OBJECTIVE: To examine the relationship of acute alcohol consumption with an injury compared to a non-injury event in the emergency room across ERs in five countries.
DESIGN: Meta-analysis was used to evaluate the consistency and magnitude of the association of a positive blood alcohol concentration (BAC) at the time of arrival in the ER and self-reported consumption within 6 hours prior to the event with admission to the ER for an injury compared to a non-injury, and the extent to which contextual (socio-cultural and organizational) variables explain effect sizes.
FINDINGS: When controlling for age, gender and drinking five or more drinks on an occasion at least monthly, pooled effect size was significant and of a similar magnitude for both BAC and self-reported consumption, with those positive on either measure over half as likely again to be admitted to the ER with an injury compared to a medical problem. Effect sizes were found to be homogeneous across ERs for BAC, but not for self-report. Trauma center status and legal level of intoxication were positively predictive of self-reported consumption effect size on injury.
DISCUSSION: These data suggest a moderate, but robust association of a positive BAC and self-report with admission to the ER with an injury, and that contextual variables also appear to play a role in the alcohol-injury nexus.
Communicating worst-case scenarios: neighbors' views of industrial accident management.
- Johnson BB, Chess C. Risk Anal 2003; 23(4): 829-840.
Correspondence: Branden B. Johnson, Bureau of Risk Analysis, Division of Science, Research and Technology, New Jersey Department of Environmental Protection, P.O. Box 409, Trenton, NJ 08625-0409, USA; (Branden.Johnson@dep.state.nj.us).
The prospect of industrial accidents motivated the U.S. Congress to require in the Clean Air Act of 1990 that manufacturing facilities develop Risk Management Plans (RMP) to submit to the U.S. Environmental Protection Agency (USEPA) by July 1999. Industry worried that the requirement to communicate to the public a "worst-case scenario" would arouse unnecessary and counterproductive fears among industry neighbors. We report here the results of focus groups and surveys with such neighbors, focusing particularly upon their reactions to messages about a hypothetical worst-case scenario and management of these risks by industry, government, and other parties. Our findings confirmed our hypotheses that citizens would be skeptical of the competence and trustworthiness of these managers and that this stance would color their views of industrial-facility accident risks. People with job ties to industry or who saw industrial benefits to the community as exceeding its risks had more positive views of industrial risks, but still expressed great concern about the risk and doubt about accident management. Notwithstanding these reactions, overall respondents welcomed this and other related information, which they wanted their local industries to supply. Respondents were not more reassured by additional text describing management of accidents by government and industry. However, respondents did react very positively to the concept of community oversight to review plant safety. Claims about the firm's moral obligation or financial self-interest in preventing accidents were also received positively. Further research on innovative communication and management of accident risks is warranted by these results, even before recent terrorist attacks made this topic more salient.
Hospitals and disasters: how they fared; what they learned.
Although having a comprehensive disaster plan in place and augmenting it with regular drills is essential in preparing for an emergency, unforeseen challenges inevitably arise when a disaster occurs. In this article, hospital officials who have experienced such emergencies share the lessons they learned from an actual event.
Electric water heaters: a new hazard for pediatric burns.
- Chuang SS, Yang JY, Tsai FC. Burns 2003; 29(6): 589-591.
Correspondence: Shiow-Shuh Chuang, Department of Plastic and Reconstructive Surgery, Burn Center, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kwei-Shan, 333, ROC, Taoyuan, TAIWAN; (email: sschuang@ms1.hinet.net).
The electric water heater has recently become a popular household appliance replacing the hot water dispensing jug. This device provides hot water and potable cool water directly from the faucets thus removing the need to refill the container or boil water separately in a kettle. Along with the convenience of dispensing hot water immediately has come an increased incidence of pediatric burns. This paper presents a 6-year retrospective study of such pediatric scald burns from 1996 to 2001. Computer database records revealed that the incidence of pediatric scald burns caused by the electric water heater during the past 6 years was 6.4% (66/1028). The age of victims ranged 0-6 years (mean 1.5+/-1.1 years), most of the victims were in the 1-2-year-old group. In most common cases burn location was the trunk. The accidents often occurred during the cold months and in the living room of the house. From this retrospective study, it was seen that the etiology and incidence of scald burns among children have changed as people have modified their household practice for obtaining hot water in our country. This study aims to increase public awareness to the problem and suggest some prevention measures to reduce this type of scald injury.
European Action on Injury: A comprehensive set of proposals for collaborative actions on injury monitoring and safety promotion in the EU (including other countries in the region in the framework of their agreements with the EU)
- European Injury Prevention Network. Vienna, AUSTRIA: Austrian Institute for Home and Leisure Safety (2003)
This report is a comprehensive set of proposals for collaborative actions on injury monitoring and safety promotion in the European Union and associated countries.
A Guide to Child Safety Regulations and Standards in Europe.
- European Consumer Safety Association. Amsterdam, THE NETHERLANDS: European Child Safety Alliance (2003).
This guide describes the role of regulation in child accident prevention in today's Europe. The different aspects of the regulatory process are examined and a state of the art review of existing standards and regulations is presented.
Correspondence: Hongwei, Hsiao, Division of Safety Research National Institute for Occupational Safety and Health, Morgantown, West Virginia USA; (email: unavailable).
