Blood samples of all patients (269) involved in a traffic accident and admitted to the Emergency Room of the University Hospital of Trauma Surgery in Innsbruck were analyzed for alcohol and benzodiazepines. The large majority were drivers (55%) followed by passengers (19.7%), cyclists (12.6%) and pedestrians (12.3%).Alcohol was obviously the most commonly found drug in all groups (drivers: 36.9%; passengers: 15.1%; cyclists: 29.4%; pedestrians: 18.2%), with a mean BAC (blood alcohol concentration) high above the legal limit at the time of the study in Austria of 0.8 g/l (drivers: 1.49 +/- 54 g/l; passengers: 1.52 +/- 71 g/l; cyclists: 1.72 +/- 51 g/l; pedestrians: 1.67 +/- 25 g/l). The percentage of alcohol users was highest in drivers. Concerning BAC levels no significant differences were found between the groups. The most commonly detected benzodiazepine was diazepam. Benzodiazepine consumption (drivers: 8.1%; passengers: 5.7%; cyclists: 8.8%; pedestrians: 3%) as well as plasma levels (drivers: 68.7 +/- 62.6 microg/l; passengers: 61.0 +/- 69.3 microg/l; cyclists: 135.7 +/- 118.3 microg/l; pedestrians: 18 microg/l) were nearly equal in all groups. Concerning alcohol or benzodiazepine use, females showed lower frequencies of both alcohol and benzodiazepine positive blood samples. The frequency of alcohol use was higher in patients </= 60 years of age.
Consideration of driver home county prohibition and alcohol-related vehicle crashes.
- Schulte Gary SL, Aultman-Hall L, McCourt M, Stamatiadis N. Accid Anal Prev 2003; 35(5): 641-648.
Correspondence: Sarah Lynn Schulte Gary, Jordon Jones and Goulding, 870 Corporate Drive Suite 104, KY 40503, Lexington, USA; (email: sgary@jmt-engineering.com).
This study examines the characteristics of alcohol-related crashes in wet versus dry counties in the state of Kentucky, USA and incorporates the location of driver residences through use of geographic information system (GIS) analysis. Between 1991 and 1997, 39,344 alcohol-related crashes by Kentucky residents on Kentucky State roads were reported. The location of the crash and the home ZIP code from the driver's address were used to consider distance from home in the GIS. Analysis of the crash data revealed that a similar proportion of crashes in wet and dry counties are alcohol-related but that a higher proportion of dry counties residents are involved in an alcohol-related crash. However, when the distance from home variable is considered, several results suggest that dry county residents may be driving further when consuming alcohol. In part due to the rural nature of dry counties, drivers from dry counties have both alcohol-related and non-alcohol related crashes farther from their homes than residents from wet counties. Alcohol-related crashes by dry county residents in wet counties are the greatest average distance from home while crashes by wet county residents in wet counties are the smallest average distance. Drivers from dry counties over 21 years of age have alcohol-related crashes significantly farther from home than those under 21 who would not legally be admitted to drinking establishments in the wet counties. Furthermore, residents from dry counties that do not border wet counties have alcohol-related crashes on average farther from home than the border county residents. These last three results provide circumstantial evidence that some dry county drivers may be driving to wet counties to consume alcohol thus increasing impaired driving exposure. In conclusion, by considering crash location and driver residence, these findings indicate that county-level prohibition is not necessarily effective in improving highway safety.
Identifying factors that predict persistent driving after drinking, unsafe driving after drinking, and driving after using cannabis among young adults.
Correspondence: Dorothy J. Begg, Department of Preventive and Social Medicine, Injury Prevention Research Unit, University of Otago Medical School, P.O. Box 913, Dunedin, NEW ZEALAND; (email: dorothy.begg@ipru.otago.ac.nz).
PURPOSE: The main aim of this study was to identify adolescent/young adulthood factors that predicted persistent driving after drinking, persistent unsafe driving after drinking, and persistent cannabis use and driving among young adults.
METHODS:It was a longitudinal study of a birth cohort (n=933, 474 males and 459 females) and was based on data collected at ages 15, 18, 21 and 26 years. At each of these ages members of the cohort attended the research unit for a personal interview by a trained interviewer, using a standardized questionnaire. For this study, the data for the outcome measures (persistent driving after drinking, persistent unsafe driving after drinking, and persistent driving after using cannabis) were obtained at ages 21 and 26 years. The main explanatory measures were collected at ages 15, 18, 21 years and included demographic factors (academic qualifications, employment, parenting); personality measures; mental health measures (substance use, cannabis dependence, alcohol dependence, depression); anti-social behavior (juvenile arrest, aggressive behavior, court convictions); early driving behavior and experiences (car and motorcycle licenses, traffic crashes).The analyses were conducted by gender.
FINDINGS: The results showed that females who persisted in driving after drinking (13%, n=61) were more likely than the others to have a motorcycle licence at 18. The males who persisted in driving after drinking (28%, n=135) were more likely than the other males to have some school academic qualifications and to be employed at age 26. Compared to the other males, those who persisted in unsafe driving after drinking (4%, n=17) were more likely to be aggressive at 18 and alcohol dependent at 21. Only six (1%) females persisted in unsafe driving after drinking so regression analyses were not conducted for this group. For persistent driving after using cannabis, the univariate analyses showed that females who persisted with this behavior tended to have high substance use at 18, cannabis dependence at 21, police contact as a juvenile, and to be a parent at 21. For this group, because of the small numbers (3%, n=13) multivariate analyses were not appropriate. For the males who persisted in driving after using cannabis (14%, n=68) a wide range of variables were significant at the univariate stage. The multivariate analysis showed that the most important factors were dependence on cannabis at 21, at least one traffic conviction before 21, a non traffic conviction before 18, and low constraint at 18.
DISCUSSION: These results show different characteristics were associated with persistence in each of these outcome behaviors. This indicates that different approaches would be required if intervention programs were to be developed to target these behaviors.
Evidence for an early onset of endogenous alcohol production in bodies recovered from the water: implications for studying alcohol and drowning.
- Hadley JA, Smith GS. Accid Anal Prev 2003; 35(5): 763-769.
Correspondence: Jeffrey A. Hadley, National Study Center for Trauma and EMS, School of Medicine, University of Maryland, 701 West Pratt Street, 5th Floor, 21201, Baltimore, MD, USA; (email: jhadley@som.umaryland.edu).
Endogenous alcohol production can increase the blood alcohol concentration (BAC) of drowning victims following submersion and confound epidemiological studies of the role of alcohol. This study seeks to determine how soon after a drowning death a victim's BAC is influenced by post-mortem alcohol production. The drop in mean lung weight that occurs over time in the water was hypothesized to serve as a proxy for the time course of decomposition, and thus provide an empirical measure to determine how soon after death to first suspect endogenous alcohol. The autopsy lung weights of 562 previously healthy males who drowned were compared across six submersion time groups (0-11.9, 12-23.9, 24-47.9, 48-95.9, 96-167.9 and >/=168h) and two times of year (winter and non-winter). The hypothesis that a drop in lung weight is sensitive to the time course of decomposition was supported by (1) a statistically significant drop in mean lung weight that occurred 12-23.9h post-submersion in the non-winter months, but not until 96-167.9h in the colder winter months; and (2) a significant drop in lung weight was not observed in the group of cases with zero BAC. With a parallel finding that an increase in the proportion of cases with a positive BAC first occurred at the 12-23.9h submersion group during the warmer non-winter months, we concluded that production of alcohol can occur in bodies recovered from the water as early as 12h after death. Because excluding drownings with submersion durations greater than 12h would exclude almost half of our cases from epidemiological studies of alcohol and drowning, additional evidence from the forensic literature was used to develop an adjustment procedure to account for endogenous alcohol production for submersion times of up to 1 week.
