Correspondence: W.A. Wulf, Department of Computer Science School of Engineering and Applied Science
University of Virginia, Charlottesville, VA 22903-2442, USA; (email: wulf@cs.virginia.edu).
The terrorist acts of September 11, 2001 were a wake-up call for changing our traditional response to risks of terrorism. Given that government and worldwide think-tank organizations maintain that risks of terrorism will continue for the indefinite future, the following questions deserve strategic answers. How long can we respond to terrorism with tactical measures only, sustain current curtailments of some of our freedoms, travel, and quality of life, and absorb losses in human life and properties? Should not underlying strategic motivation lead to the tactical measures? Why do so many groups and individuals in some developing countries hate us? Is it because they fear that the ideas we export through television, movies, literature, and music have a corrupting influence on their cultures? Is it because of past operations that we conducted in such countries as Iran, Nicaragua, El Salvador, and Granada? Can the genesis of the risks of terrorism to the homeland be traced to the unfavorable socioeconomic conditions in less-privileged and developing countries, where civil and religious freedoms are close to nonexistent, and sanitary conditions, health and education, and critical infrastructures of essential utilities are almost at the same level that existed in the United States almost a century ago? If we could make progress at improving the quality of life of the billions of people in the developing countries and become more sensitive to their needs, cultures, and heritage, would their hatred subside? What other measures can we take to reduce their hatred, without compromising our basic cultural and democratic principles or their cultural and social heritage?
Correspondence: Deborah C. Girasek, Preventive Medicine and Biometrics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; (email: dgirasek@usuhs.mil).
(Copyright 2003, Society for Public Health Education)
It has been speculated that many safety campaigns fail because planners assume -- simplistically -- that their content is acceptable to all. The science of injury control has advanced impressively in recent decades, yet little is known about the degree to which public views match those of prevention experts. This is problematic because health promotion campaigns work best when they are tailored to the target audience.
This report is based upon a random digit dialed telephone survey in which adults were asked to name effective strategies for preventing deaths due to motor vehicle crashes, falls, drowning, fires /burns, and poisoning. A majority of the 943 respondents could name prevention techniques, although they were least likely to do so for fatal falls. Participants at highest risk for not naming a countermeasure were those with fewer years of education. These findings suggest that more advantaged members of the public feel that know how to prevent America's leading causes of injury death. They may not fully appreciate, however, the options of creating health-promoting environments and safer products. This work makes it very clear that people with less education also need to be exposed to the breadth of effective injury countermeasures.
Correspondence: Anthony D Woolf, Institute of Health and Social Care, Peninsula Medical School, Royal Cornwall Hospital, Truro TR1 3LJ, UK; (email: anthony.woolf@rcht.swest.nhs.uk).
Preventing fractures in elderly people is a priority, especially as it has been predicted that in 20 years almost a quarter of people in Europe will be aged over 65. This article describes the factors contributing to fracture, interventions to prevent fracture, and the various treatments.
An occupational therapy perspective on falls prevention among community-dwelling older adults.
- Woodland JE, Hobson SJ. Can J Occup Ther 2003; 70(3): 174-182.
Correspondence: Jill E. Woodland, Health for Older Adults Program, St. Joseph's Centre for Ambulatory Health Services, 2757 King Street East, Hamilton, ON L8G 5E4, CANADA; (email: jwoodland@sympatico.ca).
BACKGROUND: Prevention of falls among community-dwelling older adults is an important area of research because of the serious consequences that can result from falls for this population. The risk factors associated with falls tend to be categorized into two groups: intrinsic, or personal factors, such as fear of falling, age, gender, and extrinsic, or environmental factors, such as lighting or slippery surfaces.
METHOD: The current falls prevention literature was reviewed using an occupational therapy perspective.
FINDINGS: It revealed that there are only a few brief examples of the relationship between occupation and falls in the literature. The profession of occupational therapy appears to be underrepresented in the current falls prevention literature. The review highlights the important contributions that occupational therapists could make to this functional problem.
DISCUSSION: For occupational therapy, important areas for consideration when attempting to prevent falls among older adults living in the community include using a client-centered approach, compliance, and follow up on recommendations. There is a need for more occupational therapy research specifically on occupation and falls, that explores their relationship and influence upon one another.
Community-based group exercise improves balance and reduces falls in at-risk older people: a randomized controlled trial.
- Barnett A, Smith B, Lord SR, Williams M, Baumand A. Age Ageing 2003; 32(4):407-414.
CONTEXT: Recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls in older people. However, research is required to determine whether supervised group exercise programs, conducted in community settings with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group.
OBJECTIVES: To determine whether participation in a weekly group exercise program with ancillary home exercises over one year improves balance, muscle strength, reaction time, physical functioning, health status and prevents falls in at-risk community-dwelling older people.
METHODS: The sample comprised 163 people aged over 65 years identified as at risk of falling using a standardized assessment screen by their general practitioner or hospital-based physiotherapist, residing in South Western Sydney, Australia. Subjects were randomized into either an exercise intervention group or a control group. Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial. Falls were measured over a 12-month follow-up period using monthly postal surveys.
