completed the interviews. There were 118 pairs of parents and youth. Fifty percent of male youth, and 18 percent of females had performed agricultural work at some time in their life. Twenty-five percent of all male youth, and 5 percent of females were currently working on farms. Close to 30 percent had driven tractors, all-terrain vehicles, and pick-up trucks. Despite the legal prohibition of hazardous work by children under age 16, several younger children reported that they had driven a self-propelled combine, worked in silos, or handled and applied fertilizers in the past 12 months. Youth began riding on tractors at a mean age of 7. The mean ages for driving tractors and all-terrain vehicles were 11 and 10, respectively. The mean age for driving a self-propelled combine was 13. Children began applying or handling fertilizers at the age of 12. There were discrepancies between parent and youth reports regarding the frequencies, starting age, and opinions relative to performing agricultural tasks. These results suggest the need for implementing guidelines, particularly for age appropriate agricultural tasks.
Does low reading achievement at school entry cause conduct problems?
- Bennett KJ, Brown KS, Boyle M, Racine Y, Offord D. Soc Sci Med 2003; 56(12): 2443-2448.
Correspondence: Kathryn J. Bennett, Department of Clinical Epidemiology and Biostatistics, McMaster University, Room 3V43D, 1200 Main Street West, Ont., L8N 3Z5, Hamilton, CANADA; (email: kbennett@mcmaster.ca).
Conduct problems place children at increased risk for a broad array of negative health and social outcomes that include conduct disorder, injuries and violence, school failure, substance abuse, depression, and suicide. Prevention interventions have the potential to interrupt the chain of events linking early conduct problem symptoms to future negative life outcomes, but have received much less emphasis than interventions designed to treat established cases of disorder. Reading problems are a well-established correlate of conduct disorder. However, whether or not reading problems cause conduct disorder continues to be debated. If they are in fact a causal risk factor this would justify the design and evaluation of interventions designed to enhance reading skills and/or remediate problems. In this paper we use logistic regression techniques to evaluate the relation between reading achievement at school entry and conduct problems 30 months later, in a representative, non-clinic sample of kindergarten and grade one children, in Ontario, Canada. The findings show that an eight point increase in reading scores (equivalent to an moderate effect size of 0.5) would result in a 23 per cent decrease in the risk of conduct problems 30 months later, after controlling for gender, income and baseline conduct problem symptoms. We conclude that reading problems may contribute to the early onset of conduct disorder. Randomized experimental studies designed to evaluate the effects of reading programmes in non-clinic samples of children are needed to: (i) establish whether the link between reading problems at school entry and conduct disorder is causal; and (ii) determine whether reading intervention programmes are an effective conduct disorder prevention strategy.
In this study, recent trends in the incidence and methods of suicide in Singapore, over the period 1991-2000, were compared with the results of a previous study covering the period 1975-1984 (Tan, 1986). The present study included a total of 3,834 suicidal deaths reported to the coroner and investigated by the Centre for Forensic Medicine of the Health Sciences Authority. The results showed that the crude suicide rate had stabilised over the last decade and that the rate was highest among elderly males. The three most common methods employed were falls from a height (69.3%), hanging (20.7%) and poisoning (5.5%). Comparison of the results of both studies showed that the crude suicide rate had stabilised over the last two decades. However, there was an increase in the suicide rates among males, as compared with the previous study, and a marginal decrease in suicide rates among females over this time. There was also an appreciable change in the methods of suicide employed, in that there was an increase in the proportion of deaths due to falls from a height and corresponding reductions in the proportions of deaths by hanging and poisoning.
Suicide deaths and suicide attempts.
- Langlois S, Morrison P. Health Rep 2002;13(2):9-22.
Correspondence: S. Langlois, Small Business and Special Surveys Division, Statistics Canada, Ottawa, Ontario, K1A OT6, CANADA; (email: stephanie.langlois@statcan.ca).
OBJECTIVES: This article examines suicide deaths among Canadians aged 10 or older between 1979 and 1998. It also examines hospital records for 1998/99 to provide some insight into suicide attempts.