Balance self-efficacy predicts risk factors for side falls and frequent falls in community-dwelling elderly.
- Gunter KB, De Costa J, White KN, Hooker K, Hayes WC, Snow CM. J Aging Phys Activity 2003; 11(1): online.
Katherine B. Gunter, Exercise & Sport Science, Oregon State University, 120 Women's Bldg, Corvallis, OR 97331-6802, USA; (email: kathy.gunter@oregonstate.edu).
This study assessed changes in balance self-efficacy (BSE) over 1 year in community-dwelling elderly, compared changes in BSE between fallers and nonfallers, and assessed the relationship between specific balance and mobility risk factors for side falls and BSE scores. Elderly fallers (n = 67; 80.2 ± 5.9 years) and nonfallers (n = 75; 79.4 ± 4.9), categorized based on self-reported falls over 1 year, were tested at baseline on postural sway, hip-abduction strength, lateral-stepping velocity, tandem walk, and get-up-and-go and given a BSE questionnaire. Fallers had lower BSE scores than nonfallers did (141.6 ± 33.5 and 154.9 ± 25.4; p = .008). BSE did not change over 1 year. In stepwise regression, BSE scores were predictive of time on the get-up-and-go, mediolateral sway, and tandem walk independent of age, height, and strength (p < .001). The BSE scale might be useful for screening individuals at risk for injurious falls because it is inexpensive and noninvasive.
How safe are child care products, toys and playground equipment? A Swedish analysis of mild brain injuries at home and during leisure time 1998-1999.
The aim was to highlight the role of child care products as causes for mild brain injury (concussion) in small children (0-4 years of age) and to determine the most dangerous products. By child care products this report means the following items: child and baby furniture, nursing tables, baby walkers, toys, baby carriages, sport equipment for children, playground equipment and security equipment for children. The data were derived from the EHLASS (European Home and Leisure Accident Surveillance System) for 1998 and 1999 and covered a restricted population of Sweden (approximately 5 per cent). According to this register 182 mild brain injuries (concussions) were recorded following a fall, an accident or a blow to the head among children (0-4 years of age) during 1998 and 158 for 1999. Of those injuries, child care products were the cause of the accident in 84 (46 per cent) and 76 (48 per cent) cases respectively for 1998 and 1999. The number of children admitted for hospital care was 68 (57/84) and 74 (56/76) per cent respectively. The home was the most common place of the accident and play and leisure activity were the most common activities. More than 50 per cent of these accidents took place during daytime. The product type that caused most accidents was nursery furniture and, in this category, the baby walker was the most dangerous. The product type that caused the second most frequent accidents was playground equipment.
Correspondence: René Rossi, EMPA, Swiss Federal Laboratories for Materials Testing and Research Lerchenfeldstrasse 5 CH-9014 St.Gallen, SWITZERLAND; (email: Rene.Rossi@empa.ch).
Working conditions for fire fighters can be described according to the environment temperature and the incident radiant heat flux. Measurements for this study in buildings for fire fighting training have shown that fire fighters are typically exposed to radiant heat fluxes of between 5 and 10 kWm(-2) during this kind of exercise. The heat load can nevertheless be much higher. In one case, 42 kWm(-2) was measured. The temperatures reached between 100 and 190 degrees C at 1 m above ground, going up to 278 degrees C in one case. Human trials have been performed with 17 fire fighters. After exercises (about 15 min) in a heated room, the mean core temperature of the fire fighters rose by 0.6 degrees C with a surrounding temperature of 31 degrees C and 1.0 degrees C with 38 degrees C. The sweat production varied from 0.7 to 2.1 lh(-1); 16% to 45% of sweat remained in the clothing layers. During the exercises in the training buildings, a mean of 48 degrees C has been measured between fire fighters' clothing and workwear. These conditions lead to an increase of the relative humidity in all the jackets up to 100%. When the fire fighters came out of the fire, the humidity remained at this level in the PVC coated jackets while it was in some cases strongly reduced in breathable jackets.
Are the self-employed at higher risk of fatal work-related injury?
Correspondence: Tim R. Driscoll, Centre for Occupational and Environmental Health, Department of Public Health and Community Medicine, University of Sydney, NSW 2001, AUSTRALIA; (email: unavailable).
PURPOSE: The aim of this paper was to determine if the rates of work-related fatal injury differed between employees and self-employed persons, allowing for differences in their industry and occupation.
METHODS: The analysis was part of a much larger study of all work-related fatalities that occurred in Australia during the 4-year period 1989-1992 inclusive and which was based on information from coroners' files. Analysis was based on both practical and legal definitions of self-employment. Unadjusted rates, rates for specific industry and occupation groups, and rates adjusted for differences in industry and occupation distribution were calculated.
FINDINGS: The unadjusted rate for self-employed persons per 100,000 persons per year (95% CI) was 8.4 (7.5-9.2), which was 70% higher than the employee rate of 5.0 (4.7-5.2). However, after adjustment for industry, the rates were almost identical (self-employed: 5.8; employee: 6.0). Adjustment for occupation still left a 40% higher rate for self-employed persons, but this was probably due to inability to fully adjust for differences at the specific occupation level.
DISCUSSION: There was no strong evidence of an increased fatality rate in self-employed persons compared with employees, once differences in industry and occupation are taken into account. More detailed analysis of specific industry and occupation sub-groups would provide greater insight into this issue.
Factors contributing to the differences in work related injury rates between Danish and Swedish construction workers
Comparison of Danish and Swedish national occupational injury statistics shows that the reported LTI-rate, or number of reported lost-time injuries per million working hours, for Danish construction workers is significantly higher than the reported LTI-rate for Swedish construction workers. In terms of injury prevention it is important to identify injury risk factors that contribute to the observed differences in LTI-rates. In the present Øresund Link case study Danish and Swedish workers worked in cross-national work gangs, carried out the same types of tasks and utilized the same reporting procedures for occupational injuries. Thus, factors that usually confound comparisons between countries were eliminated in this study. Furthermore, factors at company level were to a great extent excluded in the study design, which therefore provided a unique opportunity to investigate the importance of injury risk factors at group and individual level for Danish and Swedish workers. LTI-rates and injury risk factors were compared for Danish and Swedish workers during the construction of the combined rail and road link across the 16-km wide sound, Øresund, between Denmark and Sweden. The comparison showed that the LTI-rate of the Danish construction workers was approximately fourfold the LTI-rate of the Swedish construction workers. Factors at the micro-level (group and individual level) e.g. differences in education and experience, training and learning, and attitude were important for the explanation of the significant difference in LTI-rates between Danish and Swedish construction workers. The study also indicated that comparison of national data on LTI-rates should be carried out with great caution.
Comparison of team and individual judgments of solutions to safety problems.
Knowledge about how best to solve problems in occupational health and safety and how to be innovative in general is important to all industry. With the advent of non-prescriptive workplace safety legislation in Australia (and internationally), the need for problem solving at an enterprise level has never been greater. The legislation calls for problem solving to take place via a cooperative approach between employers and employees and this manifests itself as committees, risk improvement teams and the like. Unfortunately research in problem solving generally has showed us that interacting teamwork is less effective that individual thinking in terms of generating solutions to problems. However, there has been little research on the comparison of individuals and teams as regards the decision-making stage of problem solving that must naturally follow the idea generation stage. This research compared individuals and teams based on decision-making in health and safety. Subjects were 294 manufacturing industry employees arranged into 38 teams. Subjects ranked solutions to safety problems individually and then repeated the exercise in teams where they sought to develop a team consensus. The average of individual judgments were compared with the team consensus judgments in a paired design. The results indicate that the consensus judgment of the teams was much better than the average of the individuals that comprised the team. The implications are that, while idea generation is probably best achieved individually, judgments and decision about solutions is probably best performed through a consensus approach.