FINDINGS: At baseline both groups were well matched in their physical performance, health and activity levels. The intervention subjects attended a median of 23 exercise classes over the year, and most undertook the home exercise sessions at least weekly. At retest, the exercise group performed significantly better than the controls in three of six balance measures; postural sway on the floor with eyes open and eyes closed and coordinated stability. The groups did not differ at retest in measures of strength, reaction time and walking speed or on Short-Form 36, Physical Activity Scale for the Elderly or fear of falling scales. Within the 12-month trial period, the rate of falls in the intervention group was 40% lower than that of the control group (IRR=0.60, 95% CI 0.36-0.99).
DISCUSSION: These findings indicate that participation in a weekly group exercise program with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people.
Recognition related to the need for ergonomic design improvements among health care workers, management and administration, and equipment manufacturers is growing. The future should bring new concepts and innovations which can provide many benefits. Beyond the potential reduction in caregiver injuries, many possibilities exist to improve patient outcomes through better equipment design. As an additional benefit, applying the principles of ergonomics may enhance and increase caregiver productivity through a reduction of patient transfers required, and by minimizing staff required to ambulate patients. Another added value to applying ergonomics to equipment design is the development of convertible furnishing which could create a reduction in operating and capital expenses by reducing the need for some furnishings. Equipment such as cardiac chairs, sling scales, patient chairs, special rental surfaces, and other features might be incorporated into bed design. Ergonomic programs make sense and provide opportunities to create win-win situations throughout the health care industry. Current and future innovations will provide improvements resulting in outcomes from which everyone will benefit. These benefits include a higher quality of work life for health care workers and an improved quality of care for patients.
Back injury prevention: a lift team success story.
Correspondence: Kelli S. Hefti, Employee Health Services, Sioux Valley Hospital University of South Dakota Medical Center (SVHUSDMC), USA; (email:unavailable).
Work related back injuries among hospital personnel account for high volume, high cost workers' compensation claims. These injuries can be life altering experiences, affecting both the personal and professional lives of injured workers. Lifting must be viewed as a skill involving specialized training and mandated use of mechanical equipment, rather than as a random task performed by numerous health care providers. The use of a lift team specially trained in body mechanics, lifting techniques, and the use of mandated mechanical equipment can significantly affect injury data, financial outcomes, and employee satisfaction. The benefits of a lift team extend beyond the effect on injury and financial outcomes--they can be used for recruitment and retention strategies, and team members serve as mentors to others by demonstrating safe lifting techniques. Ultimately, a lift team helps protect a valuable resource--the health care worker.
Occupational sharps injuries in a Dublin teaching hospital.
- O'Connell T, Hayes B. Ir Med J 2003; 96(5): 143-145.
Correspondence: Tom O'Connell, Civil Service Occupational Health Department, South Frederick St, Dublin, IRELAND; (email: unavailable).
Contaminated sharps injuries pose a risk of infection to health care workers and represent a major workload for hospital occupational health departments (OHDs). The aim of this study was to review the epidemiology and management of sharps injuries in an Irish tertiary referral center, which has not been previously described. Occupational health records of sharps injuries occurring between January 1998 and December 2000 inclusive were reviewed from the hospital OHD. A total of 332 sharps injuries were reported to the OHD in this period. More than two-thirds of injuries involved medical or nursing staff. Support staff such as cleaners and porters accounted for 13.5% of injuries. The majority of sharps injury recipients (86%) were immune to hepatitis B. Of those injured, 22% were not wearing gloves at the time of their injury. Eight source patients were hepatitis C antibody positive, two were HIV antibody positive and one was hepatitis B surface antigen positive. No instances of occupational acquisition of blood borne viruses were documented. The results of this study confirm that health care workers need further education to prevent sharps injuries, and that the risk of blood borne virus acquisition through an occupational sharps injury is low but not negligible.
Early return to work of injured workers: multidimensional patterns of individual and organizational factors
The research reported here, part of a larger exploratory project about the factors that may play a role in the implementation of corporate return to work measures, characterized workers having suffered an occupational injury. These workers constitute the target population of a governmental policy designed to favor early return to work. The study population was composed of 13,728 cases of occupational injury. The characteristics of workers, characteristics of injuries and structural characteristics of companies in cases in which return to work measures were present were compared with these same characteristics in cases in which such measures were absent. Using correspondence and ascending hierarchical classification analyses, homogenous groups were identified. Bivariate analysis revealed that the following eight variables were associated with the presence of early return to work measures (i.e. the proportion of cases benefiting from early return to work measures was significantly higher than expected): nature of the injury (inflammation); site of injury (upper limbs and shoulder); CSST assessment category (=100%, i.e. large company); duration of absence (0-44 days and 183-365 days); gender (female); sector (rubber and plastics); relapse (present); and age (30-39 years). The presence or absence of return to work measures was a defining characteristic of five of the seven classes identified by multivariate analysis. The composition of these classes reflects the complex interaction between return to work measures on the one hand and the socio-demographic characteristics of workers, characteristics of injuries, and structural characteristics of companies on the other.
Technological innovations, organizational change and workplace accident prevention
- Harrisson D, Legendre C. Safety Science 2003; 41(4): 319-338.
Correspondence: Denis Harrisson, Département de relations industrielles, Université du Québec en Outaouais, C.P. 1250, succursale B, Hull, Québec, CANADA; (email:denis.harrisson@uqah.uqo.ca).