Full-body fall-protection harnesses have been a critical work-practice control technology for reducing the number of fall-related injuries and fatalities among construction workers; yet, very little is known about the fit of these harnesses to the population that wears them. This study evaluated the fit and sizing efficacy of a harness system. Seventy-two male and 26 female construction workers participated in the study. Their body size-and-shape information was measured while they were suspended (with a harness) and standing (with and without a harness), using a 3-D full-body laser scanner and traditional anthropometric calipers. Fisher's discriminant analysis results did not point to the need for a change in the current sizing selection scheme by body height and weight for end users. However, an integrated redesign of harness components is needed because 40% of subjects did not pass fit-performance criteria in either the standing or suspended condition. A multivariate accommodation analysis has identified 15 representative body models for the 'standard-size' harness design. These models can serve as a useful population to test harness design until a larger survey of the nation's construction workers can be done. Finally, further developments in 3-D shape quantification methods are recommended to improve the harness design process; the point-to-point anthropometric information currently used seems to be insufficient for harness design.
Occupational injuries in Oslo: a study of occupational injuries treated by the Oslo Emergency Ward and Oslo Ambulance Service.
Background: There is little reliable information about the incidence and severity of occupational injuries in Norway.
Methods: Occupational injuries occurring at worksites in Oslo and treated by Oslo Emergency Ward or Oslo Ambulance Service were recorded over a period of three months. Patients with serious injuries were interviewed about the accident.
Findings: 1153 injury incidents were registered, 229 (20 %) of which were considered serious. Median age of patients was 32 years. Estimated annual incidence of injuries at worksites in Oslo treated by Oslo Emergency Ward/Oslo Ambulance Service was 14 per 1000 employees, for all injuries in Oslo requiring treatment, 20 per 1000 employees. Men had three times the incidence of women. The incidence was highest in the youngest age groups. Of those with serious injuries, 30 % had a non-Scandinavian language as their first language. Electricians, carpenters and police officers had the highest observed incidences. 87 injuries (8 %) were caused by violence.
Discussion: The incidence of occupational injuries in Oslo is reduced by about 40 % since the 1970s. There is, however, no reduction for women. Construction workers are still at high risk. Workers of non-Scandinavian origin are also at high risk, probably because of selection into high-risk occupations. The injury register provides a good overview, but in-depth studies are needed to identify specific risk factors.
Underreporting of occupational injuries to the Labour Inspection.
Background: The Labour Inspection investigates occupational accidents and publishes injury statistics annually. Information is based upon two main sources: Copies of reports to the National Insurance Service and mandatory reports from employers to the Labour Inspection.
Methods: Occupational injuries treated by Oslo Emergency Ward and Oslo Ambulance Service during a period of three months were compared with injuries recorded by the Labour Inspection.
Findings: Four months after the end of the study period, the Labour Inspection had received reports from the National Insurance Service on 150 (13 %) of the 1,153 injuries recorded by Oslo Emergency Ward/Oslo Ambulance Service. Among all injuries registered, 208 were serious according to the criteria of the Labour Inspection. Only 19 (9 %) of these were reported directly to the Labour Inspection from employers in accordance with the legal requirement. The study recorded 17 serious injuries caused by violence affecting employees; none of these were reported directly to the Labour Inspection.
Discussion: Data on occupational injuries collected by the Labour Inspection are far from complete. In Oslo alone, the Labour Inspection may annually overlook some 900 - 1,000 serious injuries. Data quality can be improved and delayed reporting avoided by using information from doctors and medical institutions that provide treatment.
Worker substance use, workplace problems and the risk of occupational injury: a matched case-control study.
- Spicer RS, Miller TR, Smith GS. J Stud Alcohol 2003; 64(4): 570-578.
Correspondence: Rebecca Spicer, Pacific Institute for Research and Evaluation, Calverton, Maryland, USA; (email: spicer@pire.org).
OBJECTIVE: This study examines the tendency toward problem behavior as an explanation for the relationship between problem substance use and occupational injury.
METHOD: The authors used a matched case-control study nested in a cohort of 26,413 workers, in which cases (n = 3,994) were workers suffering an occupational injury. Five controls per case (n = 19,970) were selected from the cohort of workers active on the day of the injury and matched on job type. Conditional logistic regression modeled the association of problem substance use with occupational injury, controlling for problem behaviors and worker characteristics. Problem substance use was indicated indirectly if any of the following were alcohol/drug-involved during the comparison period: Employee Assistance Program visit, excused absence or disciplinary action. Discipline records identified minor (absenteeism) and serious (dishonesty, theft, assault, harassment, disrespect) problem behaviors during the comparison period.
FINDINGS: The odds of injury among workers with an indicator of problem substance use was 1.35 (p = .015) times greater than the odds among workers without an indicator, controlling for job type and demographics as well as adjusting for exposure. This ratio declined to 1.21 (p = .138) when problem behaviors were also controlled for. Minor and serious problem behaviors were significantly associated with occupational injury (odds ratio [OR] = 1.73, p < .001, and OR = 2.19, p < .001, respectively), controlling for demographics and substance use.
DISCUSSION: The relationship of problem substance use with occupational injury was weak when problem behaviors were controlled for, suggesting that this relationship, observed in previous studies, may be explained by a workers tendency toward problem behaviors. Workplace injury prevention programs should address the expression of problem behaviors as a complement to drug and alcohol deterrent programs.
Temporal factors and the prevalence of transient exposures at the time of an occupational traumatic hand injury.
- Lombardi DA, Sorock GS, Hauser R, Nasca PC, Eisen EA, Herrick RF, Mittleman MA. J Occup Environ Med 2003; 45(8): 832-840.
Correspondence: David A. Lombardi, Liberty Mutual Research Center for Safety and Health, Hopkinton, Massachusetts 01748, USA; (email: david.lombardi@libertymutual.com).