Correspondence: Lucy Johnston, Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, NEW ZEALAND; (email: l.johnston@psyc.canterbury.ac.nz).
The reported study employed a virtual reality (VR) system, using a head mounted display (HMD), to investigate road crossing behavior in children and young adults. Younger children (aged 5-9 years) made the greatest number of unsafe road crossings and the oldest participants (aged >19 years) the fewest. Overall performance was better (fewer unsafe road crossings) in uniform speed than uniform distance trials, consistent with previous research suggesting that pedestrians base road crossing decisions on inter-vehicle distance rather than vehicle speed. Results are discussed in terms of road crossing behavior and the use of VR simulations in the study of pedestrian behavior.
Behavioral observations of adult-child pairs at pedestrian crossings.
Pedestrian accidents are a serious health risk to children in the UK and other Western countries. There remains a considerable amount to be learned about children's behavior in real-traffic environments. The present study was intended to help fill this gap, by observing unobtrusively the behaviors of 123 adult-child pairs as they crossed the road at pedestrian light-controlled crossings. Eight behaviors were coded, including whether or not the pair stopped at the kerb, waited for the light to change, and checked to ensure traffic flow had stopped. Results showed that the adults observed provided reasonably good models of pedestrian behavior, but that they rarely treated the crossing event as an opportunity to teach children explicitly about road safety. The only gender difference to emerge revealed that adults were more likely to hold girls' hands than boys' hands. No differences were observed in relation to (estimated) age of child. The implications of these findings for parental training programs are explored.
Correspondence: Pierre Fonlupt, Inserm-Unité de recherche U280. 151, Cours Albert Thomas, 69424, Lyon Cedex 03, FRANCE; (email: fonlupt@lyon.inserm.fr).
One basic type of 'mechanical' causality is that which occurs between physical objects. Subjects were presented with mechanically causal events (ball collides with and causes movement of another ball) or two non-causal events (a ball either passes underneath another ball, or rolls across the screen and changes color). We investigated which brain regions exhibit increased activity during the judgment of causality ('judged causality') as compared with judgment of movement direction ('perceived causality'). We show an increase of medial frontal cortex activity when subjects were explicitly instructed to search for causality. Moreover, this increase was specifically associated with the search for causality and not with the perception of causality because the signal increase occurs whatever the nature of the stimulus (causal or non causal). Our study provides evidence for brain regions involved in a conscious level of inference about the presence of causality.
Predictors of a child's ability to use a visual analogue scale.
- Shields BJ, Palermo TM, Powers JD, Grewe SD, Smith GA. Child Care Health Dev 2003; 29(4): 281-290.
Brenda J. Shields, Center for Injury Research and Policy; Children's Hospital; 700 Children's Drive; Columbus, OH 43205, USA; (email: Shieldsb@pediatrics.ohio-state.edu).
CONTEXT: Visual analogue scales (VAS) are used to assess the strength of perceptions of both children and adults in many clinical and research settings. Although the VAS has been shown by some authors to be reliable for use by children aged 5 years and older, others have proposed that young children, generally </= 7 years of age, may not have the conceptual ability to use a VAS.
PURPOSE: To identify demographic and cognitive variables that would maximize the accuracy of predicting children's abilities to use a VAS.
METHODS: Forty kindergarten children performed a seriation task, used a VAS to perform a calibration task and completed the Block Design and Vocabulary subtests of the Wechsler Preschool and Primary Scale of Intelligence - Revised (WPPSI-R). An estimated IQ was calculated from the WPPSI-R subtest scores. Socioeconomic status was assessed using the Hollingshead Four Factor Index of Social Status. Logistic regression was used to determine the best predictive models. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy were calculated for statistically significant predictive models.
MAIN OUTCOME MEASURE: Successful completion of the calibration study by the child.
FINDINGS: Only 42% of the subjects could use a VAS. The subject's age (>/= 5.6 years), combined with estimated IQ (>/= 100), was the best predictor of a child's ability to use a VAS (88% accuracy).
DISCUSSION: The majority of kindergarten children in our study could not complete a VAS accurately. Cognitive ability, combined with chronological age, was the best predictor of a child's accurate use of a VAS, as determined by logistic regression. Pediatric researchers may need to consider alternative rating scales to measure perceptions in children under 7 years of age.
- Mortelmans LJ, Van Rossom P, Du Bois M, Jutten G. Eur J Emerg Med 2003; 10(2): 105-107.
Correspondence: Luc J. M. Mortelmans, Department of Emergency Medicine, AZ KLINA Augustijnslei 100, b2930 Brasschaat, BELGIUM; (email: luc.mortelmans@klina.be).
Personal experience and reports of colleagues made the authors aware of a possible problem of carbon monoxide exposure in indoor carting arenas. Symptoms such as nausea, headache and altered coordination are not uncommon. This prompted us to register carbon monoxide levels in 15 healthy volunteers in a recreational carting event in a random arena. After two sessions of 10 min and a finale of 20 min we measured a clear increase in carboxyhaemoglobin levels, up to a 16.5-fold increase. The mean rise in the carboxyhaemoglobin level (expressed as a percentage) was 2.06 (mean start carboxyhaemoglobin 0.49%, mean end carboxyhaemoglobin 2.55%). Nausea was noted in 53% of the drivers, headache and altered coordination in 33%, and 13% had a vague abdominal pain. The effects of carbon monoxide exposure during indoor carting should thus not be underestimated, and healthcare workers should be aware of the possible risks.
The importance of normative beliefs to the self-prophecy effect.
Sprott DE, Spangenberg ER, Fisher R. J Appl Psychol 2003, 88(3): 423-431.
Correspondence: David E. Sprott, Department of Marketing, Washington State University, Todd Add 390, Pullman, WA 99164-4730, USA; (email: dsprott@wsu.edu).
Asking people to predict whether they will undertake a target behavior increases their probability of performing that behavior. Now referred to as the self-prophecy effect, this phenomenon has been demonstrated across several contexts. Although theoretical explanations for the effect have been offered, empirical evidence for proposed accounts is sparse. The current research tests the theoretically relevant precondition for the effect that normative beliefs-evaluations of what is socially desirable or appropriate-underlie manifestation of the self-prophecy effect. Results of 2 experiments for different behaviors indicate that the act of making a prediction is most effective when normative beliefs are strong. Implications of these findings are discussed in relation to theoretical explanations for the effect and successful use of self-prophecy to promote socially desirable behaviors.
Personality and speeding: some policy considerations.
Tay R, Champness P, Watson B. IATSS Res 27(1): 68-74.
Correspondence: Richard Tay, Centre for Accident Prevention and Road Safety, Queensland University of Technology, Carseldine, Queensland, AUSTRALIA; (email: r.tay@qut.edu.au).
While there has been extensive research on the effect of sensation seeking on risky driving, relatively little research has been conducted on Type-A personality. The motivations for speeding are likely to be different for each group and these differences have important implications for the design, implementation and expected efficacy of road safety countermeasures. This paper examines the influence of sensation seeking and Type-A behavior pattern on speeding behavior. A sample of 139 staff and students in an Australian university were surveyed in July 2001 to gather information on their gender, age, personality and self-reported speeding behavior. The data were analyzed using correlations and analysis of variance procedures. Finally, some implications for road safety are discussed.
CONTEXT: Little is known about the pattern of injury in short track speed skating.
PURPOSE: To investigate the incidence and characteristics of injuries in short track speed skating.
STUDY DESIGN: Retrospective study.