In a case study involving seven industrial firms, the objective of the study was to generate new postulates about the relationship between the way technological change is managed, the organizational transformations leading to more workers' participation, the introduction of a health and safety program, and the occurrence of occupational accidents and illnesses. Data were obtained from interviews with managers, workers and union representatives and analysis of statistics and a detailed nominal list of work injuries. The changes contribute to improving the working conditions, but at the same time, the intensity of work and the increasing of work load mitigate the results which appeared as a series of ambiguities with which workers must deal.
CONTEXT: Crossing the street is a complex task that involves gathering, processing, and acting on information that is time dependent. The gaze behavior of subjects has been previously studied on increasingly complex and dynamic tasks such as making tea, walking indoors, and driving. The purpose of this study was to assess how normally sighted people use their vision to cross a street safely. Specifically, we identified the environmental features people look at when crossing two types of intersections.
METHODS: We measured the eye movements and head directions of 12 normally sighted people as they approached, evaluated, and crossed a light-controlled "plus" intersection and a roundabout. The primary measures were percentage of fixations and head direction.
FINDINGS: Crossing the street can be divided into three phases, walking to the curb, standing at the curb, and crossing the street. We found that while moving, subjects fixated primarily on crossing elements and when standing at the curb, they fixated primarily on vehicles. At the plus intersection, fixation behavior corresponded with crossing strategy; the subjects who crossed early fixated on cars, and the subjects who waited for the light to change fixated on traffic controls. At the roundabout, all subjects determined an appropriate time to cross from vehicular traffic flow by directing the majority of their fixations on cars. When moving, the head position of subjects was predominately centered. Subjects also made head turns in both directions before crossing and directed the head toward the danger zone while crossing.
DISCUSSION: Crossing the street is a complex task that can be described in three phases. Common head and eye behaviors were found near the critical moments of crossing the street. Fixation behavior was closely related to street crossing behavior.
Two eyes for an eye: the neuroscience of force escalation.
Correspondence: Daniel M. Wolpert1, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, U.K. 2 Institute of Psychiatry, De Crespigny Park, London, UK; (email: wolpert@hera.ucl.ac.uk).
Physical conflicts tend to escalate. For example, as tit-for-tat exchanges between two children escalate, both will often assert that the other hit him or her harder. Here we show that, in such situations, both sides are reporting their true percept and that the escalation is a natural by-product of neural processing.
Six pairs of naïve participants took part in a tit-for-tat experiment. Each member of a pair rested his or her left index finger in a molded support. A force transducer, which was attached to a lightweight lever of a torque motor, was placed on top of this finger. A trial was started by one torque motor producing a 0.25 N force on one participant's finger. Participants then took turns to press with their right index finger down for 3 s on the force transducer resting on the other's left index finger. They were instructed to apply the same force on the other participant that had just been exerted on them. Each participant was unaware of the instructions given to the other.
In all cases, the forces escalated rapidly. Across the six pairs, there was a significant (F1,5 = 12.1, P < 0.05) average increase of 3.2 N over the eight turns corresponding to a 38% mean escalation on each turn. The increase was also significant (P < 0.05) within every pair of participants. Thus, force escalation occurs rapidly even under instructions designed to achieve parity.
To investigate the basis of the escalation process, we examined the perception of force in an additional 12 naïve participants tested individually. A torque motor applied a brief constant force to the tip of the participant's left index finger that was resting in a molded support.
When participants were required to use their right index finger to match the perceived force, by pushing on their left index finger through the force transducer, they consistently overestimated the force required. This observation suggests that self-generated forces are perceived as weaker than externally generated forces of the same magnitude. This could arise from a predictive process in which the sensory consequences of a movement are anticipated and used to attenuate the percepts related to these sensations. Such a mechanism removes some of the predictable component of the sensory input to self-generated stimuli, thereby enhancing the salience of sensations that have an external cause.
In a second condition, participants were required to reproduce the experienced force using their right index finger to move a joystick that controlled the force output of the torque motor. The active hand does not generate the force directly; the hand's movement is translated into a force through the torque motor. In this unusual situation, predictive mechanisms are not employed. When the force was generated via the joystick, the reproduced force matched the original force much more accurately. A regression analysis showed a significant increase in both the intercept (F 1,11 = 18.1, P < 0.01) and slope (F 1,11 = 25.7, P < 0.001) when the force was applied directly rather than via the joystick. The average increase across the 12 participants was 0.53 N (0.12 N, SE) for the intercept and 49% (9%, SE.) for the slope.
The attenuation of self-generated forces occurred in our experiments even though accurate perception of force was the primary requirement of the task, suggesting that such attenuation is very unlikely to be mediated via attentional mechanisms. Previous studies have shown that sensory perception is attenuated in a moving arm or finger. Here we have shown substantial attenuation in the resting finger when the tactile stimulus is self-generated. Despite the stimuli being identical at the level of peripheral sensation, the perception of force is reduced by about a half when the force is self-generated. Force escalation can, therefore, be seen as a by-product of predictive sensory attenuation.
A diffusion model analysis of the effects of aging on brightness discrimination.
- Ratcliff R, Thapar A, McKoon G. Percept Psychophys 2003; 65(4): 523-535.