DATA SOURCES: Data are mainly from the Vital Statistics Database, the Hospital Morbidity Database, and the Person-oriented Information Database. Supplementary data are from the Adult Correctional Services and Homicide surveys, the National Longitudinal Survey of Children and Youth, and the World Health Organization.
ANALYTICAL TECHNIQUES: Age-standardized rates for suicide deaths and hospitalized suicide attempts were calculated by sex and province/territory for Canadians aged 10 or older. Age- and sex-specific rates for suicide deaths and parasuicide-related hospitalizations were also calculated for seven age groups.
FINDINGS: The suicide death rate remained fairly stable between 1979 and 1998. The suicide rate of males was four times that of females, but females were hospitalized for attempted suicide at about one and a half times the rate of males. In 1998/99, about 9% of individuals who were hospitalized for an attempted suicide had been discharged more than once for a suicide attempt the same year.
Suicidal ideation and behavior in children's homes.
- Hukkanen R, Sourander A, Bergroth L. Nord J Psychiatry 2003; 57(2): 131-137.
The aim of this cross-sectional study is to report the self-destructive and suicidal behavior of 98 children and adolescents in child welfare institutions. The children were evaluated using the Child Behavior Checklist (CBCL), the Children's Global Assessment Scale (CGAS) and questionnaires about suicidal and violent behavior, filled in by the child's key worker. Thirty-two per cent of the sample had presented suicidal thoughts, threats or suicide attempts during the previous 6 months. Suicidality was associated with low general functioning level (CGAS<61), self-mutilating behavior and violence. Furthermore, suicidal children had significantly higher CBCL total, externalizing, internalizing, anxious-depressive and aggressive scores. Children with suicide attempts (8% of the sample) had a significantly higher number of different types of traumatic experiences before the placement and higher somatization syndrome scores compared to children with suicidal ideation or non-suicidal children.
Adolescent suicide prevention.
- Novick LF, Cibula DA, Sutphen SM. Am J Prev Med 2003; 24(4 Suppl): 150-156.
Correspondence: Lloyd F. Novick, SUNY-Upstate Medical University, Syracuse, New York, USA; (email: PMP@upstate.edu).
This case-prevention of adolescent suicide-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine.This teaching case examines the issue of prevention of adolescent and young adult suicide both at an individual and at a population or community level, using data from the Onondaga County Health Department. In the first section of the case, students are asked to determine whether five deaths related to falling or jumping at a local shopping mall should be considered to be suicidal deaths. Students then develop skills in the reporting as well as in the epidemiology of adolescent suicidal deaths in Onondaga County. As the case progresses, students analyze the results of a local surveillance study of suicidal attempts and ideation. The case concludes with students evaluating a hypothetical screening study intended to reduce the risk of suicidal death and discussing a research design to examine the effectiveness of this prevention strategy.
As part of an organizational review of safety, interviews and questionnaire surveys were performed on over 700 commercial goods drivers and their managers within a series of related companies operating across 17 countries. The results examine the reported incidence of fatigue-related problems in drivers and their associations with near miss and accident experience as well as work and organizational factors. Experience of fatigue problems while driving was linked to time of day and rotation of shifts, though most associations were small. There were significant associations found between fatigue experiences and driver and management systems of break taking and route scheduling. The quantitative combined with qualitative information suggested that, where feasible, more flexible approaches to managing the scheduling and sequencing of deliveries assisted drivers in managing their own fatigue problems through appropriate break-taking. The results are interpreted within the overarching principles of risk assessment and risk control.
Some methodological deficiencies in studies on traffic accident predictors.
Correspondence: A. E. af W�hlberg, Department of Psychology, Uppsala University, Box 1225, 75142, Uppsala, SWEDEN; (email:anders.af_wahlberg@psyk.uu.se).
The paper discusses some methodological problems in (psychological) research on traffic accident predictors and reviews a convenience sample of the literature. Three methodological aspects are identified as being important: reliability of accident predictors, time period for accidents used as dependent variable, and culpability for accidents. Papers are scrutinized and most are found to be wanting in these aspects. Traffic researchers do not adhere to, or hardly even discuss, these basic methodological problems. It is concluded that the current research into (psychological) accident predictors is fraught with methodological deficiencies. Why most studies seem to be deficient in these aspects is not clear, as several researchers have pointed out these problems.