Temporal factors and the prevalence of exposure to transient risk factors for occupational traumatic hand injury were analyzed among 1166 subjects participating in a case-crossover study. Temporal factors included time of injury and elapsed time to injury since the start of the work shift. Transient exposures included work equipment, work practice, and worker-related factors. The highest frequency of injury was observed from 08:00 am to 12:00 pm (54.6%), with a peak from 10:00 to 11:00 am (14.9%). The median time into the work shift for injury was 3.5 hours. Subjects injured 2 to 3 hours into their work shift most often reported using a machine, tool, or work material that performed differently than usual (23.9%). These results suggest that acute hand injuries occur earlier in the workday and safety programs should place increased vigilance on these times.
Correspondence: Lucie Laflamme, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, SE-17176 Stockholm, SWEDEN; (email: Lucie.laflamme@smd.sll.se).
OBJECTIVES: To assess the impact of a community based bicycle helmet programme aimed at children aged 5-12 years (about 140 000) from poor and well off municipalities.
METHODS: A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle related head injuries leading to hospitalisation were measured, using rates ratios.
FINDINGS: Reductions in bicycle related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR= 0.45 95%CI 0.26 to 0.78) as among those from richer municipalities (RR=0.55 95%CI 0.41 to 0.75).
DISCUSSION: Population based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours.
- Romaine LJ, Davis SE, Casebolt K, Harrison KA. J Strength Cond Res 2003; 17(3): 580-586.
Correspondence: Linda J. Romaine, Department of Movement Studies and Exercise Science, East Stroudsburg University of Pennsylvania, East Stroudsburg, Pennsylvania 18301, USA; (email: unavailable).
Cardio kickboxing classes have become a popular form of exercise to enhance fitness. This study surveyed kickboxing participants and instructors to ascertain the severity, type, and incidence of injuries sustained while performing cardio kickboxing exercise. The respondents consisted of 77.4% instructors and 29.3% participants with a mean age of 32.29 years (+/-8.98 years). Injury from kickboxing exercise was reported by 29.3% of the respondents, 31% of the instructors, and 15.5% of the participants. The most common site of injury for instructors was the back, followed by the knee, hip, and shoulder. The most common site of injury for participants was the back, knee, and ankle. Strains were the most common type of injury reported, followed by sprains and tendinitis. More than half of the injuries reported were new injuries (64%), with almost 59% of the total injuries reported causing a disruption of the normal exercise routine or an alteration of normal daily activities. Instructors who reported using music speeds greater than 140 beats per minute had a higher incidence of injury, compared with instructors who used music between 125 and 139 beats per minute. The wrist and elbow had the highest percentage of new injuries reported. This study suggests that kickboxing exercise can be a safe form of exercise for fitness purposes. Keeping music speeds below 140 beats per minute and limiting the number of kickboxing sessions per week may help to reduce injury rates.
Catastrophic Spine Injuries in American Football, 1977-2001.
Correspondence: Frederick O. Mueller, National Center for Catastrophic Sports Injury Research, University of North Carolina, Chapel Hill, North Carolina, USA; (email: mueller@email.unc.edu).
OBJECTIVE: Cervical spinal cord injuries have been the most common catastrophic football injury and the second leading direct cause of death attributable to football skills. This study looks at the 25-year (1977-2001) experience with catastrophic neck injuries and examines not only the incidence but also the cause of injury and variables that have either increased or decreased these injuries.
METHODS: Data were collected on a national level from all organized football programs, including public school, college, professional, and youth programs, through personal contact and questionnaires on each catastrophic football injury. Funded by the National Collegiate Athletic Association, the National Federation of State High School Associations, and the American Football Coaches Association, data were collected by the National Center for Catastrophic Sports Injury Research, University of North Carolina at Chapel Hill (Frederick O. Mueller, Director, and Robert C. Cantu, Medical Director).
FINDINGS: Teaching the fundamental techniques of the game, equipment standards, and improved medical care both on and off the playing field have led to a 270% reduction in permanent spinal cord injury from a peak of 20 per year during the period 1971 to 1975 to 7.2 per year during the past 10 years.
DISCUSSION: The type of injury, activity at the time of injury, level of play, and whether the injury was incurred in a game or practice are presented. On the basis of the data, recommendations are given for reducing catastrophic cervical spine injury in football.
Knowledge and practices regarding injury care among stone quartz workers.
- Tiwari RR, Narayan R, Saiyed HN. Am J Ind Med 2003; 44(3): 300-302.
Correspondence: Rajnarayan R. Tiwari, Occupational Medicine Division, National Institute of Occupational Health, Meghani Nagar, Ahmedabad - 380016, Gujarat, INDIA; (email: unavailable).
(Copyright 2003 Wiley-Liss, Inc.)
The present study designed as cross sectional study was carried out to study the knowledge and practice regarding injury care among stone quartz workers of Chhotaudepur. A total of 137 stone quartz workers were included in the study, which consisted of 54.7% males and 45.3% females. 85.4% of the workers were illiterate and almost all the workers belonged to lower socio-economic strata according to the Modified Kuppuswamy's socio-economic scale. Majority of the subjects (56.2%) responded that they would consult doctor if they get injured while 32.2% responded that they would neglect the wound, as it will heal spontaneously. Thus the present study suggests that the knowledge regarding injury care among stone quartz workers was poor. Even the attitude and practice regarding injury care was also inappropriate.