Correspondence: Roger Ratcliff, Department of Psychology, Northwestern University, Evanston, Illinois 60208, USA; (email: r-ratcliff@nwu.edu).
The effects of aging on decision time were examined in a brightness discrimination experiment with young and older subjects (ages, 60-75 years). Results showed that older subjects were slightly slower than young subjects but just as accurate. Ratcliff's (1978) diffusion model was fit to the data, and it provided a good account of response times, their distributions, and response accuracy. There was a 50-msec slowing of the nondecision components of response time for older subjects relative to young subjects, but response criteria settings and rates of accumulation of evidence from stimuli were roughly equal for the two groups. These results are contrasted with those obtained from letter discrimination and signal-detection-like tasks.
Recovering slant and angular velocity from a linear velocity field: modeling and psychophysics.
- Domini F, Caudek C. Vision Res 2003; 43(16): 1753-1764.
Correspondence: Fulvio Domini, Department of Cognitive and Linguistic Sciences, Brown University, P.O. Box 1978, 02912, Providence, RI, USA; (email: fulvio_domini@brown.edu).
The data from two experiments, both using stimuli simulating orthographically rotating surfaces, are presented, with the primary variable of interest being whether the magnitude of the simulated gradient was from expanding vs. contracting motion. One experiment asked observers to report the apparent slant of the rotating surface, using a gauge figure. The other experiment asked observers to report the angular velocity, using a comparison rotating sphere. The results from both experiments clearly show that observers are less sensitive to expanding than to contracting optic-flow fields. These results are well predicted by a probabilistic model which derives the orientation and angular velocity of the projected surface from the properties of the optic flow computed within an extended time window.
Sensitivity to the acceleration of looming stimuli.
The aim of this study was to determine if observers could discriminate between looming stimuli simulating targets approaching the observers at either constant or non-constant speeds. Discrimination between accelerating and constant-speed approaches improved after 7090 trials for accelerations > 2 m/s2. For lower accelerations the ability to discriminate was poor regardless of the trial number. Following the learning phase, observers were able to identify accelerating targets from constant-speed approaches fairly consistently at performance levels of 7075% for accelerations as low as 4 m/s2 and at 8096% for accelerations of 614 m/s2. Observers' accuracy in identifying decelerating from constant-speed targets did not increase as a function of increasing deceleration. In fact, observers had a slight bias to select the constant-speed stimulus as being the decelerating stimulus. In summary, the sensitivity to acceleration for simulated motion in depth is poor, but increases as acceleration increases and sensitivity to acceleration is far greater than for deceleration.
Surveillance for acute insecticide-related illness associated with mosquito-control efforts: nine states, 1999--2002.
- Mauer MP, Rosales R, Sievert J, Propeck M, Becker A, Arvizu E, Hadzizanovic M, Mehler L, Profant D, Thomsen C, Baum L, Lackovic M, Granger J, Calvert GM, Alarcon WA. MMWR 2003; 52(27): 629-634.
This report including all tables, references, and an editorial note is available online: Download Document.
Ground and aerial applications of insecticides are used to control populations of adult mosquitoes, which spread such diseases as West Nile virus--related illness, eastern equine encephalitis, and dengue fever. This report summarizes investigations of illnesses associated with exposures to insecticides used during 1999--2002 to control mosquito populations in nine states (Arizona, California, Florida, Louisiana, Michigan, New York, Oregon, Texas, and Washington) (estimated 2000 population: 118 million). The findings indicate that application of certain insecticides posed a low risk for acute, temporary health effects among persons in areas that were sprayed and among workers handling and applying insecticides. To reduce the risk for negative health effects, public health authorities should 1) provide public notice of application times and locations and appropriate advice about preventing exposures, 2) ensure that insecticide handlers and applicators meet state-mandated training and experience requirements to prevent insecticide exposure to themselves and the public, and 3) implement integrated pest management control strategies that emphasize mosquito larval control, reduction of mosquito breeding sites, and judicious use of insecticides to control adult mosquito populations.
Staff in state-based pesticide poisoning surveillance programs identified patients who had been exposed to insecticides used in mosquito-control efforts in nine states during April 1999--September 2002. Information was gathered on persons who had illnesses consistent with the national case definition for pesticide poisoning, which requires the collection of data on pesticide exposure, health effects, and toxicologic evidence supporting an association between exposure and effect. Cases of insecticide-related illness or injury were classified as either definite, probable, or possible, depending on the certainty of exposure and whether health effects were signs observed by a health-care provider or symptoms reported by a patient.
Of the 133 cases of acute insecticide-related illness associated with mosquito control that were identified, two (1.5%) were classified as definite, 25 (18.8%) as probable, and 106 (79.7%) as possible. Of the 132 cases for which work-relatedness could be assessed, 36 (27.3%) were work-related and 96 (72.7%) were not work-related; 31 (86.1%) of the 36 work-related cases occurred among males, and 66 (68.8%) of the 96 cases that were not work-related occurred among females.
Of the 49 cases identified in 2001, a total of 29 (59.2%) were related to a single event at a softball game in which workers operating a mosquito-control truck inadvertently sprayed 29 persons (16 spectators, 12 players, and one coach) with Fyfanon ULV, which contains malathion. All 29 persons were treated in emergency departments (EDs).