METHODS: Ninety-five of 150 elite-level skaters (63.3%) were surveyed to collect information on training and competition load as well as on injuries sustained during the 1999-2000 competitive season. Injuries were characterized in terms of anatomic location, type of injury, time loss from training and competition, and circumstance of injury (acute onset during competition, on-ice practice, off-ice training, or insidious onset).
FINDINGS: Sixty-one of the 95 skaters (64.2%) reported sustaining at least one injury. The knee, ankle, spine, leg, and groin were the most commonly reported sites of injury. Skaters were also asked to list previous on-ice injuries. The two most common injuries occurring on-ice before the 1999-2000 season were lacerations from the knee down (11.1%) and ankle fractures (10.2%).
DISCUSSION: The results of this study suggest that there is a high incidence of injury in competitive short track speed skating.
The Incidence of Injuries in Elite Junior Figure Skaters.
- Dubravcic-Simunjak S, Pecina M, Kuipers H, Moran J, Haspl M. Am J Sports Med 2003; 31(4):511-517.
Correspondence: Sanda Dubravcic-Simunjak, Department of Physical Medicine and Rehabilitation, General Hospital: "Sveti Duh" Sveti Duh 64, 10000 Zagreb, CROATIA; (email: unavailable).
CONTEXT: There has been rapid growth in the technical and physiologic demands made on skaters who perform more and more difficult jumps, spins, lifts, throws, and free skating movements.
PURPOSE: To investigate the frequency of injuries and overuse syndromes in elite junior skaters. STUDY DESIGN: Questionnaire.
METHODS: During four consecutive Junior World Figure Skating Championships and the Croatia Cup, we interviewed 236 female and 233 male skaters by questionnaire to determine the frequency of injuries and overuse syndromes.
FINDINGS: Fifty-nine of the female skaters (25%) and 65 of the male skaters (27.9%) reported sustaining acute injuries; 101 female (42.8%) and 106 male (45.5%) skaters reported overuse syndromes. Low back pain was reported by 19 female and 23 male skaters. The most frequent acute injury was ankle sprain. In singles female skaters, the most frequent overuse injury was stress fracture (19.8%), followed by jumper's knee (14.9%). In singles male skaters, jumper's knee (16.1%) was the most frequent injury, followed by Osgood-Schlatter disease (14.2%). More than 50% of injuries in young singles figure skaters involved overuse syndromes. Pairs skaters and ice dance skaters had a higher risk of acute injury than overuse syndrome because of falls from lifts and throw jumps.
DISCUSSION: Programs to improve postural alignment, flexibility, and strength, especially during the asynchronous period of bone and soft tissue development, should be instituted to prevent and reduce overuse syndromes.
Jeffrey J Bazarian, Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (email: jeff_bazarian@urmc.rochester.edu).
CONTEXT: Pre-hospital GCS scores are used to make critical patient care decisions and to fill in gaps in hospital-based TBI surveillance, but they may not be accurate.
PURPOSE: To determine the relationship between pre-hospital (EMS-GCS) and emergency physician GCS scores (ED-GCS).
METHODS: Prospective observational study of 60 TBI patients with a field GCS of 8-13 and age > 18. ED-GCS, EMS-GCS, time of GCS and vitals signs were recorded. Simple and multiple linear regression methods were used.
FINDINGS: The median EMS-GCS was 13 and that for ED-GCS was 15. There was a significant linear relationship between ED-GCS and EMS-GCS (r = 0.45, p = 0.003). There was improvement in the prediction of ED-GCS when alcohol/drug use and age (but not time) were added to EMS-GCS.
DISCUSSION: EMS-GCS is usually two points lower than ED-GCS, but the correlation between them is strong and independent of the time between score determinations. These results could prevent unnecessary procedures based on the EMS-GCS and improve the accuracy of TBI surveillance.
Gender differences in recovery from injuries to the extremities in older persons. A prospective study.
Correspondence: Gijm Kempen, Department of Health Care Studies, Section of Medical Sociology, Maastricht University, Maastricht, THE NETHERLANDS; (email: g.kempen@zw.unimaas.nl).
PURPOSE: This paper examines gender differences in trajectories of basic activities of daily living after fall-related injuries to the extremities in independently living older people in the Netherlands.
METHOD: The study comprised a prospective design. Data were collected from 31 men and 140 women at baseline, when they had not yet sustained injuries (hip fractures, other fractures or contortions and dislocations), and 8 weeks, 5 months and 12 months after their accident. Analysis of variance was used to test for differences in change in basic activities of daily living between baseline and follow-ups for men, for women and for the total study sample while adjusting for several covariates.
FINDINGS: The patients did not generally regain their pre-injury levels of functioning 12 months after their event. However, in contrast to the women, older men more closely reached their pre-injury levels of functioning. Although women deteriorated more than men, differences were not statistically significant at 8 weeks and 5 months post-injury. Long-term recovery, however, was significantly associated with gender when the impact of severity seemed to have expired.
DISCUSSION: Recovery of basic activities of daily living one year after injuries to the extremities seems to be influenced by gender. Female patients recovered less well compared to males. These gender-related changes warrant concern and attention in clinical practice.
Behavioral characteristics and accidents: findings from the Health Survey for England, 1997.
Correspondence: R. Lalloo, Department of Epidemiology and Public Health, Royal Free and University College London Medical School, 1-19 Torrington Place, WC1E 6BT, London, UK; (email: rlalloo@uwc.ac.za).
This study analyzed the relationship between major and minor accidents, and major accidents involving a moving vehicle, and behavioral and emotional factors in children, aged 4-15 years, using the Strengths and Difficulties Questionnaire (SDQ), and adjusting for demographic, socio-economic and family type factors. Data from a large representative national sample of about 6000 children were analyzed using simple and multiple logistic regression. The analysis shows that the prevalence of SDQ scales, such as hyperactivity and conduct disorder were significantly higher in boys, lower social classes and step- and single-parent families. After adjusting for the demographic, socio-economic and family type factors, children who scored borderline or high for hyperactivity were almost two times more likely to report having major accidents. Children who scored high for hyperactivity and emotional symptoms were one and a half times more likely to report having minor accidents. For major accidents involving moving vehicles, the relationships with the behavioral and emotional factors were generally stronger than for major accidents in general. Hyperactivity, in particular, was significantly associated with the occurrence of major and minor accidents, and major accidents involving moving vehicles. The behavioral risk factors were significantly more common in the lower social classes, families receiving benefits and step- and single-parent families.
A failed model-based attempt to implement an evidence-based nursing guideline for fall prevention.
- Semin-Goossens A, van der Helm JM, Bossuyt PM. J Nurs Care Qual 2003; 18(3): 217-225.
Correspondence: A. Semin-Goossens, Center for Clinical Practice Guidelines, Academic Medical Center at the University of Amsterdam, Amsterdam, THE NETHERLANDS; (email: a.semin@amc.uva.nl).
CONTEXT: An evidence-based nursing guideline had been locally developed in 1993 to reduce fall incidence rates, creating a 30% reduction. Implementation had failed though. Between 1999 and 2001 the guideline was updated. A multifaceted intervention was chosen based on a model for implementing change.
METHOD: The study was performed in 2 wards. All recommendations of Grol's 5-step implementation model were followed. The aim was a reduction of 30% in fall incidence within a year. Data on falls were extracted from nursing records and Incidence Report Forms (IRFs).
FINDINGS: In a pilot study an average of 9 falls per 1000 patients per day had been recorded in the department of internal medicine and 16 in the neurology ward. Given the desired reduction of 30%, the target averages were 6 and 11 falls respectively. During the intervention year the average incidences were 8 and 13 falls (95% CI: 6-11 and 10-15). There was a changeable pattern over time without any declining trend. The percentage filled in IRFs varied strongly, with an average of 52% in the department of internal medicine and 60% in the neurology department.
