CONTEXT: Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia.
METHODS: Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents.
FINDINGS: There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers.
COMMENTS: Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents.
IMPACT ON INDUSTRY: Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.
Community based program to improve firearm storage practices in rural Alaska.
- Horn A, Grossman DC, Jones W, Berger LR. Inj Prev 2003; 9: 231-234.
Correspondence: David Grossman, Harborview Injury Prevention and Research Center, 325 Ninth Ave Box 359960, Seattle, WA 98104, USA; (email: navajo@u.washington.edu).
CONTEXT: To develop and evaluate a pilot program to reduce unauthorized access to firearms by youth by distributing gun safes and trigger locks to households.
DESIGN: Pilot intervention with pre/post-evaluation design.
SETTING: Two Alaska Native villages in the Bristol Bay Health Corporation region of southwest Alaska.
SUBJECTS: Forty randomly selected households with two or more guns in the home.
INTERVENTION: Initially, a focus group of community members who owned guns was convened to receive input regarding the acceptability of the distribution procedure for the gun storage devices. One gun safe and one trigger lock were distributed to each of the selected households during December 2000. Village public safety officers assisted with the distribution of the safes and provided gun storage education to participants.
MAIN OUTCOME MEASURES: Baseline data were collected regarding household gun storage conditions at the time of device distribution. Three months after distribution, unannounced onsite home visits were conducted to identify if residents were using the gun safes and/or trigger locks.
FINDINGS: All selected households had at least two guns and 28 (70%) of the 40 households owned more than two guns. At baseline, 85% of homes were found to have unlocked guns in the home and were most often found in the breezeway, bedroom, storage room, or throughout the residence. During the follow up visits, 32 (86%) of the 37 gun safes were found locked with guns inside. In contrast, only 11 (30%) of the 37 trigger locks were found to be in use.
COMMENTS: This community based program demonstrated that Alaska Native gun owners accepted and used gun safes when they were installed in their homes, leading to substantial improvements in gun storage practices. Trigger locks were much less likely to be used.
Terrorism and the international classification of functioning, disability and health: a speculative case study based on the terrorist attacks on New York and Washington.
CONTEXT: To argue that there is a need for a standard classification of functional status to track the consequences of large scale human disasters, such as the terrorist attacks on New York and Washington on September 11, 2001; and that the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) can meet that need.
METHOD: The need for tracking functional status following the September 11 attacks is assessed, and three hypothetical case studies of victims of terrorist attacks are presented and coded using a clinical short form of the ICF.
FINDINGS: It is demonstrated that typical clinical case histories can be coded to the ICF and that the resulting information is useful for tracking the functional consequences of large scale terrorist attacks on civilian populations.
COMMENTS: ICF research, development, and training should proceed with the goal of implementing the classification in professions and settings concerned with the functional consequences of terrorist attacks and other human disasters.
Feasibility of forest-fire smoke detection using lidar.
- Utkin AB, Fernandes A, Simoes F, Lavrov A, Vilar R. Int J Wildlands Fire 2003, 12(2): 159-166.
Correspondence: Andrei B. Utkin, Instituto de Novas Tecnologias, Rua Alves Redol, 9 - 1000-029 Lisboa, PORTUGAL; (email: andrei.utkin@inov.pt).
The feasibility and fundamentals of forest fire detection by smoke sensing with single-wavelength lidar are discussed with reference to results of 532-nm lidar measurements of smoke plumes from experimental forest fires in Portugal within the scope of the Gestosa 2001 project. The investigations included tracing smoke-plume evolution, estimating forest-fire alarm promptness, and smoke-plume location by azimuth rastering of the lidar optical axis. The possibility of locating a smoke plume whose source is out of line of sight and detection under extremely unfavourable visibility conditions was also demonstrated. The eye hazard problem is addressed and three possibilities of providing eye-safety conditions without loss of lidar sensitivity (namely, using a low energy-per-pulse and high repetition-rate laser, an expanded laser beam, or eye-safe radiation) are discussed.