The goals of the present study were to examine (a) whether battered women in a sample of both shelter and nonshelter women are sustaining brain injuries from their partners and (b) if so, whether such brain injuries are associated with partner abuse severity, cognitive functioning, or psychopathology. Ninety-nine battered women were assessed using neuropsychological, psychopathology, and abuse history measures. Almost three quarters of the sample sustained at least 1 partner-related brain injury and half sustained multiple partner-related brain injuries. Further, in a subset of women (n = 57), brain injury severity was negatively associated with measures of memory, learning, and cognitive flexibility and was positively associated with partner abuse severity, general distress, anhedonic depression, worry, anxious arousal, and posttraumatic stress disorder symptomatology.
Association between childhood community safety interventions and hospital injury records: a multilevel study.
- Sellstrom E, Guldbrandsson K, Bremberg S, Hjern A, Arnoldsson G. J Epidemiol Community Health 2003; 57(9): 724-729.
Correspondence: Eva Sellstrom, MidSweden University, Department of Nursing and Health Sciences, SE-831 25 Ostersund, SWEDEN; (email: eva.sellstrom@mh.se).
STUDY OBJECTIVE: To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome.
DESIGN: A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics-that is, population density and municipal safety measures-were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression.
SETTING: Twenty five municipalities in Stockholm County in Sweden were studied.
PARTICIPANTS: Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years.
FINDINGS: Municipality injury rates varied between 3.84-7.69 per 1000 person years among 1-6 year olds and, between 0.86-6.18 among 7-15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children.
DISCUSSION: This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.
CONTEXT: About one million accidents occur yearly in Finland (population 5.2 million), resulting in over 3,000 deaths, annually. The governmental and municipal authorities are responsible for the healthcare services that respond to these accidents. So far, resources for these services have been allocated according to regional equality, or in some cases, on the basis of population numbers. However, economical and effective resource allocation should be based on detailed risk analysis of the accidents.
HYPOTHESIS: In areas with more dense populations, the level of social activity is greater, which leads to an increased risk for accidents (traffic, civil disturbance, etc.).
METHODS: The number of accidents was estimated on the basis of registered emergency trauma patients using the Finnish healthcare statistics for the year 1999. The emergency visits were compared to the populations and populations' densities of the regional sub-units. The rate of emergency injuries was analysed by regression analysis according to varying population density in Finland.
FINDINGS: The number of accidents per inhabitants was related directly to population density. There was a correlation between emergency visits per inhabitant and population density (p < 0.0001). According to estimates, each 1% increase in population density is associated with a 0.4% increase in the risk of accidents.
DISCUSSION: The relationship between population density and rate of emergency visits is decisive for the planning of emergency services. Services should be placed in areas of high population densities where there are more people with greater risk of accidents.
Incidence and costs of unintentional falls in older people in the United Kingdom.
Correspondence: P. Scuffham, York Health Economics Consortium Ltd, Level 2, Market Square, University of York, Heslington, York YO10 5NH, UK; (email: pas8@york.ac.uk).
STUDY OBJECTIVE: To estimate the number of accident and emergency (A&E) attendances, admissions to hospital, and the associated costs as a result of unintentional falls in older people.
DESIGN: Analysis of national databases for cost of illness.
SETTING: United Kingdom, 1999, cost to the National Health Service (NHS) and Personal Social Services (PSS).
PARTICIPANTS: Four age groups of people 60 years and over (60-64, 65-69, 70-74, and >/=75) attending an A&E department or admitted to hospital after an unintentional fall. Databases analysed were the Home Accident Surveillance System (HASS) and Leisure Accident Surveillance System (LASS), and Hospital Episode Statistics (HES).
FINDINGS: There were 647 721 A&E attendances and 204 424 admissions to hospital for fall related injuries in people aged 60 years and over. For the four age groups A&E attendance rates per 10 000 population were 273.5, 287.3, 367.9, and 945.3, and hospital admission rates per 10 000 population were 34.5, 52.0, 91.9, and 368.6. The cost per 10 000 population was pound 300 000 in the 60-64 age group, increasing to pound 1 500 000 in the >/=75 age group. These falls cost the UK government pound 981 million, of which the NHS incurred 59.2%. Most of the costs (66%) were attributable to falls in those aged >/=75 years. The major cost driver was inpatient admissions, accounting for 49.4% of total cost of falls. Long term care costs were the second highest, accounting for 41%, primarily in those aged >/=75 years.
DISCUSSION: Unintentional falls impose a substantial burden on health and social services.
National Ambulatory Medical Care Survey: 2001 summary.
- Cherry DK, Burt CW, Woodwell DA. Adv Data 2003; (337): 1-44.
Correspondence: Donald K. Cherry, U.S. Department of Health and Human Services, National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD, 20782, USA; (email: unavailable).
OBJECTIVE: This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. Results highlighting new items on continuity of care are presented. They include whether the visit was the first or a followup for a problem, number of visits to this provider in the past 12 months for established patients, and whether other physicians shared care for the patient's problem. The report also highlights estimates of practice characteristics for office-based physicians.
METHODS: The data presented in this report were collected from the 2001 National Ambulatory Medical Care Survey (NAMCS). NAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization by various types of providers. NAMCS is a national probability sample survey of visits to office-based physicians in the United States. Sample data are weighted to produce annual national estimates. Selected trends from the 1992 and 1997 NAMCS are also presented.