DISCUSSION: There has been no durable decrease in monthly falls despite the use of a model-based procedure for implementing change. Neither did we observe any improvement in filling in IRFs. It can be questioned if the nurses themselves did experience patient falls to be troublesome enough. Investigating this is difficult though. Although the most successful strategy still appears to be changing attitudes of nurses in order to increase fall prevention, there is no clear strategy on how to create this successfully.
Using tools to assess and prevent inpatient falls.
CONTEXT: Inpatient falls and fall-related injuries continue to be a complex challenge that health care organizations face. Protecting patients from falls and injury and ensuring a safe environment are fundamental to providing high-quality care. In June 2000 NorthEast Medical Center (Concord, North Carolina) experienced an inpatient fall rate (6.1 falls/1,000 patient days) that exceeded the internal benchmark (4.1 falls/1,000 patient days). The interdisciplinary Fall Team developed the Fall Risk Assessment tool. Patients were given a fall risk score and were categorized as either low or high risk. Interventions were chosen by the caregiver and became part of each patient's overall safety plan of care.
METHODS: Root cause analyses were performed for each inpatient fall to expose possible relationships between assessed fall risks and root causes. For example, approximately 80% of the patients who fell were confused, had gait disturbance, and were attempting to toilet alone. Through use of Failure Mode and Effects Analysis, the team was able to review the fall process in a prospective fashion.
FOCUS ON HIGH-RISK INPATIENT POPULATIONS: In January 2001 the Fall Team began to focus on preventing falls in this patient population. An action plan for fall prevention was implemented, resulting in a decrease from 67 to 28 falls per 1,000 patient days.
FINDINGS: From the team's inception in June 2000 to the first quarter of 2003, the inpatient fall rate decreased from 6.1 to 2.6 falls per 1,000 patient days--a 43% decrease.
DISCUSSION: With increased patient acuity and specialization in care of new and more challenging patient populations, health care organizations must quickly identify patients' fall risks and develop innovative methods to prevent falls.
The objective of this paper is to study injuries from motorcycle and moped crashes in Sweden from 1987 to 1999. Databases at the National Board for Health and Welfare and codes from both ICD9 and ICD10 systems were used, including patterns of age, gender, E-code and type of injury. Length of hospital stay, type of injuries and trends over time was evaluated. To get a more detailed picture of the age distribution, type of vehicle used and number of killed, data from the Swedish National Road Administration were also used. In Sweden, 27,122 individuals received in-patient care due to motorcycle and moped injuries between 1987 and 1999. The motorcycle and moped injury rate was reduced in the second half of the studied period and so were the total days of treatment per year. Males had eight times the incidence of injuries compared to females. Riders under the age of 26 and in particular those at an age of 15 had the highest incidence rate. Head injuries were the most frequent diagnosis, followed by fractures to the lower limbs. Concussion was the most frequent head injury. Focal and diffuse brain injuries combined showed the same frequency as concussion. It is concluded that more preventative strategies must be presented before the injury rate can be reduced.
Household survey of injuries in a Kenyan district.
- Nordberg E, Kimani V, Diwan V. East Afr Med J 2000; 77(5): 240-244.
Correspondence: Vinod Diwan, Karolinska Institutet, 17176 Stockholm, SWEDEN; (email: Vinod.Diwan@phs.ki.se).
PURPOSE: To determine the pattern and burden of injuries, their causes and action taken in a rural and urban community in Kenya.
DESIGN: Household interview survey and focus group discussions. SETTING: Four rural villages and five urban clusters in Kiambu District, Kenya. SUBJECTS: A total of 1,980 members of 200 rural and 230 urban households.
FINDINGS: The number of reported injuries was 495, corresponding to 300,000 injuries per 100,000 people per year. Most common were cut or piercing (38.4%), followed by fall (16.2%), burn or scald (14.3%), animal bite or kick (10.1%), hit by moving object (5.9%) and road traffic accident (3.6%). Poisoning, sub-mersion/drowning and explosion were uncommon, each below three per cent. Of all reported injuries, 149 (30.1%) sought care from traditional healers, 91 (18.4%) were subject to self-care, 76 (15.4%) obtained service from drug shops, 22 (4.4%) were brought to a health facility for attention and 17 (3.4%) took no action at all. Additional information was obtained through focus group discussions with students, teachers and members of women groups. These generated detailed information about cases of sexual assault within and outside households which had not been captured during the previous household interviews.
DISCUSSION: Injuries are very common but most of them are mild, prompting only home care or no action at all. Only one out of 25 injuries were brought to a health facility for attention. Some types of injury, such as domestic violence and sexual assault, are more likely to be captured through focus group discussions than during household interviews. A combination of methods is likely to best reflect the pattern of injury at community level.
Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident.
- Walshe DG, Lewis EJ, Kim SI, O'Sullivan K, Wiederhold BK. Cyberpsychol Behav 2003; 6(3): 329-334.
Correspondence: David G. Walshe, Department of Psychiatry, University College Cork, St. Stephens Hospital, Cork, IRELAND; (email: unavailable).
Specific phobia, situational type-driving, induced by accident (accident phobia) occurs in 18-38% of those involved in a vehicular accident of sufficient severity to warrant referral to the emergency departments of a general hospital. The objective is to investigate, in an open study, the effectiveness of the combined use of computer generated environments involving driving games (game reality [GR]) and a virtual reality (VR) driving environment in exposure therapy for the treatment of driving phobia following a motor vehicle accident (MVA) program. Fourteen subjects who met DSM-IV criteria for Simple Phobia/Accident Phobia and were referred from the emergency department of a general hospital were exposed to a Virtual Driving Environment (Hanyang University Driving Phobia Environment) and computer driving games (London Racer/Midtown Madness/Rally Championship). Patients who experienced "immersion" (i.e., a sense of presence with heightened anxiety) in one of the driving simulations (defined as an increase in SUD ratings of 3 and/or an increase of heart rate > 15 BPM in a 1-h trial session of computer simulation driving) were exposed to a cognitive behavioral program of up to 12 1-h sessions involving graded driving simulation tasks with self-monitoring, physiological feedback, diaphragmatic breathing and cognitive reappraisal. Subjects were assessed at the beginning and end of therapy with measurements of: physiological responsivity (heart rate), subjective ratings of distress (SUD), rating scales for severity of fear of driving (FDI), Posttraumatic Stress Disorder (CAPS) and depression (HAM-D) and achievement of target behaviors. Of all patients 7/14 (50%) became immersed in the driving environments. This immersed group (n = 7) completed the exposure program. Pre- and post-treatment comparisons showed significant post treatment reductions on all measures SUDS (p = 0.008), FDI (p = 0.008), CAPS (p = 0.008), HR (p = 0.008), CAPS (p = 0.008), HAM-D (p = 0.031). Further analysis of the FDI showed significant reductions in all three subscales: travel distress (p = 0.008), travel avoidance (p = 0.008), and maladaptive driving strategies (p = 0.016). The findings of this study suggest that VR and GR may have a useful role in the treatment of driving phobia post-accident even when co-morbid conditions such as post-traumatic stress disorder and depression are present.
Hand injuries in young children.
- Ljungberg E, Rosberg HE, Dahlin LB. J Hand Surg [Br] 2003; 28(4): 376-380.
Correspondence: E. Ljungberg, From the Department of Hand Surgery, University Hospital of Malmo, SWEDEN; (email: elliljungberg@hotmail.com).