Adherence to occupational therapist recommendations for home modifications for falls prevention.
- Cumming RG, Thomas M, Szonyi G, Frampton G, Salkeld G, Clemson L. Am J Occup Ther 2001; 55(6): 641-648.
Correspondence: Robert Cumming, Department of Public Health and Community Medicine, University of Sydney, Sydney NSW 2006, AUSTRALIA; (email: bobc@health.usyd.edu.au).
CONTEXT: This study examined adherence to home modification recommendations made by an occupational therapist and attempted to identify predictors of adherence.
METHOD: An experienced occupational therapist visited the homes of 178 people (mean age = 764 years) to evaluate for and recommend appropriate home modifications for falls prevention. One year later, a research assistant visited these persons' homes to assess adherence.
FINDINGS: At least one home modification was recommended in 150 of the 178 homes visited. The most common recommendations were to remove mats and throw rugs (48%), to change footwear (24%), and to use a nonslip bathmat (21%). In the 121 homes revisited after 12 months, 419 home modifications had been recommended, and 216 (52%) were met with partial or complete adherence. The only significant predictors of adherence were a belief that home modifications can prevent falls and having help at home from relatives.
COMMENTS: A major barrier to adherence to home modification recommendations is that many older people do not believe that home modifications can reduce their risk of falling.
Correspondence: James C. Cawley, National Institute for Occupational Safety and Health, Pittsburgh Research Laboratory, P.O. Box 18070, 15236, Pittsburgh, PA, USA; (email: Jcawley@cdc.gov).
CONTEXT: CFOI and SOII data show that 2,287 U.S. workers died and 32,807 workers sustained days away from work due to electrical shock or electrical burn injuries between 1992 and 1998.
METHOD: The narrative, work activity, job title, source of injury, location, and industry for each fatal electrical accident were examined. A primary causal factor was identified for each fatality.
FINDINGS: Electrical fatalities were categorized into five major groups. Overall, 44% of electrical fatalities occurred in the construction industry. Contact with overhead power lines caused 41% of all electrical fatalities.
COMMENTS: Electrical shock caused 99% of fatal and 62% of nonfatal electrical accidents. Comprising about 7% of the U.S. workforce, construction workers sustain 44% of electrical fatalities. Power line contact by mobile equipment occurs in many industries and should be the subject of focused research. Other problem areas are identified and opportunities for research are proposed.
IMPACT ON INDUSTRY: Improvements in electrical safety in one industry often have application in other industries.
Case studies of occupational falls from heights: Cognition and behavior in context.
CONTEXT: The aim of this study was to examine individual workers' cognitive, behavioral, and motivational processes leading up to occupational falls from heights.
METHOD: The study is based on 26 semistructured personal interviews and on-site investigations with male workers who reported to an emergency department for treatment of injuries due to falls from heights.
FINDINGS: A greater number of workers carrying out nonroutine compared to routine tasks perceived, identified, interpreted, and attempted to control a fall hazard. Two cases are presented illustrating how cognition and behavior in context progresses from a lesser to a greater active role in the incident processes.
COMMENTS: The addition of full-scale investigations of how and why workers thought and behaved the way they did in a particular situation can give important clues as to whether preventive measures will be effective in a similar situation in the future.
We provide a brief critical review and assessment of engineering modifications to the built environment that can reduce the risk of pedestrian injuries. In our review, we used the Transportation Research Information Services database to conduct a search for studies on engineering countermeasures documented in the scientific literature. We classified countermeasures into 3 categories-speed control, separation of pedestrians from vehicles, and measures that increase the visibility and conspicuity of pedestrians. We determined the measures and settings with the greatest potential for crash prevention. Our review, which emphasized inclusion of studies with adequate methodological designs, showed that modification of the built environment can substantially reduce the risk of pedestrian-vehicle crashes.