FINDINGS: During 2001, an estimated 880.5 million visits were made to physician offices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2001, the visit rate for persons 45 years of age and over increased by 17%, from 407.3 to 478.2 visits per 100 persons. The mean age of patients at each office visit has steadily increased from 1992 through 2001 as has the mean number of diagnoses rendered and the overall drug mention rate. The visit rate to physician offices in metropolitan statistical areas (MSAs) (338.3 visits per 100 persons) was significantly larger than the rate in non-MSAs (218.0 visits per 100 persons). Females had a higher visit rate compared with males, and white persons had a higher rate than black or African-American persons. Half of all office visits were to the patient's primary care physician (PCP). Of the visits to physicians other than the patient's PCP, about one-third (32.6 percent) were referrals. About 1 in 10 office visits were made by new patients (11.8 percent), down 20% since 1992. More than one physician shared the care for the patient's condition at about one-fifth of the office visits. Of all visits made to offices in 2001, 58.8 percent listed private insurance as the primary expected source of payment, followed by Medicare (21.8 percent) and Medicaid and/or State Children's Health Insurance Program (7.2 percent). For preventive care visits, the female visit rate was over 75% higher than the rate for males (67.1 versus 37.7 visits per 100 persons). Essential hypertension, arthropathies, acute upper respiratory infection, and diabetes mellitus were the leading illness-related primary diagnoses. There were an estimated 99.8 million injury-related visits in 2001, or 35.6 visits per 100 persons. Diagnostic and screening services were ordered or provided at 82.8 percent of visits, therapeutic and preventive services were ordered or provided at 41.4 percent of visits, and medications were prescribed or provided at 61.9 percent of visits. On average, 2.4 medications were ordered or provided at each office visit with any mention of a medication. The leading therapeutic class for drugs mentioned at office visits included cardiovascular-renal drugs (14.7 percent of mentions) and pain-relieving drugs (12.1 percent of mentions). A physician was seen at a majority of visits (95.8 percent), and a registered or licensed practical nurse was seen at 31.3 percent of visits. From 1992 through 2001, changes were observed in the leading diagnoses, therapeutic drug classes, and drug mentions. Physician estimates revealed that primary care physicians were twice as likely as specialists to make home visits during an average week of work; when they conducted them, they made twice as many (6 versus 2-3 visits per week) as specialists. Approximately 3 in 10 physicians reported not accepting new capitated, privately insured patients, whereas only 6.8 percent did not accept noncapitated, privately insured patients.
Adult burn injuries in an Emergency Department in Central Anatolia, Turkey: a 5-year analysis.
- Avsarogullari L, Sozuer E, Ikizceli I, Kekec Z, Yurumez Y, Ozkan S. Burns 2003; 29(6): 571-577.
Correspondence: Levent Avaroullar, Department of Emergency Medicine, Medical School of Erciyes University, Kayseri, TURKEY; (email: lavsar@erciyes.edu.tr).
OBJECTIVE: Burn injuries require a multidisciplinary approach. Emergency Departments can play vital roles in the treatment of burns. The purpose of this study is to investigate the epidemiological and clinical characteristics of the adult burn patients admitted to our Emergency Department and to determine the frequency of the patients who were treated on an outpatient basis and discharged from the Emergency Department.
PROCEDURE: A retrospective review of 314 adult burn patients who presented to the Emergency Medicine Department of Erciyes University Hospital from January 1996 to December 2000.
RESULTS: Sixty-four percent of the patients were male. Mean age was 32.9+/-14.7. Ninety-nine patients (32%) had moderate to major burns. The highest numbers of patients were in the 21-30 age group. Flame burns comprised the majority of presentations and admissions (48 and 69%, respectively). Thirteen patients had associated injuries (4%). Eighty-seven patients (28%) were hospitalized, 21 of these died. Death occurred mostly from respiratory failure and sepsis. Domestic accidents were the leading mechanism (63%).
DISCUSSION: Burns were mostly due to accidents arising from carelessness, ignorance, hazardous traditions and improperly manufactured products. These can be prevented through mass education programs countrywide. Because almost all burn patients present to Emergency Departments first and not all hospitals can employ burn specialists, the patients with minor burns can be treated on an outpatient basis and the treatment of severe burns can be effectively initiated by emergency physicians.
Epidemiology of burns presenting to an emergency department in Shiraz, South Iran.
- Ansari-Lari M, Askarian M. Burns 2003; 29(6): 579-581.
Correspondence: Maryam Ansari-Lari, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IRAN; (email: askariam@sums.ac.ir).
A retrospective study of 1493 burn patients attending the Ghotbeddin emergency burn center in Shiraz, South Iran during the 1 year period 2001-2002 was undertaken in order to describe the epidemiological features of burns in Shiraz. The following results were obtained: the mean age of attendees was 21.84+/-19.05 with an overall male to female ratio of 1.12. 41.2% of patients were children under 15 years with a M/F ratio of 1.36. The main causes of burns were scalds (53%) followed by flame (25%). The frequency of scalds was much higher among children (70%). The majority of accidents (81%) occurred at home, 5.2% occurred in workplace and domestic accidents were more frequent among women. The mean total body surface area (TBSA) burned was 7.4+/-14.3%. Extensive TBSA had a significant association with flame burns and sex, showing that female patients have higher risk for more extensive burns. Finally, there was a significant seasonal variation for burns, with most burns occurring in winter months.
Epidemiology of hospitalized burns patients in Taiwan.
- Chien WC, Pai L, Lin CC, Chen HC. Burns 2003; 29(6): 582-588.
Correspondence: Wu-Chien Chien, Graduate Institute of Life Sciences, National Defense Medical Center, National Defense University, ROC, Taipei, TAIWAN; (email: lupai@ndmctsgh.edu.tw).