Four hundred and fifty five young children (0-6 years old) were treated for hand injuries between 1996 and 2000. Boys (61%) were injured more often and a higher number of injuries occurred during May and September. Fingertip injuries were the most common injuries (37%), and were often caused by jamming in doors at home. Fractures were caused by falls and punches and tendon/nerve injuries by sharp objects. The incidence of hand injuries increased from 20.4/10,000/year in 1996 to 45.3/10,000/year in 2000. Only 4% of the children had complex injuries but these placed a high demand on resources. The incidence of injuries was not higher amongst children from immigrant families.
A review of available data on the health of the Latino population in North Carolina.
Correspondence: Paul Buescher, State Center for Health Statistics, North Carolina Division of Public Health, 1908 Mail Service Center, Raleigh, NC 27699-1908, USA; (email: paul.buescher@ncmail.net).
PURPOSE: To portray major health problems and conditions in the Latino population of North Carolina.
STUDY DESIGN: Presentation of descriptive information from North Carolina data sets on Latino health issues, with whites and African Americans as comparison groups.
DATA SOURCES/STUDY SETTING: Statewide data on the health of the Latino population are provided from the following data sets: North Carolina Behavioral Risk Factor Surveillance System (BRFSS), death certificates, North Carolina Office of the Chief Medical Examiner records, sexually transmitted disease reports, reported pregnancies, certificates of live birth, North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), and North Carolina Birth Defects Monitoring Program (BDMP) cases.
DATA COLLECTION METHODS: Review of existing data systems.
FINDINGS: Latinos in North Carolina have high death rates from motor vehicle injuries and homicide. Latinos who die from unintentional injuries, homicide, and suicide are much more likely than whites or African Americans to have a high blood alcohol level. Latinos are less likely than other groups to have health insurance. Latinos have much higher pregnancy rates, both for teens and older women, and are more likely to begin prenatal care late or have no prenatal care. Rates of sexually transmitted disease are higher than those for whites but lower than those for African Americans. Latinos are more likely to initiate breastfeeding. Latinos have a higher rate of neural tube defects compared to the other groups, while being less likely to take folic acid every day before pregnancy. Despite lower family incomes, later entry into prenatal care, and higher rates of certain birth defects, Latinos had the lowest rates of low birth weight and infant mortality. Lower rates of smoking during pregnancy among Latinos may partially account for the better birth outcomes.
DISCUSSION: Many of the health issues among Latinos in North Carolina are consistent with the fact that they are a very young, mainly recently-arrived, immigrant population with more males than females. These findings may provide a basis for designing more effective health improvement programs for the Latino population of North Carolina.
Accidents, especially accidents involving children or young people, are a key health problem that needs to find higher prominence in preventative measures. The school as the central socialization institution plays a key role in the process of continual improvement. However, to date the prevailing approaches of technical accident prevention and behavior led safety training have not led to sustained improvements in the safety of children and young people. This article presents the key elements and characteristics of a new approach that not only aims to make significant improvements in safety but is also aimed at schools having an improved perception of their key role--to instruct and educate. The authors assume that greater security can only be achieved in and through schools if safety promotion is at the same time school development. In this understanding, safety promotion focuses on the key players in the school and school life itself, and in particular endeavors to strengthen relationships and behavior that promote safety and to minimize those that can have a negative effect. It emphasizes practical changes to daily school life with regard to construction and fittings, education, training, organization and politics, and involves the needs of everybody who lives and works at the school.
PURPOSE: To investigate the attitudes towards suicide among Grade II secondary school pupils among three cultural groups in South Africa. DESIGN: Cross sectional study.
SETTING: Grade II Secondary school pupils chosen at random from three urban schools in Pietersburg.
PARTICIPANTS: The sample included 366 pupils, 150 (41%) males and 216 (59%) females, the mean age was 19.3 years (SD = 2.6), with a range from 17 to 24 years. The three cultural groups were 142 blacks, 112 whites and 112 Asians.
MAIN OUTCOME MEASURES: Socioeconomic and family background (14 items), suicide data (4 items), and a 30-item Multi-Attitude Suicide Tendency Scale for Adolescents (MAST-12).
FINDINGS: Suicide ideation and plans to commit suicide are the highest among Asians, closely followed by Whites and lowest among Black pupils. The frequency of attempted suicide was lower among Blacks (11.3%) than that among Asians (13.5%) and Whites (13%). Analysis of variance indicated a significantly higher score among suicide attempters on attraction to death and repulsion by life and a significantly lower score on attraction to life and repulsion by death. Furthermore, this study found a significant correlation between total MAST, suicide ideation, suicide intent, history of completed suicide in family or friend, parents divorced, family size and suicide attempt.
DISCUSSION: This study found differential effects across diverse ethnocultural adolescent groups for suicidal ideation, plants and attempts. This gives indications on how suicide prevention programs can be constructed in culture-congenial ways.
Correspondence: Rod McClure, School of Population Health, Mayne Medical School, University of Queensland, Herston, Queensland 4006, AUSTRALIA; (email: r.mcclure@sph.uq.edu.au).
Risk-taking behavior has been identified as a possible explanation for the high incidence of motor vehicle crashes involving young male drivers. This study examines the extent to which differences in risk-taking behavior explain the differential crash rates by age and gender. A random sample of 689 adults aged 17-88 were selected from motor vehicle license holders within randomly selected geographical areas across Queensland. Participants completed a questionnaire covering their attitudes towards driving behavior and general risk-taking behavior, selected demographic characteristics and self-reported history of road crashes as a driver. Univariate analysis showed that males scored higher means than females in driver aggression and thrill seeking and in their general risk acceptance. Multivariate logistic regression analysis indicated that males were twice as likely (OR 2.46, CI 1.59-3.83) to have reported at least one crash as a driver compared to females and nearly three times as likely (OR 2.88, CI 1.84-4.49) to have reported two or more crashes. Drivers aged 17-29 were also twice as likely (OR 2.31, CI 1.10-4.19) to have reported at least one crash when compared to those aged over 50 years. When risk-taking behaviors were introduced into the logistic model the odds of males (OR 1.70, CI 1.29-3.30) or 17-29 year olds (OR 1.30, CI 0.93-3.91) being involved in at least one crash substantially reduced. An increased risk of a crash as a driver can, in part, be explained by the age and gender differential in risk-taking behavior. The challenge for public health professionals is to determine suitable strategies to modify risk-taking behavior in young or male drivers.
Do child safety seat installation instructions need to be simplified?
Mark V. Wegner, Wisconsin Department of Health and Family Services, 1 West Wilson Street, Room 318, Madison, WI 53701-2659, USAA; (email: wegnemv@dhfs.state.wi.us)
The objective of the study was to measure the required reading level of a sample of child safety seat (CSS) installation instructions, and compare readability levels among different prices of CSSs. A CD-ROM containing CSS installation instructions was obtained from the National Highway Traffic Safety Administration (NHTSA). Their readability levels were determined using the SMOG test. The study demonstrated that the readability of instruction sets ranged from the seventh to twelfth grade levels, with an overall SMOG score of 10.34. No significant associations were found to exist between readability and seat prices. The authors thus conclude that CSS instruction manuals are written at a reading level that exceeds the reading skills of most American consumers.
Restricting intersection visibility to reduce approach speeds.
Correspondence: Samuel G. Charlton, Department of Psychology, Waikato University, Private Bag 3105, Hamilton, NEW ZEALAND; (email: samiam@waikato.ac.nz).