Estimating transport fatality risk from past accident data.
Correspondence: Andrew W. Evans, Centre for Transport Studies, University College London, Gower Street, WC1E 6BT, London, UK; (email: aevans@transport.ucl.ac.uk).
This paper examines the statistical properties of estimates of fatal accident rates, mean fatalities per accident, and fatality rates when these estimates are based on past accident data. The statistical properties are illustrated by two long-term transport fatal accident datasets from Great Britain, the principal one for railways and the other for roads, chosen to provide a statistical contrast. In both modes, the accident rates have fallen substantially over the long term. Two statistical estimates of current accident and fatality rates are presented for each dataset, one based only on recent data and the other based on estimates of long-term trends. The trend-based estimate is preferred for train accidents because this makes maximum use of the limited and variable data; the recent data are preferred for road accidents because this avoids unnecessary dependence on modelling the trends. For train accidents, the estimated fatality rate based on past accidents is compared with an estimate produced by the railway industry using a risk model. The statistical estimate is less than half the industry's estimate, and the paper concludes that the statistical estimate is to be preferred.
Traffic fatalities and injuries: the effect of changes in infrastructure and other trends.
Correspondence: Robert B. Noland, Department of Civil and Environmental Engineering, Centre for Transport Studies, Imperial College of Science, Technology and Medicine, SW7 2BU, London, UK; (email:r.noland@ic.ac.uk).
An analysis of how various road infrastructure improvements affect traffic-related fatalities and injuries is conducted while controlling for other factors known to affect overall safety. The road infrastructure elements analysed include total lane miles, the fraction of lane miles in different road categories (interstates, arterial, and collector roads), the average number of lanes for each road category, and lane widths for arterials and collector roads. Other variables that are controlled for in the study include total population, population age cohorts, per capita income, per capita alcohol consumption, seat-belt legislation (and seat-belt usage), and a proxy variable that represents underlying changes in medical technology. The data used is a cross-sectional time-series database of US states and is analysed using a fixed effects negative binomial regression that accounts for heterogeneity in the data. Data from all 50 states over 14 years is used. Results strongly refute the hypothesis that infrastructure improvements have been effective at reducing total fatalities and injuries. While controlling for other effects, it is found that demographic changes in age cohorts, increased seat-belt use, reduced alcohol consumption and increases in medical technology have accounted for a large share of overall reductions in fatalities.
Analysis of injuries among pilots involved in fatal general aviation airplane accidents.
- Wiegmann DA, Taneja N. Accid Anal Prev 2003; 35(4): 571-577.
Correspondence: Douglas A. Wiegmann, Aviation Human Factors Division, University of Illinois at Urbana-Champaign, 1 Airport Road, 61874, Savoy, IL, USA; dwiegman@uiuc.edu).
The purpose of this study was to analyze patterns of injuries sustained by pilots involved in fatal general aviation (GA) airplane accidents. Detailed information on the pattern and nature of injuries was retrieved from the Federal Aviation Administration's autopsy database for pilots involved in fatal GA airplane accidents from 1996 to 1999. A review of 559 autopsies revealed that blunt trauma was the primary cause of death in 86.0% (N=481) of the autopsies. The most commonly occurring bony injuries were fracture of the ribs (72.3%), skull (55.1%), facial bones (49.4%), tibia (37.9%) and pelvis (36.0%). Common organ injuries included laceration of the liver (48.1%), lung (37.6%) heart (35.6%), and spleen (30.1%), and hemorrhage of the brain (33.3%) and lung (32.9%). A fractured larynx was observed in 14.7% of the cases, a finding that has not been reported in literature until now. It was observed that individuals who sustained brain hemorrhage were also more likely to have fractures of the facial bones rather than skull fractures.
Comparison of road crashes incidence and severity between some French counties.