Previous studies based on either single hospital data or sampling of specific groups of hospitalized burns victims in Taiwan have provided only minimal epidemiological information. The study is designed to provide additional data on the epidemiology of hospitalized burns patients in Taiwan. Data were obtained from the Burn Injury Information System (BIIS), which brings together information supplied by 34 contracted hospitals. The study time course spanned a 2-year period from July 1997 to June 1999. Patient characteristics (age, sex, education level, etc.), causes and severity of injuries, and medical care measures were explored. A total of 4741 patients were registered with BIIS over the study period. The majority of hospitalized patients (67%) were male. The age distribution of burns patients showed peaks occurring at the age groups of 0-5 and 35-44 years. Over the time course of a day, burn injuries occurred more frequently from 10:00 to 12:00h and 16:00 to 18:00h. Injuries suspected as the result of suicide, homicide or child abuse accounted for 4.8% of hospitalized cases. More than 48% of the burns occurred in the home. The leading type of burn injury was scalding, followed by naked flame, explosion, electrical burns, and chemical burns due to caustic or corrosive substances. The mean percent total body surface area (%TBSA) for adults was 19%, and for young children was 12%. The average length of hospital stay was 18 days. In conclusion, children under 5 years and adults between 35 and 44 years of age are two high-risk groups for burn injuries. Corresponding to meal preparation time, hot substances such as boiling water, hot soup, etc. are the most common agents responsible for scalds. Prevention programs for reducing the risk of burn injuries during cooking and eating are required, especially for parents with young children.
Risk factors for falls among Iowa farmers: A case-control study nested in the Agricultural Health Study.
- Sprince NL, Zwerling C, Lynch CF, Whitten PS, Thu K, Gillette PP, Burmeister LF, Alavanja MC. Am J Ind Med 2003; 44(3): 265-272.
Correspondence: Nancy L. Sprince, Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA; (email: nancy-sprince@uiowa.edu).
(Copyright 2003 Wiley-Liss, Inc.)
CONTEXT: Farmers are at increased risk for fall-related injury compared with other occupations. Little is known about risk factors for non-fatal falls on the farm. This case-control study, nested within the Agricultural Health Study, aimed to assess risk factors for work-related falls among Iowa farmers.
METHODS: A screener questionnaire sent to 6,999 farmers in 1998 identified 79 farmers who reported a fall-related farm injury that required medical advice or treatment in the previous year. Multivariable logistic regression analysis was used to assess several possible risk factors for injury among these farmers compared with 473 farmers with no injury in the previous year.
FINDINGS: There were significant associations between fall-related farm injury and age between 40 and 64 years (OR = 2.21; 95% CI = 1.20-4.07), doctor-diagnosed arthritis/rheumatism (OR = 2.05; 95% CI = 1.11-3.79), difficulty hearing normal conversation (even with a hearing aid, in the case of those who used one) (OR = 1.82; 95% CI = 1.07-3.08), and taking medications regularly (OR = 1.80; 95% CI = 1.02-3.18).
DISCUSSION: Aging and health impairments, such as arthritis and hearing difficulties, are risk factors for which accommodations and preventive strategies can be devised to prevent fall-related injuries on the farm.
Agricultural injury in California migrant Hispanic farm workers.
- McCurdy SA, Samuels SJ, Carroll DJ, Beaumont JJ, Morrin LA. Am J Ind Med 2003; 44(3): 225-235.
Correspondence: Stephen A. McCurdy, Department of Epidemiology and Preventive Medicine, University of California, Davis, One Shields Ave., Davis, California, USA; (email: samccurdy@ucdavis.edu).
(Copyright 2003 Wiley-Liss, Inc.)
CONTEXT: Agriculture is among the most hazardous industries in the United States.
METHODS: A longitudinal study of injury among migrant Hispanic farm workers residing in six Northern California Migrant Family Housing Centers (MHCs) during the 1997 harvest season was conducted. Participants completed an initial interviewer-administered work-and-health questionnaire at the beginning of the harvest season addressing the preceding year; there were three periodic follow-up surveys.
FINDINGS: There were 1,201 adult farm workers (participation 85.2%) who completed the initial questionnaire. Of these, 837 (69.7%) completed the final follow-up survey. There were 86 agricultural injuries (incidence 9.3/100 full-time equivalent employees (FTEs), 95% CI 7.5-11.5/100 FTE). Increased risk for agricultural injury occurred among women paid piece-rate (RR 4.9, 95% CI 1.8-12.8). Sprains and strains were most common (31%), followed by lacerations (12%).
DISCUSSION: Agricultural injury experience in this cohort is comparable to that of agricultural workers in other U.S. settings. Increased risk among women paid piece-rate suggests further study and potential policy changes regarding payment regimens. Heterogeneity of injury in this population presents a major prevention challenge. In view of high frequency of strain and sprain injuries, ergonomic interventions deserve further study.
A report on the nature and incidence of accidents and zoonoses to children under sixteen years on farms and in the countryside.
A literature review of the nature and incidence of accidents and zoonoses affecting children as farm residents and also users of the countryside.
- Jones LM. Institute of Rural Health. Norwich, UK: Her Majesty's Stationery Office (2003).
This research report presents the findings from a quantitative and qualitative study conducted prospectively by collecting data over a sixteen month period through established primary care networks. General practitioners were selected from defined areas of the country in England and Wales to collect data on farm accidents and zoonoses seen in children under the age of sixteen years in primary care. The data was gathered and analysed to identify on the nature and numbers of accidents and illness occurring in children, under sixteen years of age, emanating from the use of the countryside and the agricultural industry. The report presents a typology of high risk situations for childhood accidents and zoonoses connected with the countryside and agriculture seeking to locate the findings within the present body of knowledge by reviewing available literature.
Discussion of the changing demography in the farming industry and the financial crisis presently affecting farming is pursued as it relates to the collection of data for this project. The belief that increased car ownership and the changes to out of hours services in primary care in recent times is also explored.