This paper reports the field test of a visual restriction treatment for a rural intersection with a high rate of injury crashes. A human factors analysis of the asymmetric pattern of crashes at the site suggested that most of the crashes were the result of anticipatory decision-making occasioned by visual characteristics of the eastbound approach to the intersection. The field test examined the effectiveness of a visual restriction treatment directed at eliminating drivers' anticipatory decision-making. The treatment consisted of a hessian screen erected along the eastbound approach to the intersection beginning 125m prior to intersection and ending 25m prior to intersection. Over 2 days of testing, approximately 300 drivers' reactions at the intersection were observed and their responses to a brief survey recorded. The test indicated a 23% reduction in the 80th percentile and mean approach speeds and elimination of all approach speeds over 57km/h following introduction of the treatment. Survey results showed that the treatment was visually acceptable to the majority of drivers using the intersection and did not affect its perceived safety. Follow-on analyses compared speed data before the treatment, and 2, 21, and 37 weeks after installation of the treatment. These analyses showed that approach speeds remained low; 30% lower than pre-treatment speeds for both the 80th percentile and the average approach speeds. Of perhaps the greatest significance, no crash resulting in serious injury or death has occurred at the intersection since installation of the treatment to the present time.
Older drivers and road safety: the acceptability of a range of intervention measures.
A survey questionnaire was used to ascertain the views of 1932 UK drivers aged between 50 and 90 on a range of measures designed to promote safer driving among the elderly. Factor analysis of the items produced six factors, relating to statistically distinct types of measure. Differences in acceptability on the basis of age and sex were explored. Ratings of the effectiveness of each measure revealed little consensus about which measures would be most effective. Compulsory re-testing after a driving ban, a police power to require an assessment of the driving of anyone observed driving in a risky manner, and a requirement for opticians to report to the licensing authority any driver with sight problems likely to affect driving emerged as the individual measures offering the best combination of acceptability and perceived effectiveness.
Traffic sense-which factors influence the skill to predict the development of traffic scenes?
Vogel K, Kircher A, Alm H, Nilsson L. Accid Anal Prev 2003; 35(5): 749-762.
Correspondence: Katja Vogel, Swedish National Road and Transport Research Institute, 58195, Linkoping, SWEDEN; (email: katja.vogel@vti.se).
A study was conducted to evaluate the skill to predict the development of traffic situations. A stop-controlled intersection was filmed over several days, and 12 scenes with varying traffic complexity were selected. In half of the scenes, the traffic rules were violated, in half of the scenes, the rules were observed. A total of 36 participants were asked to watch the scenes and predict how the scene would most likely develop in the 2s after the film was paused. Additionally, the participants rated how certain they were about their prediction, and how complex and dangerous they assessed the scenes to be. With the method used here, experienced drivers were not found to make more correct predictions of situational development, and no difference in skill to predict could be found between genders. Nevertheless, more experienced drivers were more certain in their judgments and evaluated the situations on average as less complex and dangerous than did less experienced drivers. Scenes in which the traffic rules were violated were more difficult to predict correctly. The scenes in which the participants predicted violations were rated as more complex and dangerous. It is concluded that the low-cost method used here is more useful for examining which scenes are generally easy or difficult to predict and how they are experienced subjectively than to investigate differences in performance for different driver categories.
Occupant deaths in large truck crashes in the United States: 25 years of experience.
There is public concern about the magnitude of the problem of large truck crashes in the US. Fatalities in large truck crashes have not declined much; however, more large trucks are driving more miles than ever before while fatalities per mile driven have dropped substantially. This study examined how the public health burden of large truck crashes versus the risk per unit of travel has changed over 25 years. The present study focused on the US vehicle occupants in fatal crashes involving a large truck during 1975-1999. Occupant fatalities per 100,000 population, per 10,000 licensed drivers, per 10,000 registered trucks and per 100 million vehicle-miles of travel (VMT) were calculated to determine trends in occupant deaths in large truck crashes. In 1999, large truck crashes resulted in 3916 occupant deaths in passenger vehicles and 747 in large trucks. Passenger vehicle occupant deaths in large truck crashes per 100,000 population have increased somewhat since 1975 (1.28 in 1975 and 1.44 in 1999). There have been appreciable declines in occupant deaths per truck VMT since 1975, but the percentage reduction has been greater for occupants of large trucks (67%) than for passenger vehicle occupants (43%). However, truck drivers are at elevated risk of dying relative to their numbers in the workforce. Overall large truck involvements in fatal crashes per truck VMT decreased more than passenger vehicle involvements per passenger VMT (PVMT; 68% versus 33% decreases for single-vehicle crashes and 43% versus 23% for multiple-vehicle crashes).Large truck involvement in fatal crashes has dropped substantially when measured per unit of travel, but the public health burden of large truck crashes, as measured by deaths per 100,000 population, has not improved over time because of the large increase in truck mileage. Research is needed on measures to better protect both occupants of large trucks and passenger vehicle occupants colliding with them.
Analysis of traffic accidents at urban intersections in Riyadh.
Correspondence: Ali S. Al-Ghamdi, College of Engineering, King Saud University, P.O. Box 800, 11421, Riyadh, SAUDI ARABIA; (email: asghamdi@ksu.edu.sa).
Previous studies have shown that intersection-related accidents account for about 50% of all accidents registered annually in Riyadh, the capital of the Kingdom of Saudi Arabia (KSA). More than half of these accidents are classified as severe. In this study, an attempt was made to investigate traffic accidents that occurred at both intersections and non-intersection sites. The goal was to analyze the nature of such accidents to determine their characteristics so that remedies could be sought or at least future research could be suggested. For this purpose, a sample of 1774 reported accidents was collected in a systematic random manner for the period 1996-1998 (651 severe accidents (accidents resulting in at least one personal injury or fatality) and 1123 property-damage-only (PDO) accidents). Conditional probability and contingency table analyses were used to make inferences from the data. The study found that improper driving behavior is the primary cause of accidents at signalized urban intersections in Riyadh; running a red light and failing to yield are the primary contributing causes. The analysis indicates that there is an urgent need to review existing intersection geometry along with the traffic control devices installed at these sites. In addition, public education campaigns and law enforcement strategies are urgently needed.
Changes in collision rates among novice drivers during the first months of driving.
Mayhew DR, Simpson HM, Pak A. Accid Anal Prev 2003; 35(5): 683-691.
Correspondence: Daniel R. Mayhew, Traffic Injury Research Foundation, 171 Nepean Street, Suite 200, Ont., K2P OB4, Ottawa, CANADA; (email: danm@trafficinjuryresearch.com).
As a group, young drivers have crash rates that far exceed those of older, experienced drivers. But even among teenagers there are age-related differences; crash rates decline consistently and dramatically with each yearly increase in age. A more precise understanding of how crash rates decline within the teenage group might provide insights into when experience is most influential. To address this issue, this study examines month-to-month changes in collisions among new drivers. It was found that crash rates drop most dramatically during the first 6 months of driving. Involvement in certain types of crashes-e.g. run-off-the-road, single-vehicle, night, weekend-declines more rapidly. The findings suggest that novices improve their driving in a relatively short period of time. A graduated driver licensing system is identified as an effective method for ensuring that this development takes place in a more forgiving environment.
Mental workload while driving: effects on visual search, discrimination, and decision making.
The effects of mental workload on visual search and decision making were studied in real traffic conditions with 12 participants who drove an instrumented car. Mental workload was manipulated by having participants perform several mental tasks while driving. A simultaneous visual-detection and discrimination test was used as performance criteria. Mental tasks produced spatial gaze concentration and visual-detection impairment, although no tunnel vision occurred. According to ocular behavior analysis, this impairment was due to late detection and poor identification more than to response selection. Verbal acquisition tasks were innocuous compared with production tasks, and complex conversations, whether by phone or with a passenger, are dangerous for road safety.
Cell phone-induced failures of visual attention during simulated driving.
David L. Strayer, Department of Psychology, University of Utah, 380 South, 1530 East, Room 502, Salt Lake City, Utah 84112, USA; (email: david.strayer@utah.edu).