Of the 133 persons with acute insecticide-related illness associated with mosquito control, 35 (26.3%) were identified from monitoring media reports (including 34 reported subsequently by health-care providers), 32 (24.1%) were reported by poison-control centers, 27 (20.3%) were self-reported, and seven (5.3%) were reported by state health departments. Physicians and EDs were responsible for initial reporting of five and three cases, respectively. The remaining cases were reported initially by friends or relatives (n = seven), government agencies (n = five), employers (n = four), laboratories (n = two), and other sources (n = six).
Of the 85 persons with reported illness who were known to have sought medical care, 45 (52.9%) were treated in EDs, 35 (41.2%) were treated in physicians' offices, four (4.7%) were treated in employee health centers, and one (1.2%) was hospitalized. An additional 16 persons received advice from a poison-control center, and 15 did not seek medical care; information about medical treatment was not available for 17 persons.
Of the 133 reported cases of pesticide-related illness, 95 (71.4%) cases were associated with organophosphates, primarily malathion. Malathion alone was associated with 64 (67.4%) of the 95 cases; 37 (27.8%) cases were associated with pyrethoids, primarily sumithrin (24 cases) and resmethrin (10 cases).
Illness severity was categorized for all cases. One exposure was associated with illness of high severity. When her neighborhood was sprayed, a woman aged 54 years was exposed to sumithrin, which passed through operating window fans and a window air conditioner. She had exacerbation of her asthma and chronic obstructive pulmonary disease. The majority of the remaining cases were of low (65.4%) or moderate (33.8%) severity.
The majority of cases were associated either with respiratory (66.2%) or neurologic (60.9%) dysfunction. Other systems affected were gastrointestinal (45.1%), ocular (36.1%), dermal (27.1%), cardiovascular (12.0%), renal-genitourinary (3.0%), and miscellaneous (28.6%).
Of 36 persons who were exposed at their workplaces, 14 (38.9%) were insecticide applicators, and 22 (61.1%) were performing tasks that did not involve pesticide application. Seven (50.0%) of 14 applicators were exposed to sumithrin; of the other 22 workers, 11 (50%) were exposed to malathion, and five (22.7%) were exposed to resmethrin. Illness of moderate severity was more frequent among applicators (42.9%) than nonapplicators (27.3%).
Children's decision making: the effects of training, reinforcement, and memory aids
- Howse RB, Best DL, Stone ER. Cogn Dev 2003; 18(2): 247-268.
Corrrespondence: Robin B. Howse, Department of Psychology, University of North Carolina at Greensboro, P.O. Box 26170 UNC, Greensboro, NC 27402-6164, USA; (email: rbhowse@uncg.edu).
Previous research on children's decision making [Cogn. Dev. 6 (1991a) 77] has found that, unlike older children and adults, young children are frequently unable to eliminate an alternative as soon as it is clear that it is unsuitable. More precisely, young children have difficulty ignoring irrelevant information and attending to relevant information when examining alternatives. The present study explored whether children's tendency to ignore relevant information is due to the saliency of that information, the child's lack of motivation, or memory limitations of the child. To test these hypotheses, 197 second and fifth graders were divided into four groups: a training group designed to overcome saliency concerns, a reinforcement group designed to overcome motivation problems, a marking group designed to overcome memory limitations, and a control group. Children in the training and reinforcement groups examined less irrelevant information than did children in the control group; however, marking unsuitable alternatives did not improve children's performance. This left the role of memory unclear. Additionally, verbal skill level was related to the number of irrelevant items examined for all children, but accounted for a minimal amount of variance.
Correspondence: Ronald P. Danis, Department of Ophthalmology, Indiana University School of Medicine, 1120 South Drive, Fesler Hall 302 - Indianapolis, IN 46202-5114, USA; (email: rdanis@iupui.edu).
Danis comments on a report by Marshal and colleagues by pointing out the possibility that the incidence of injuries to young baseball players may have been underestimated and discussing the potential impact of this underestimate on the study findings. Using data from the US Eye Injury Registry, Danis briefly describes the epidemiology of serious ocular injury and the protective effect of the face-guard. He also cites a study reporting that only 1 in 10 facial impacts to youth baseball players resulted in a medical visit despite the apparently severe nature of some of the injuries. Danis asserts that although the individual player's injury risk may be low, the prevalence of ocular injuries is very high due to the more than 5 million annual youth league baseball players. "Thus, even if Marshall et al did underestimate the true incidence of injuries in youth baseball, it is still significant that they found a protective effect for safety equipment."
Correspondence: Stephen W. Marshall, Department of Epidemiology, University of North Carolina, 2101-E Mcgavran-Greenberg, Chapel Hill, NC, USA; (email: smarshall@unc.edu).
Marshall et al agree that estimates of injury incidence based upon insurance data should be viewed with caution but they stand by their conclusion that there is a low rate of injury in youth baseball. In a 3-year study of 10 high schools on North Carolina, the injury rate for baseball was 1.5 per 1000 athlete-exposures. This was lower than the overall injury rate of 2.3 per athlete-exposures for the 12 sports studied and well below the rate for football (4.2 per 1000 athlete-exposures).
The authors comment on their methodology and give further justification of their incidence estimates. Further, the authors provide reassurance that, even in the event that they underestimated the incidence of injuries, there is no indication that this would bias their findings that using safety equipment provides a strong protective effect.