- Amoros E, Martin JL, Laumon B. Accid Anal Prev 2003; 35(4): 537-547.
Correspondence: E. Amoros, Transport, Work and Environment Epidemiology Laboratory, French Research Institute on Transport and Safety (INRETS), 25 Avenue F. Mitterrand, Case 24, 69675 Cedex, Bron, FRANCE; (email:amoros@cancer.dk).
Our aim is to compare traffic safety among several counties in France, and explore whether observed differences can be explained by differences in road types distribution and by differences in socio-economic characteristics between counties. Traffic safety is measured by incidence and severity, where incidence is defined by the ratio of counts of injury accidents and exposure, measured by the amount of kilometres driven. Severity is measured by the ratio between fatal and injury accidents. These indexes are analysed in the framework of Generalised Linear Models: counts of injury accidents are analysed with a Negative Binomial regression, which accounts for over-dispersion. Severity being the proportion of fatal accidents among injury accidents corresponds to the probability of a Binomial setting and this is modelled by a logistic regression.This modelling provides an easy way to adjust for covariates such as road type, environment (urban/rural) and evolution over time, and to test their possible interactions. We find that the time trend of each indice (incidence and severity) is the same across counties and across road types. There is a significant interaction between county and road type, meaning that, first, differences in traffic safety between counties are not fully explained by different road type distributions, and second, that the "ranking" of counties in term of incidence or severity varies according to the road type considered, and vice-versa. It was planned to explore global characteristics of the counties (driving and socio-economic data) as possible explanatory factors of differences between counties, but the existence of an interaction of county with road types shows the necessity of collecting and exploring characteristics of the sub-levels of road type within county.
Overall injury risk to different drivers: combining exposure, frequency, and severity models.
Correspondence: Kara M. Kockelman, The University of Texas at Austin, 6.9 E. Cockrell Jr. Hall, 78712-1076, Austin, TX, USA; (email: kkockelm@mail.utexas.edu).
Traffic crash risk assessments should incorporate appropriate exposure data. However, existing US nationwide crash data sets, the NASS General Estimates System (GES) and the Fatality Analysis Reporting System (FARS), do not contain information on driver or vehicle exposure. In order to obtain appropriate exposure data, this work estimates vehicle miles driven (VMD) by different drivers using the Nationwide Personal Transportation Survey (NPTS). These results are combined with annual crash rates and injury severity information from the GES for a comprehensive assessment of overall risk to different drivers across vehicle classes.Data are distinguished by driver age, gender, vehicle type, crash type (rollover versus non-rollover), and injury severity. After correcting for drivers' crash exposure, results indicate that young drivers are far more crash prone than other drivers (per VMD) and that drivers of sports utility vehicles (SUVs) and pickups (PUs) are more likely to be involved in rollover crashes than those driving passenger cars. Although, the results suggest that drivers of SUVs are generally much less crash prone than drivers of passenger cars, the rollover propensity of SUVs and the severity of that crash type offset many of the incident benefits for SUV drivers.
- Dolan M, Guly O, Woods P, Fullam R. Med Sci Law 2003; 43(2): 153-169.
Correspondence: Mairead Dolan, Neuroscience and Psychiatry Unit, University of Manchester, Department of Psychiatry and Mental Health Services of Salford, UK; (email: mdolan@edenfield.mhss-tr.nwest.nhs.uk).
Between 1967 and 1988, 69 cases of single perpetrator/single victim child homicide resulted in remands into custody in the Yorkshire region. Sixty-four of these cases were examined retrospectively to identify the characteristics of the perpetrators and of victims under 16 years, the relationship of the victim to the accused and the circumstances of the offence. Sixty-four men singly accused of killing a single child victim are described in detail. They were characterized by relatively young age and a lack of long-term stable relationships. Previous psychiatric contact and/or a history of self-harm was noted in one-third of cases. Over half of the group had a criminal record and previous violence to children was noted in 28% of cases. Fathers or surrogate fathers accounted for nearly two-thirds of the accused. In terms of the victims, children under six months were at greatest risk. Nearly one-third of victims were the biological offspring of the accused. Sexually motivated homicide accounted for approximately 18.7% of deaths. Victim behaviours and domestic disharmony acted as precipitants in 64% of the cases, with 54.7% of the victims dying as a result of physical beatings. Alcohol consumption at the material time was more common than noted in previous studies of child homicide.