Promoting safe walking and cycling to improve public health: lessons from the Netherlands and Germany.
Correspondence: John Pucher, Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Ave, Room 363, New Brunswick, NJ 08901-1900, USA; (email: pucher@rci.rutgers.edu).
OBJECTIVES: We examined the public health consequences of unsafe and inconvenient walking and bicycling conditions in American cities to suggest improvements based on successful policies in The Netherlands and Germany.
METHODS: Secondary data from national travel and crash surveys were used to compute fatality trends from 1975 to 2001 and fatality and injury rates for pedestrians and cyclists in The Netherlands, Germany, and the United States in 2000.
FINDINGS: American pedestrians and cyclists were much more likely to be killed or injured than were Dutch and German pedestrians and cyclists, both on a per-trip and on a per-kilometer basis.
COMMENTS: A wide range of measures are available to improve the safety of walking and cycling in American cities, both to reduce fatalities and injuries and to encourage walking and cycling.
Arnold DH, Johnson A. Nature 2003, 425(6954): 181-184.
Correspondence: Derek H. Arnold, Department of Psychology and Institute of Cognitive Neuroscience, University College London, Gower Street, London WC1E 6BT, UK; (email: derek.arnold@ucl.ac.uk).
Borders defined by small changes in brightness (luminance contrast) or by differences in colour (chromatic contrast) appear to move more slowly than those defined by strong luminance contrast. As spatial coding is influenced by motion, if placed in close proximity, the different types of moving border might appear to drift apart. Using this configuration, we show here that observers instead report a clear illusory spatial jitter of the low-luminance-contrast boundary. This visible interaction between motion and spatial-position coding occurred at a characteristic rate ( 22.3 Hz), although the stimulus motion was continuous and invariant. The jitter rate did not vary with the speed of movement. The jitter was not due to small involuntary movements of the eyes, because it only occurred at a specific point within the stimulus, the low-luminance-contrast boundary. These findings show that the human visual system contains a neural mechanism that periodically resolves the spatial conflict created by adjacent moving borders that have the same physical but different perceptual speeds.
Correspondence: Joshua Rotenberg, Departments of Child and Adolescent Neurology and Pediatrics, Walter Reed Army Medical Center, Washington, DC 20307, USA; (email: joshua.rotenberg@lackland.af.mil).
Nerve agents (NAs) are the most lethal chemical weapons. We review the pathophysiology and management of NA poisoning of children. NAs cause cholinergic crisis. Children may manifest signs of cholinergic poisoning differently than adults. Children may be less likely to manifest miosis and glandular secretions. They may present with neurologic derangements alone. The goals of treatment should be to limit additional exposure, to provide respiratory support, and to prevent neurologic morbidity. Autoinjectors are optimal delivery vehicles for intramuscular antidotes and are likely to be used in civilian prehospital care. Antidotes include anticholinergics, oximes, and benzodiazepines. Several medications may be available within each class of antidotes. Clinicians will select an antidote based on the status of the individual victim, the accessibility of supportive care, and the availability of the drug. Atropine is well-tolerated and high doses may be required. The oxime pralidoxime chloride has a longer half-life in children. Currently, diazepam is the standard NA anticonvulsant. Midazolam may be the most effective intramuscular anticonvulsant after NA exposure, but, despite its efficacy, it is not an approved agent for seizures. Supportive care and long-term complications are summarized.