Experienced Scuba Divers in Australia and the United States Suffer Considerable Injury and Morbidity
OBJECTIVES: Scuba diving-specific injuries have been well described. However, the injury experiences of individual divers over long diving careers have rarely been investigated. Our objective was to study the acute and chronic injuries of experienced, recreational scuba divers.
METHODS: This was an international, cross-sectional, descriptive postal survey of experienced, recreational scuba divers belonging to diving clubs in Australia and the United States.
FINDINGS: Seven hundred nine divers were enrolled (346 Australian divers and 363 US divers). Most participants were experienced (mean number of dives, 262) male divers (488; 68.8%) aged 31 to 50 years (425; 59.9%). Mild barotrauma was common. Ear, sinus, and tooth "squeeze" had been experienced on 1 occasion by 369 (52.1%), 245 (34.6%), and 66 (9.2%) divers, respectively. Tympanic membrane (TM) rupture, round/oval window rupture, and subcutaneous emphysema had been experienced by 38 (5.4%), 8 (1.1%), and 5 (0.7%) divers, respectively. No diver reported pneumothorax or arterial gas embolism (AGE); however, 31 divers (4.4%) had suffered decompression sickness (DCS). A wide range of other injuries were reported. Sixteen divers (2.3%) reported permanent disabilities, which largely consisted of hearing loss, tinnitus, and balance disorder.
DISCUSSION: The majority of experienced divers who responded to the survey had suffered diving-related injuries, mainly barotrauma. Further research and diver education are needed to better document injury rates and minimize serious diving-related injuries and permanent disabilities.
Pulley Injuries in Rock Climbers
- Schöffl V, Hochholzer T, Winkelmann HP, Strecker W. Wilderness Environ Med 2003; 14(2); 94-100.
Correspondence: Volker Schöffl, Department of Trauma Surgery, Teaching Hospital of University Erlangen-Nürnberg, Klinikum Bamberg, GERMANY; (email: unavailable).
OBJECTIVE: The closed traumatic rupture of finger flexor tendon pulleys in rock climbers appeared as a new complex finger trauma in the mid 1980s. The objectives of this study are to characterize this injury and to describe diagnostic and therapeutic guidelines. A grading system for the severity of pulley injuries was developed and used to set therapeutic pathways.
METHODS: Six hundred four injured rock climbers were prospectively evaluated from January 1998 to December 2001 with a questionnaire and standard examination protocol. Diagnostic ultrasound was performed in all rock climbers with finger injuries; if necessary, an additional magnetic resonance imaging was done. All pulley injuries were graded according to an introduced pulley-injury score (grade 1-4).
FINDINGS: Three of four of the most frequent injuries were related to the fingers: pulley injuries accounted for 20%, tendovaginitis for 7%, and joint capsular damage for 6.1%. One hundred twenty-two (20.2%) rock climbers presented an injury of the flexor tendon pulley system, 48 had pulley strains, and 74 had ruptures (a single rupture in 90.5% and multiple pulley ruptures in 9.5%). According to the pulley-injury score, 39% were grade 1, 25% were grade 2, 30% were grade 3, and 6% were grade 4 injuries.
DISCUSSION: Pulley injuries were the most frequent injuries in rock climbers. Whereas grade 1-3 injuries respond well to conservative treatment, grade 4 injuries require surgical repair. We recommend the "loop and a half" technique of Widstrom and colleagues and, alternatively, the Weilby repair. We also recommend postoperative initial immobilization and early functional treatment under external pulley protection.
Correspondence: Ricardo D. Blasco, Universitat de Barcelona, Facultat de Psicologia, Passeig de la Vall d'Hebron, 171 08035, Barcelona, SPAIN; (email: unavailable).
This research paper deals with the question of how the probability of having a traffic accident changes when one previous accident has already occurred. This is a follow-up study upon the earlier hypothesis of "accident proneness" launched by Greenwood and Yule in the 1920s. It is based on data gathered during 8 years in the public bus company of a large Spanish city and examines the implications in the magnitude of intervals between accidents. Data analysis shows evidences of several clear-cut and stable trends towards clusters of two, three and more accidents structured around short intervals. This feature, considered a tendency, seems to be stable throughout the time and independent of densities among accidents.
The focus of analysis has been (1) the comparison of the observed distribution versus the distribution by chance of intervals between consecutive accidents; (2) the estimate and comparison of both theoretical and empirical probabilities of having two consecutive accidents, considering the interval by days elapsed; (3) the estimate of empirical and theoretical cumulated probabilities of having two consecutive accidents separated by a maximum number of days, showing up the differences of these probabilities.
Results obtained are highly significant and the three hypotheses are confirmed. There seem to be two different driving styles, related to the accumulation versus the non-accumulation of accidents in short intervals.
The main contribution of this paper is the concept of "grouped accident proneness" evidenced through the analysis of data. The influence of some psychological dimensions is suggested.
Few models have been proposed to explain the etiology of traumatic dental injuries. Those that have, focus on risk factors at present stage of life. The contribution of risk factors for dental injuries at different stages of life needs to be investigated.
OBJECTIVE: To test the relationship between life course experiences and the occurrence of traumatic dental injuries in adolescents.