Attitudes and practices of doctors toward domestic violence victims in South Africa.
Our study intended to ascertain doctors' attitudes and practices toward domestic violence in a sample of 402 doctors randomly chosen for a mail survey from a list of registered medical practitioners in South Africa. We found that the mean number of patients treated for domestic violence per month was 11.4 (SD = 13.4); for White doctors 15.8, African Black 6.2, and for Asian doctors 5.3. The high frequency of domestic violence detected in this sample seems to reflect national surveys on domestic violence. Most doctors believed that they should play a role in prevention and treatment, and their attitudes toward victims of domestic violence were generally sympathetic and supportive. Male doctors and long-serving practitioners tended to have more conservative views of the causes and attitudes of spousal assault and of the doctors' role in prevention. Only 9.7% of the doctors had received any training on domestic violence. Further research is needed to establish the prevalence of domestic violence in women presenting to medical practitioners and to investigate how the problem currently is being addressed.
Preparedness of health care practitioners to screen women for domestic violence in a border community.
Health care professionals do not always screen patients for domestic abuse. In the absence of screening, the likelihood of misdiagnoses and prescriptions contraindicated for symptoms of abuse survivors is increased. Several factors may contribute to the lack of routine and uniform screening, including a lack of educational preparedness. The qualitative findings presented here are part of a larger quantitative study investigating the skills, beliefs, and expectations about screening for domestic abuse among physicians, dentists, and nurse practitioners from a border community in southwest Texas. Practitioners requested specific information to enhance educational preparedness and improve clinical practice for their abused patients.
Physical abuse in low-income women in Aleppo, Syria.
Correspondence: Wasim Maziak, Institute of Epidemiology and Social Medicine, University of Muenster, Germany, and Syrian Center for Tobacco Studies, Aleppo, SYRIA; (email: unavailable).
Violence against women is a vicious practice present in all societies. Yet data about its occurrence and associated factors are scarce in the Arab world. In this study, we attempt to determine the spread of physical abuse and its sociodemographic correlates among low-income women in Aleppo, Syria. A sample of 411 women was recruited from 8 randomly selected primary care centers in Aleppo. Response rate was 97%, mean age of participants 28 +/- 8 years, and most women (88%) were married. A special questionnaire was used including questions about physical abuse, the self-reporting questionnaire (SRQ-20), and questions about relevant sociodemographic information. Current physical abuse (battering at least 3 times during the previous year) was found in 23% of the investigated and among 26% of married women, while regular abuse (battering at least once weekly) was found in 3.3% of married women. Correlates of physical abuse were women's education, religion, age, marital status, economic status, mental distress, smoking, and residence. Our data show that physical abuse is prevalent in this population and that women's education is the most important modifiable factor.
What happens when health care providers ask about intimate partner violence? A description of consequences from the perspectives of female survivors.
- Chang JC, Decker M, Moracco KE, Martin SL, Petersen R, Frasier PY. J Am Med Womens Assoc 2003; 58(2): 76-81.
Correspondence: J.C. Chang, University of North Carolina at Chapel Hill, USA; (email: jchang@mail.magee.edu).
OBJECTIVE: To describe positive and negative consequences of health care screening for intimate partner violence from the perspectives of female survivors.
METHOD: We conducted 7 semistructured focus group interviews with 41 women in battered women's shelters or intimate partner violence support groups.
FINDINGS: Positive consequences of screening included: recognizing that the violence was a problem, decreased isolation, and feeling that the medical provider cared. Negative consequences included: feeling judged by the provider, increased anxiety about the unknown, feeling that the intervention protocol was cumbersome or intrusive, and disappointment in the provider's response.