Two studies investigating the psychological, family and interpersonal correlates of adolescent violent behavior are reported in this paper. In Study 1, secondary school students (N = 1,519) responded to established scales assessing their psychological attributes, family functioning, parenting qualities and psychosocial support and conflict. Results of Study 1 showed that: a) adolescents who showed higher levels of perceived stress and psychological symptoms displayed more signs of adolescent violence; b) adolescents who had a higher sense of mastery and existential mental health displayed less signs of violence; c) adolescents' attitudes towards poverty and traditional Chinese beliefs about adversity were significantly related to adolescent violence; d) higher levels of family functioning, positive parenting styles as well as interpersonal support and lower levels of interpersonal conflicts were associated with a lower level of adolescent violence. Results further showed that some of the above factors were more strongly related to adolescent violence in adolescents experiencing economic disadvantage than in adolescents who did not experience economic disadvantage. Some of the findings of Study 1 were replicated in Study 2, where adolescents from 229 families (either families on welfare or low income families) were recruited. These studies suggested that several psychological, family and interpersonal factors are related to adolescent violent behavior, particularly in adolescents with economic disadvantage.
The transtheoretical model of change in adolescents: Implications for injury prevention.
CONTEXT: Many injury prevention interventions require changes in human behavior to reduce self-risk or risk to others. Promising injury prevention interventions may be discarded if they lack power to create a significant difference in outcomes when judging their ability to "move a person from nonaction or negative action to positive action (safety)." The transtheoretical model of change (TMC) allows greater sensitivity in detecting along the change process where an intervention may be effective. The stages of change consist of precontemplation, contemplation, preparation, action, maintenance, and termination. Change is not viewed as an "all or none phenomenon."
METHOD: Use of the TMC was examined using a quasiexperimental, cross-over design involving high school agriculture students enrolled in 21 schools in Kentucky (n=9), Iowa (n=7), and Mississippi (n=5). A series of physical and narrative simulations (safety training exercises) were developed with a focus on preventing amputation, spinal cord injury, hypersensitivity pneumonitis, and noise-induced hearing loss. Contemplation and action, as part of the TMC, were measured using a 10-item, Likert-type, stages of change (SOC) instrument comprised of two subscales (reliability coefficients were.88 and.81, respectively). The final sample consisted of 790 students (373 treatment and 417 control).
FINDINGS: There was a significant group effect for both contemplation, F(1,732)=197.4; p<.0001, and action, F(1,730)=106.1; p<.0001. A convenience sample of 29 of the participating students was selected for follow-up farm visits 1 year postparticipation. Of these students, 25 (86%) had made safety behavior changes in their farm work.
COMMENTS: The use of the TMC model can provide researchers with greater precision in examining intervention effectiveness in promoting change.
A 16 year study of injuries to professional boxers in the state of Victoria, Australia.
- Zazryn TR, Finch CF, McCrory P. Br J Sports Med 2003; 37(4): 321-324.
Correspondence: Tsharni Zazryn, Department of Epidemiology and Preventive Medicine, Monash University Medical School, Alfred Hospital, Prahran, Victoria, AUSTRALIA; (email: Tsharni.Zazryn@med.monash.edu.au)
OBJECTIVES: Concerns about the significant injury risks in boxers have been well documented. To inform the continuing debate, updated information about the risk of injury for participants, and suitable means of modifying or preventing these risks, need to be identified.
METHODS: Data describing all professional boxing fight outcomes and injuries sustained during competition, from August 1985 to August 2001, were obtained from the Victorian Professional Boxing and Combat Sports Board.
FINDINGS: A total of 107 injuries were recorded from 427 fight participations, corresponding to an injury rate of 250.6 injuries per 1000 fight participations. The most commonly injured body region was the head/neck/face (89.8%), followed by the upper extremities (7.4%). Specifically, injuries to the eye region (45.8%) and concussion (15.9%) were the most common. About three quarters of all injuries were lacerations/open wounds or superficial. No information was available on the mechanism of injury.
COMMENTS: Future research should collect information on the mechanism of injury, as this is crucial for the development and implementation of effective injury prevention strategies. A suggested boxing injury report form is provided to facilitate this.
Long-term outcome of sports injuries: results after inpatient treatment.
- Dekker R, van der Sluis CK, Groothoff JW, Eisma WH, ten Duis HJ. Clin Rehabil 2003; 17(5): 480-487.