METHODS: A cross-sectional survey was used to collect data retrospectively. Out of a total number of 764 eligible 13-year-old-adolescents enrolled in private and public schools located in urban areas in the town of Cianorte, Brazil, 652 (85%) agreed to participate in the study. They were interviewed and examined for traumatic dental injuries by two trained dental epidemiologists using validated criteria. The interviews collected information on socioeconomic circumstances, family related variables, school grade and anthropometric measures (height and weight).
FINDINGS: Adolescent boys, those from non-nuclear families, those reporting high levels of paternal punishment and those who were at lower grades at school for their age were more likely to experience dental injuries than girls, adolescents from nuclear families, those reporting low levels of paternal punishment and those who were at higher grades at school.
DISCUSSION: It was concluded that adolescents who experienced adverse psychosocial environments along the life course had more traumatic dental injuries than their counterparts who experienced more favorable environments.
Reducing injuries among Native Americans: five cost-outcome analyses.
- Zaloshnja E, Miller TR, Galbraith MS, Lawrence BA, DeBruyn LM, Bill N, Hicks KR, Keiffer M, Perkins R. Accid Anal Prev 2003; 35(5): 631-639.
Correspondence: Eduard Zaloshnja, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, 20705-3102, Calverton, MD, USA; (email: zaloshn@pire.org.
This paper presents cost-outcome analyses of five injury prevention efforts in Native American jurisdictions: a safety-belt program, a streetlight project, a livestock control project, a drowning prevention program, and a suicide prevention and intervention program. Pre- and post-intervention data were analyzed to estimate projects' impact on injury reduction. Projects' costs were amortized over the time period covered by the evaluation or over the useful life of physical capital invested. Projects' savings were calculated based on estimated reduction in medical and public program expenses,on estimated decrease in lost productivity, and on estimated quality adjusted life years saved. All projects yielded positive benefit-cost ratios. The net cost per quality adjusted life years was less than zero (i.e. the monetary savings exceeded project costs) for all but one of the projects.
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 4429 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.
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.
A school-based violence prevention model for at-risk eighth grade youth
- Rollin SA, Kaiser-Ulrey C, Potts I, Creason AH. Psychol Sch 2003; 40(4): 403-416.
Correspondence: Cheryl Kaiser-Ulrey, College of Education, 307 Stone Building, Florida State University, Tallahassee, FL 32306-4453, USA; (email: clku@email.msn.com).
This study examined the effectiveness of a school and community-based violence prevention program for at-risk eighth-grade students in three public schools in Florida. School officials matched intervention students with community-based mentors in an employment setting to allow targeted youth to explore careers and receive one-on-one intervention from an adult mentor. Intervention students were compared to a control group of students not receiving mentorship services. This study used MANOVA and t-test analyses to examine six outcomes measured: (1) unexcused absences; (2) number of in-school suspensions; (3) number of days of in-school suspensions; (4) number of out-of-school suspensions; (5) number of days of out-of-school suspensions; and (6) total number of infractions committed on school property. The findings suggested that mentored students, as compared to control group students, had significant reductions in total number and days of suspensions, days of sanction, and infractions committed on school property.
Criteria for homicide and suicide on victims of extended suicide due to sharp force injury.
- Dettling A, Althaus L, Haffner HT. Forensic Sci Int 2003; 134(2-3):142-146.
Correspondence: Hans T. Haffner, Department of Forensic Medicine, University of Heidelberg, Vossstr. 2, 69 115, Heidelberg, GERMANY; (email: hans_haffner@med.uni-heidelberg.de).
This report is about the findings in association with the extended suicides of nine victims killed by sharp force. All victims were killed by sharp force. The perpetrators were predominantly the parents, the victims their children. Regarding the criteria for differentiating self-inflicted injuries from injuries inflicted by another person, the victims' injuries presented patterns usually found solely in suicides. Thus eight of nine cases presented tentative and hesitation injuries, in three of five cases areas of injury covered by clothing had been exposed beforehand. Despite extremely narrow intercostal spaces in children, injuries to the bones in thoracic stabbing were avoided more often than not (four of seven cases). Only the criterion "defence injury" occurred nearly as often as in homicide victims (three of nine cases). The psychopathology of extended suicide can explain this pattern. The perpetrator's motive is characterized by his pseudoaltruistic belief to save the loved ones from a world that is in his opinion unacceptable. A fusion or integration of the victim into the perpetrator's own self is based on an identity problem. Physical interrelation of forces between perpetrator and victim restricts the victim in his defence and presents an important prerequisite for acquiring the patterns of described injuries.
Suicides and the third age.
- Di Mauro S, Leotta C, Giuffrida F, Distefano A, Grasso MG. Arch Gerontol Geriatr 2003; 36(1): 1-6.
Correspondence: S. Di Mauro, Department of Longevity Sciences, Urology and Neurology, University of Catania, Cannizzaro Hospital, Via Messina, 829, I-95124, Catania, ITALY; (email: unavailable).