Recommendations are formulated for better information, education, suitable childcare, better engineering practices and a review of existing legislation. This report and the work it describes were funded by the Health and Safety Executive (HSE). Its
contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.
BACKGROUND: Abrupt changes in the alcohol consumption level and the suicide rate associated with the anti-alcohol campaign of 1985-1991 and the market reforms of 1992.
METHODS: Epidemiological investigation of total Russian suicide rate and per capita alcohol consumption utilizing the Box-Jenkins technique and regression analysis.
FINDINGS: The decrease of per capita consumption from 14.2 to 10.5 l in 1985-1987 and the growth of this index after 1987 (14.6 l in 1994) saw a respective decline and increase of suicides per litre of alcohol: eight males and one female per 100,000 of the corresponding population (13 or 6% of male or female suicides and 12% total suicides). The maximum suicide rate was reached in 1994 (41.8 per 100,000 population, in 1981-1994 r=0.91). In 1984-1986 and 1991-1994 the distribution of suicides' age was close to that of the age distribution from fatal alcohol poisoning. Changes in the level of BAC-positive suicides are closely correlated with changes in the alcohol consumption level (r=0.98), whereas changes in the number of BAC-negative suicides were not related to changes in consumption.
DISCUSSION: Alcohol consumption level plays a considerable role in the suicide rate, especially for male suicides. The rate of alcohol-related suicides is very high in Russia, owing to the very high alcohol consumption rate in the country.
A comparison of life events between suicidal adolescents with major depression and borderline personality disorder.
- Horesh N, Sever J, Apter A. Compr Psychiatry 2003; 44(4): 277-283.
Correspondence: Netta Horesh, Clinical Division, Department of Psychology, Bar-Ilan University, Ramat-Gan;, ISRAEL; (email: unavailable).
The current study compared the correlations of different types of stressful life events (SLE) between suicidal adolescents with major depressive disorder (MDD) and suicidal adolescents with borderline personality disorder (BPD). Both groups were referred following an attempted suicide. Twenty adolescents with MDD and 20 adolescents with BPD who were consecutively referred to an outpatient clinic following a suicide attempt were evaluated. A community control group of adolescents with no lifetime history of suicidal behavior was also assessed. The following measurements were employed: the Suicide Risk Scale (SRS) Beck Depression Inventory (BDI), the Life Events Checklist (LEC), and the Childhood Sexual Abuse Questionnaire (CSEQ). Both groups of suicidal subjects reported more SLE in general and more physical abuse than community controls in the 12 months before the suicide attempt. The MDD adolescents had more lifetime death-related SLE than the BPD and control groups, while the BPD adolescents reported more lifetime sex abuse-related SLE than the other two groups. Thus, suicidal behavior in general may be related to the amount of SLE. However, different disease-specific life events may precipitate suicide attempts in adolescents with MDD and BPD.
Risk factors for suicide and medically serious suicide attempts among alcoholics: analyses of Canterbury Suicide Project data.
Correspondence: Kenneth R. Conner, Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, New York 14642, USA; (email: Kenneth_conner@urmc.rochester.edu).
OBJECTIVE: Alcohol dependence is a potent risk factor for completed suicide and medically serious attempts, but data are limited on factors that distinguish risk within this high-risk population. The purpose of this study is to identify risk factors for serious suicidal behavior among individuals with alcohol dependence.
METHOD: Data on completed suicides and medically serious suicide attempters and controls were gathered in the Canterbury region of New Zealand, using psychological autopsy methodology. A subsample of adult alcoholic subjects was selected for analyses yielding 38 completed suicides, 62 medically serious suicide attempters and 46 community controls, all with alcohol dependence (past month). Multinomial logistic analyses were used to compare the two case groups to controls on demographic and diagnostic variables.
FINDINGS: Mood disorders and financial difficulties were more frequent among medically serious attempters than controls. Completed suicides were older and were more likely to be male, to have mood disorders, partner-relationship difficulties and other interpersonal life events than were controls. Completed suicides were older and more likely to be male than were medically serious attempters.
DISCUSSION: Risk factors in alcoholics are generally consistent with reports based on general samples of suicide and medically serious suicide attempts. Suicide prevention efforts in alcoholics, if they are to be successful, must include a focus on depression as well as interpersonal factors, including partner-relationship difficulties.
Correspondence: R. Mervyn Letts, Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1 CANADA; (email: letts@exchange.cheo.on.ca).
INTRODUCTION: The most common type of school bus crash resulting in injury and death involves the "rollover" mechanism, which may be linked to bus design. To investigate this possibility, we carried out a detailed investigation of a severe school bus crash.
METHODS: The crash involved 12 children, passengers in the school bus. Analysis included the determination of crash dynamics by examination of physical evidence at the crash site and deformation sustained by the structure of the bus and the other vehicle involved. The mechanism of injury was determined by comparing physical evidence collected inside the bus to injuries sustained by the children.
FINDINGS: Two children sustained severe injuries and 1 child was killed. The most common injuries involved the head, neck and shoulder as demonstrated by 3 illustrative reports. Specified changes to school bus design, based on mechanism of injury to the occupants include, in addition to the compartmentalization now in effect, more padding to the sides of the bus, over the window headers and on the panelling between the windows.
DISCUSSION: Injuries to the head, neck and spine are the most common types when children are involved in rollover school bus collisions. For additional safety, changes to the current bus design are needed.
Injury to arms protruding through vehicle windows.
- Nikitins MD, Ibrahim S, Cooter RD. Hand Surg 2003; 8(1): 75-79.
Correspondence: R.D. Cooter, Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, AUSTRALIA; (email: rdcooter@plasticsurgeryadelaide.com).