DISCUSSION: We found that both positive and negative consequences can result from screening for intimate partner violence and that they are related to provider behavior. The positive consequences described by the participants reflect changes in their attitudes, thoughts, and feelings that may precede help seeking. A better understanding of consequences can help providers tailor screening approaches and interventions for intimate partner violence.
ASSERT: The Effectiveness of a Continuing Medical Education Video on Knowledge and Attitudes about Interpersonal Violence.
PURPOSE: Developing ways to educate busy clinicians is especially challenging when the subject includes medical, social, and legal aspects, as is the case with interpersonal violence (IPV). Organizations such as the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommend routine IPV screening for patients. Videotape efficiently provides training in multiple locations using experts from different fields. The authors created and evaluated a multidisciplinary continuing medical education (CME) videotape on IPV.
METHOD: The video, ASSERT: A Guide to Child, Elder, Sexual, and Domestic Abuse for Medical Professionals, was developed by experts from medicine, social work, nursing, and law. The video featured role-plays to demonstrate different approaches to these difficult clinical encounters. Pre- and post-viewing questionnaires assessed the video's effectiveness.
FINDINGS: In all, 120 physicians and 172 other personnel (e.g., nurses, social workers) at 24 sites associated with four academic medical centers completed paired questionnaires. Using a conservative level of significance (p <.002), there was significant improvement for physicians in 77% of the knowledge items and 75% of the attitude items from pre- to post-viewing questionnaires. A total of 73% of viewers would recommend the video to colleagues.
DISCUSSION: The IPV video, using experts from multiple disciplines, improved knowledge and attitudes about child, elder, sexual, and domestic violence, and was rated highly by clinicians. The video was useful for preparing for a JCAHO accreditation visit.
The violent matrix: a study of structural, interpersonal, and intrapersonal violence among a sample of poor women.
- James SE, Johnson J, Raghavan C, Lemos T, Barakett M, Woolis D. Am J Community Psychol 2003; 31(1-2): 129-141.
Correspondence: S.E. James, The National Center on Addiction and Substance Abuse at Columbia University, New York 10017, USA; (email: sjames@casacolumbia.org).
One goal of this paper is to present an integrated tripartite model of violence, with a focus on structural violence within an oppression paradigm. Using qualitative and quantitative data from 27 women (70% African American and 30% European American) who participated in a national substance abuse treatment demonstration program, we describe a model of violence in which structural violence is presented within a transactional relationship with interpersonal, and intrapersonal violence. We suggest that the effects of structural, interpersonal, and intrapersonal violence are magnified when race and poverty are considered. The second goal of the paper is to present a preliminary test of the new model of violence. Results indicated that different levels and types of violence are interrelated. Implications of these findings for empowering solutions are suggested.
Spouse/partner violence education as a predictor of screening practices among physicians.
Correspondence: Heather A. Sitterding, Child Transportation Safety Program, Center for Injury and Violence Prevention, Virginia Department of Health, 1500 East Main Street, Room 105, Richmond, VA 23219, USA; (email: civp@vdh.state.va.us).
INTRODUCTION: Spouse/partner violence is a major public health problem that affects 3 to 6 million women per year. Many studies show that the majority of health care practitioners do not detect or respond to cases of spouse/partner violence in their practice. Research suggests that there are potential barriers to reporting or detecting this problem. A barrier often cited is lack of proper education or training regarding spouse/partner violence. The objective of this study was to determine if physicians who received spouse/partner violence education at various stages of their careers were more likely to screen patients for spouse/partner violence.
METHODS: A survey was developed and administered to family physicians and obstetricians/gynecologists in Virginia. The data were analyzed to determine screening practice and spouse/partner violence education among respondents. Four different educational opportunities were analyzed to determine potential determinants of screening.
FINDINGS: All respondents who had spouse/partner violence education were more likely to screen every patient than those who were lacking this education. Receiving lectures during residency training was found to be a significant predictor of screening every patient for spouse/partner violence among respondents.
DISCUSSION: Screening every patient for exposure to spouse/partner violence is the ideal situation. This study indicates that education about spouse/partner violence has a significant impact on screening tendencies if provided during a physician's residency program.