The phenomenon of suicide represents a complex problem, the specific aspects of which should be examined by a multifactorial analysis, particularly in the elderly subjects. Although the research on risk factors continues to grow, only a limited knowledge is available on the biological changes increasing the risk for suicide. Similarly, limited information is at our disposal about the contributing psychosocial processes extending beyond the demographic factors. Although the best explored population is the elderly using primary care services, no proven interventions are known for the time being, although some efforts to test certain approaches reaching these older adults are under way. Apparently even more, continued efforts are needed to change the attitudes toward the mental illnesses and their treatments in general, in order to reach the older adults who are still outside of the health care services.
Strategy to improve road safety in developing countries.
- Bener A, Abu-Zidan FM, Bensiali AK, Al-Mulla AA, Jadaan KS. Saudi Med J 2003; 24(6): 603-608.
Correspondence: Abari Bener, Advisor WHO and Head of Department of Medical Statistics & Epidemiology, Hamad Medical Corporation, PO Box 3050, Doha, QATAR; (email: abener@hmc.org.qa).
OBJECTIVE: To review the road safety situation in developed and developing countries compared with the Arabian Gulf countries and suggest a strategy to improve it. The role of road engineers in reducing accidents is highlighted.
METHODS: This is a retrospective study of road traffic accidents (RTAS) for a period from 1988 to 1998 in Arabian Gulf Countries. The data was taken from the Directorate of Traffic and Ministry of Health records in Gulf Countries. Additional data was obtained from other sources including the World Health Organizations Statistics Annuals, International Road Federation, Transport Road Research Laboratory and accident facts publications. Overall fatality and injury rates of RTAs were calculated.
FINDINGS: The lack of reliable data is a serious problem in most of the developing countries. It is quite reasonable to assume that the incidence of accidents is much larger than actually reported. A comparison of vehicle ownership levels and safety parameters in both developed and developing countries is presented to highlight the relative seriousness of the road safety situation in different countries. The fatality rates (per population and per vehicles) are selected for comparison purposes from developed and developing countries.
DISCUSSION: Road traffic accidents continue to be a major cause of mortality and morbidity in the Arabian Gulf Countries leading to substantial wastage of life and national resources. Further investigation is essential and will require close inter-sectoral collaboration between, traffic police, health, law, and transport authorities. Developing a research strategy for prevention will reduce casualties and death on the road.
Personality, attitudes and risk perception as predictors of risky driving behavior among young drivers
- Ulleberg P, Rundmo T. Safety Science 2003; 41(5): 427-443.
Correspondence: Pal Ulleberg, Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, NORWAY; (email: pal.ulleberg@svt.ntnu.no).
Within psychology, different research traditions have attempted to explain individual differences in risky driving behavior and traffic accident involvement. The present study attempts to integrate two of these research traditions, the personality trait approach and the social cognition approach, in order to understand the mechanisms underlying young drivers' risk-taking behavior in traffic. The study was based on a self-completion questionnaire survey carried out among 1932 adolescents in Norway. The questionnaire included measures of risk perception, attitudes towards traffic safety and self-reported risk-taking in traffic. Personality measures included aggression, altruism, anxiety and normlessness. The results of a structural equation model suggested that the relation between the personality traits and risky driving behavior was mediated through attitudes. On this basis it was concluded that personality primarily influences risky driving behavior indirectly through affecting the attitudinal determinants of the behavior. Practical implications for traffic safety campaigns are also discussed.
Effects of Taiwan in-vehicle cellular audio phone system on driving performance
Correspondence: Yung-Ching Liu, Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, 123 Sec. 3, University Road, Douliu, Yunlin 640, TAIWAN; (email: liuyc@pine.yuntech.edu.tw).
A low cost, fixed-base driving simulator was used to investigate the impact of a new car cellular audio phone system on driver behavior. Twelve subjects drove a 30-min simulated driving scenario with a low driving load and another twelve subjects drove a 30-min scenario with a high driving load. Participants were instructed to follow traffic and speed rules, and while driving, participants also had to conduct telephone communications of different lengths and complexities as well as perform a detection task.
Results showed that in the low driving load environment, and when telephone communications were short,reaction time and accuracy for the detection task and several objective measures of driving performance (i.e. mean lane position, and variances in lane position, lateral acceleration and steering wheel angle) were all relatively good. However, these good performance results were evidently achieved because the short conversations increased the workload and thus the arousal level; when arousal levels were already high (i.e. in the high driving load condition), the short conversations were associated with a degradation in performance measures, presumably because attentional resources of the subjects' become over-stretched and thus the subjects adopt a different attention allocation strategy.
Women's status and domestic violence in rural Bangladesh: individual- and community-level effects.
- Koenig MA, Ahmed S, Hossain MB, Khorshed Alam Mozumder AB. Demography 2003; 40(2): 269-288.
Correspondence: M. Koenig, Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA; (email: mkoenig@jhsph.edu).
We explore the determinants of domestic violence in two rural areas of Bangladesh. We found increased education, higher socioeconomic status, non-Muslim religion, and extended family residence to be associated with lower risks of violence. The effects of women's status on violence was found to be highly context-specific. In the more culturally conservative area, higher individual-level women's autonomy and short-term membership in savings and credit groups were both associated with significantly elevated risks of violence, and community-level variables were unrelated to violence. In the less culturally conservative area, in contrast, individual-level women's status indicators were unrelated to the risk of violence, and community-level measures of women's status were associated with significantly lower risks of violence, presumably by reinforcing nascent normative changes in gender relations.