Driving with an arm protruding through a window can result in limb threatening injury. A series of seven upper limb injuries sustained during motor vehicle accidents (MVAs) with a limb protruding from the vehicle window is described. The severity and complexity of these injuries are related to the ultimate functional recovery for the limb. This study serves to highlight the severity of injury and morbidity following these modalities of trauma, which although rarely fatal, carry extensive consequences and could be easily prevented with appropriate education programmes and legislation.
Measuring homicide in Russia: a comparison of estimates from the crime and vital statistics reporting systems.
- Pridemore WA. Soc Sci Med 2003; 57(8): 1343-1354.
Correspondence: William Alex Pridemore, Department of Sociology, University of Oklahoma, Kaufman Hall 329, 73019, Norman, OK, USA; (email: pridemore@ou.edu).
The Russian homicide rate more than tripled between 1988 and 1994 and is now among the highest in the world. This dramatic increase, together with newly available data from a post-Soviet Russian government that is becoming more transparent, has led to a growing number of studies of homicide in Russia. As of yet, however, there has been no systematic evaluation of the homicide reporting systems in the country. This article examines the comparability of the two main sources of homicide estimates in Russia, crime data from the Ministry of the Interior and mortality data from the vital statistics registration system. These estimates are compared annually and by administrative region. Annual estimates from the vital statistics reporting system have reported an average of nearly 40% more homicides than the crime reporting system over the last decade and a half. Regionally, mortality estimates are higher than crime estimates in 66 of 78 regions, and eight of the 12 regions where crime estimates are higher are in areas where previous validation procedures suggest mortality data are suspect. As the regional homicide rate increases, so does the gap between the two estimates. Case definitions of these sources lead us to expect small discrepancies between them, but this does not account for the large differences revealed here. Both systems under-report, for different reasons, and some of the under-enumeration in both systems is purposeful and/or results from a lack of human and monetary resources. Mortality data are probably better for most purposes, especially when comparing Russia to other nations and when estimating causal models. Both systems should be used with caution, however, and the choice between them should depend on the nature of each study.
Intergenerational transmission of partner violence: a 20-year prospective study.
- Ehrensaft MK, Cohen P, Brown J, Smailes E, Chen H, Johnson JG. J Consult Clin Psychol 2003; 71(4): 741-753.
Correspondence: Miriam K. Ehrensaft, Department of Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, New York 10032, USA; (email: ehrensam@child.cpmc.columbia.edu).
An unselected sample of 543 children was followed over 20 years to test the independent effects of parenting, exposure to domestic violence between parents (ETDV), maltreatment, adolescent disruptive behavior disorders, and emerging adult substance abuse disorders (SUDs) on the risk of violence to and from an adult partner. Conduct disorder (CD) was the strongest risk for perpetrating partner violence for both sexes, followed by ETDV, and power assertive punishment. The effect of child abuse was attributable to these 3 risks. ETDV conferred the greatest risk of receiving partner violence; CD increased the odds of receiving partner violence but did not mediate this effect. Child physical abuse and CD in adolescence were strong independent risks for injury to a partner. SUD mediated the effect of adolescent CD on injury to a partner but not on injury by a partner. Prevention implications are highlighted.
Do subtypes of maritally violent men continue to differ over time?
- Holtzworth-Munroe A, Meehan JC, Herron K, Rehman U, Stuart GL. J Consult Clin Psychol 2003; 71(4): 728-740.
Correspondence: Amy Holtzworth-Munroe, Department of Psychology, Indiana University Bloomington, 47405-7007, USA; (email: holtzwor@indiana.edu).
In previous batterer typology studies, only 1 study gathered longitudinal data and no research examined whether subtypes continue to differ from one another over time. The present study did so. We predicted that, at 1.5- and 3-year follow-ups, the subtypes identified at Time 1 (A. Holtzworth-Munroe, J. C. Meehan. K. Herron, U. Rehman, G. L. Stuart, 2000; family only, low level antisocial, borderline/dysphoric, and generally violent/antisocial) would continue to differ in level of husband violence and on other relevant variables (e.g., generality of violence, psychopathology, jealousy, impulsivity, attitudes toward violence and women). Although many group differences emerged in the predicted direction, not all reached statistical significance, perhaps because of small sample sizes. Implications of the findings (e.g.. not all marital violence escalates; possible overlap of the borderline/dysphoric and generally violent/antisocial subgroups) are discussed, as are methodological issues (e.g., need for more assessments over time, the instability of violent relationships).
Pharmacological management of aggression and violence.
Correspondence: Felicity Humble, University of Melbourne, Barwon Health and Geelong Clinic, Swanston Centre, PO Box 281, Geelong, Victoria 3220, AUSTRALIA; (email: felictyh@barwonhealth.org.au).
(Copyright 2003 John Wiley & Sons)
The pharmacological management of violence and aggression is a common and substantial clinical dilemma in the emergency psychiatric situation. A literature search was conducted through PubMed and using the Cochrane Library. This was followed by a manual search of selected literature. Randomised controlled trials were sought that specifically addressed the acute situation, rather than the ongoing management of chronic conditions. There was a paucity of well-controlled data and insufficient evidence to support the use of many agents in emergency situations. Many studies had considerable limitations making comparison difficult. Efficacy data for a range of treatment options exists, including the use of classical and atypical anti-psychotic agents, benzodiazepines and combination therapies. Clinical risk, tolerability and environmental factors need to form part of a careful and considered judgement in the choice of treatment. Safety, tolerability and the potential for a positive experience are major considerations, thus paving the way for long term compliance.