Correspondence: R. Dekker, Department of Rehabilitation Medicine, University Hospital Groningen, Northern Centre for Health Care Research, University of Groningen, THE NETHERLANDS; (email: R.Dekker@rev.azg.nl).
OBJECTIVE: To investigate whether sports injuries result in long-term disabilities and handicaps and to establish variables with a prognostic value for the occurrence of these long-term consequences.
METHODS: All patients older than 17 years of age and admitted to the University Hospital Groningen because of a sports injury were entered in the study. By filling in a questionnaire 1-4 years after the injury an inventory was made of the long-term consequences.
MAIN OUTCOME MEASURES: Absenteeism from work and sports, experienced disabilities or handicaps and the Sickness Impact Profile 68 (SIP68).
FINDINGS: Out of 306 patients 229 (75%) returned a completed questionnaire. Sixty-seven per cent of the working population had been unfit for work up to one year, whereas 4% still had not resumed work. Absenteeism from sports was also considerable; nearly half of the population did not participate in sports for more than a year. Furthermore, 32% of the patients still experienced disability or handicap following the injury. This finding is in agreement with the results of the SIP68 (odds ratio 6.8; confidence interval (95% CI): 3.51-13.08). Two prognostic variables could be distinguished: 'gender' and 'type of sport'. Long-term consequences occur more often in women (p < 0.03) and with playing outdoor soccer, horse riding or skiing (p < 0.01).
COMMENTS: Sports injuries can lead to long-term disabilities and handicaps. The variables 'gender' and 'type of sport' were of prognostic significance.
CONTEXT: Recent United Kingdom strategies focus on preventable suicide deaths in former psychiatric in-patients, but natural causes of death, accidents and homicide may also be important. This study was intended to find the relative importance of natural and unnatural causes of death in people discharged from long-term psychiatric care in Scotland in 1977 -1994.
METHODS: People discharged alive from psychiatric hospitals in Scotland in 1977 - 94 after a stay of one year or longer were identified using routine hospital records. Computer record linkage was used to link hospital discharges to subsequent death records. Mortality was described using a person-years analysis, and compared to the general population rates.
FINDINGS: 6,776 people were discharged in the time period. 1,994 people (29%) died by the end of follow-up, 732 more deaths than expected. Deaths from suicide, homicide, accident and undetermined cause were increased, but accounted for only 197 of the excess deaths. Deaths from respiratory disease were four times higher than expected, and deaths from other causes, including cardiovascular disease, were also elevated.
COMMENTS: Suicide is an important cause of preventable mortality, but natural causes account for more excess deaths. Prevention activities should not focus only on unnatural causes of death.
The advent of Automatic Crash Notification Systems (ACN) offers the possibility of immediately locating crashes and of determining the crash characteristics by analyzing the data transmitted from the vehicle. A challenge to EMS decision makers is to identify those crashes with serious injuries and deploy the appropriate rescue and treatment capabilities. The objective of this paper is to determine the crash characteristics that increase the risk of serious injury. Within this paper, regression models are presented which relate occupant, vehicle and impact characteristics to the probability of serious injury using the Maximum Abbreviated Injury Scale Level (MAIS). The accuracy of proposed models were evaluated using National Automotive Sampling System/ Crashworthiness Data System (NASS/CDS) and Crash Injury Research and Engineering Network (CIREN) case data. Cumulatively, the positive prediction rate of models identifying the likelihood of MAIS3 and higher injuries was 74.2%. Crash mode has a significant influence of injury risk. For crashes with 30 mph deltaV, the risk of MAIS3+ injury for each mode is 38.9%, 83.8%, 47.8% and 19.9% for frontal, near side, far side and rear impact crashes, respectively. In addition to deltaV, a number of crash variables were identified that assist in the accurate prediction of the probability of MAIS 3+ injury. These variables include occupant age, partial ejection, safety belt usage, intrusion near the occupant, and crashes with a narrow object. For frontal crashes, added crash variables include air bag deployment, steering wheel deformation, and multiple impact crashes. The quantitative relationship between each of these crash variables and injury risk has been determined and validated by regression analysis based on NASS/CDS and CIREN data.