This research examined the effects of hands-free cell phone conversations on simulated driving. The authors found that these conversations impaired driver's reactions to vehicles braking in front of them. The authors assessed whether this impairment could be attributed to a withdrawal of attention from the visual scene, yielding a form of inattention blindness. Cell phone conversations impaired explicit recognition memory for roadside billboards. Eye-tracking data indicated that this was due to reduced attention to foveal information. This interpretation was bolstered by data showing that cell phone conversations impaired implicit perceptual memory for items presented at fixation. The data suggest that the impairment of driving performance produced by cell phone conversations is mediated, at least in part, by reduced attention to visual inputs.
Wireless telephones and the risk of road crashes.
Laberge-Nadeau C, Maag U, Bellavance F, Lapierre SD, Desjardins D, Messier S, Sai;di A. Accid Anal Prev 2003; 35(5): 649-660.
Correspondence: Claire Laberge-Nadeau, Department of Social and Preventive Medicine, Universite de Montreal, Montreal, CANADA; (email: claire@crt.umontreal.ca).
In light of the rapidly increasing development of the cell phone market, the use of such equipment while driving raises the question of whether it is associated with an increased accident risk; and if so, what is its magnitude. This research is an epidemiological study on two large cohorts, namely users and non-users of cell phones, with the objective of verifying whether an association exists between cell phone use and road crashes, separating those with injuries. The Societe de l'Assurance Automobile du Quebec (SAAQ) mailed a questionnaire and letter of consent to 175000 licence holders for passenger vehicles. The questionnaire asked about exposure to risk, driving habits, opinions about activities likely to be detrimental to driving and accidents within the last 24 months. For cell phone users, questions pertaining to the use of the telephone were added. We received 36078 completed questionnaires, with a signed letter of consent. Four wireless phone companies provided the files on cell phone activity, and the SAAQ the files for 4 years of drivers' records and police reports. The three data sources were merged using an anonymized identification number. The statistical methods include logistic-normal regression models to estimate the strength of the links between the explanatory variables and crashes. The relative risk of all accidents and of accidents with injuries is higher for users of cell phones than for non-users. The relative risks (RR) for injury collisions and also for all collisions is 38% higher for men and women cell phone users. These risks diminish to 1.1 for men and 1.2 for women if other variables, such as the kilometers driven and driving habits are incorporated into the models. Similar results hold for several sub-groups. The most significant finding is a dose-response relationship between the frequency of cell phone use, and crash risks. The adjusted relative risks for heavy users are at least two compared to those making minimal use of cell phones; the latter show similar collision rates as do the non-users.
Correspondence: Douglas J. Wiebe, Violence Prevention Research Group, UCLA School of Public Health, 650 C. E. Young Drive South, Box 951772, 90095-1772, Los Angeles, CA, USA; (email: dwiebe@cceb.med.upenn.edu).
This study used national data and a matched case-control design to estimate the relative risk of death by an unintentional gunshot associated with having firearms in the home. A sample of adults who died in the United States in 1993 from unintentional gunshot injuries was drawn from the National Mortality Followback Survey (NMFS) (n=84). Twenty controls were sought for each case from the 1994 National Health Interview Survey (NHIS) and matched to the cases by sex, age group, race, and region of residence (n=1451). Subjects were classified as having or not having guns in the home based interview responses. The relative risk of death by an unintentional gunshot injury, comparing subjects living in homes with and without guns, was 3.7 (95% confidence interval (CI)=1.9-7.2). Adjustment for covariates resulted in little change in the effect estimates. There was evidence of a dose-response effect: compared to subjects living in homes with no guns, the relative risk was 3.4 (95% CI=1.5-7.6) among subjects with one gun and 3.9 (95% CI=2.0-7.8) among subjects with multiple guns in the home. Having handguns in the home was associated with the largest effect estimates. Tests of homogeneity showed that the effect estimates did not vary significantly across categories of the matching variables. Firearms in the home appear to be a risk factor for unintentional gunshot fatality among adults. The magnitude of the observed effect estimates should be compared with those from additional studies.
This article discusses the factors that influence or induce domestic violence, and why men who experience domestic violence decline to report or admit to a problem within their relationships. It includes a case study of a man who experienced domestic violence from his wife. There is discussion about the management of the client and the lack of available resources to help with his treatment.
Exposure to partner violence and child behavior problems: a prospective study controlling for child physical abuse and neglect, child cognitive ability, socioeconomic status, and life stress.
Yates TM, Dodds MF, Sroufe LA, Egeland B. Dev Psychopathol 2003; 15(1): 199-218.
Correspondence: Tuppett M. Yates, University of Minnesota, Minneapolis, MN 55455, USA; (email: yate0019@umn.edu).
Previous research suggests an association between partner violence and child behavior problems. However, methodological shortcomings have precluded the formation of directional conclusions. These limitations include failure to control for the effects of child physical abuse and general life stress, employment of nonrepresentative samples from battered women's shelters, and reliance on a single contemporaneous reporter, usually the mother, for information on both independent and dependent measures. This study used prospective, longitudinal data (N = 155) and multiple informants to examine the relation between maternal reports of partner violence in the home and teacher - and youth-report ratings of concurrent and prospective child behavior problems. Hierarchical multiple regression analyses were used to control for the effects of child physical abuse, child physical neglect, socioeconomic status, child cognitive ability, and life stress. The contribution of partner violence to child behavior problems was confirmed for boys' (n = 81) externalizing problems and girls' (n = 74) internalizing problems. Child developmental status at the time of exposure further influenced these relations. For boys, behavior problems in middle childhood were most strongly related to contemporaneous partner violence, whereas behavior problems among both boys and girls at age 16 were most strongly related to partner violence exposure during the preschool years.
Developmental trajectories of boys' delinquent group membership and facilitation of violent behaviors during adolescence.
Lacourse E, Nagin D, Tremblay RE, Vitaro F, Claes M. Dev Psychopathol 2003; 15(1): 183-197.
Being part of a delinquent group has been shown to facilitate the expression of an individual's own delinquent propensities. However, this facilitation effect has not been investigated from a developmental perspective within a population heterogeneity model. Using a semiparametric mixture model with data from the Montreal Longitudinal Experimental Study, this article addresses important issues in the developmental trends of membership to delinquent groups. We explore how the rate of violent behaviors follows delinquent peer group trajectories and investigate a differential facilitation effect of delinquent peers on violence across multiple developmental pathways. Results suggest that 25% of males followed a childhood or an adolescence delinquent group affiliation trajectory. These two groups account far most of the violent acts assessed during adolescence. In addition, the rate of violent behaviors follows these developmental trajectories. Controlling for these delinquent group trajectories, we also found that being involved in a delinquent group at any specific time during adolescence is associated with an increased rate of violent behaviors, and that leaving these groups results in a decrease in violent behaviors. This facilitation effect appears homogeneous over time and across developmental trajectories. Results are discussed from a social interactional perspective.
Children under fire: challenging assumptions about children's resilience.
Correspondence: Jo Boyden, Refugee Studies Centre, Queen Elizabeth House, University of Oxford, 21 St Giles, Oxford OX1 3LA, UK; (email: jo.boyden@qeh.ox.ac.uk).
This article examines perceptions of childhood and child development and theories of human responses to adversity that have arisen within the social and medical sciences and highlights their influence on policy and practice in the context of armed conflict. It highlights how the idea of childhood as a decontextualized and universal life phase characterized by dependence and vulnerability interacts with and is reinforced by a view of war-survivors as traumatized individuals, victims in need of remedial care. It argues for a paradigmatic shift towards understanding childhood as a highly diverse life phase shaped not simply by biological or psychological universals but also, and more importantly, by personal and environmental factors. This paradigmatic shift involves thinking about children as agents of their own development who, even during times of great adversity, consciously act upon and influence the environments in which they live.