Correspondence: Jeffrey H. Goode, Federal Aviation Administration, Office of Aviation Policy and Plans, 20591, Washington, DC, USA; (email: jeff.goode@faa.gov).
CONTEXT: There is concern in the aviation community that pilot schedules can lead to fatigue and increased chance of an aviation accident. Yet despite this concern, there is little empirical analysis showing the relationship between pilot schedules and commercial aviation accidents. This study attempts to demonstrate an empirical relationship between pilot schedules and aviation accidents.
METHOD: Data for human factors-related accidents and pilot work patterns were identified. The distribution of pilot work schedule parameters for the accidents was compared to that for all pilots using a chi-square test to determine if the proportions of accidents and length of duty exposure were the same. If the distributions are the same, then one could infer that pilot human factor accidents are not affected by work schedule parameters.
FINDINGS: The proportion of accidents associated with pilots having longer duty periods is higher than the proportion of longer duty periods for all pilots. DISCUSSION: There is a discernible pattern of increased probability of an accident as duty time increases for commercial aircraft pilots in the United States.
COMMENTS: The analysis suggests that establishing limits on duty time for commercial pilots would reduce risk. Such a rule is likely to be expensive and could substantially impact the commercial airlines. In return, there is likely to be a reduction in the risk of commercial aviation accidents due to pilot fatigue.
Mortality from external causes: influence of age and gender
- Jakuboniene D, Gurevicius R. Medicina (Kaunas) 2003; 39(8): 773-787.
Correspondence: D. Jakuboniene, Department of Social Medicine, Institute of Public Health, Faculty of Medicine, Vilnius University, Seskines 24, 2010 Vilnius, LITHUANIA; (email: guro@smc.lt).
CONTEXT: The article aims to evaluate mortality from external causes in Lithuania in 1990 and in 1997 and influence of age and gender on it.
METHODS: The primary data of official demographic statistics were used for analysis, after adjustment by age - European standard. Four external causes of death (suicides, homicides, traffic accidents and all external causes) were examined. Years of potential life lost (YPLL) due to premature death from external causes were calculated. The results obtained showed that age adjusted male suicides mortality increased by 7.7%, from homicides - by 3.0% and from all external causes - by 3.2% per year. Female suicide mortality increased by 5.9%, from homicides - by 1.7% and from all external causes increased by 2.0% per year. Male traffic accidents decreased approximately by 4.8% and those of females approximately 5.0% per year.
COMMENTS: Males had higher mortality in almost all age groups. Male suicides and all external causes mortality increased from 10-14 years to maximum at the age of 50-54 years and then decreased. Female mortality from these two reasons from 10-14 years increased with age. Maximal female homicide mortality was found at the age of 35-49 years. Male traffic accident mortality at the age of 20-24 years and that of females at the age of 10-14 and 20-29 years increased from 1990 to 1997 despite decline in other age groups. The YPLL per 100000 due to all external causes increased from 4598 in 1990 to 5297 in 1997 for males and from 940 to 1,106 for females.
Antecedents of injury among youth in agricultural settings: A longitudinal examination of safety consciousness, dangerous risk taking, and safety knowledge.
- Westaby JD, Lee BC. J Safety Res 2003; 34(3): 227-240.
Correspondence: James Westaby, Program in Social-Organizational Psychology, Department of Organization and Leadership, Teachers College, Columbia University, Box 6, 525 West 120th Street, 10027, New York, NY, USA; (email: westaby@columbia.edu).
CONTEXT: Injuries are the leading cause of death for adolescents in the United States.
METHODS: This study longitudinally examined three psychological mediators of injury among 3,081 youths in agricultural settings: (a) safety consciousness, (b) dangerous risk taking, and (c) safety knowledge. These variables are examined within a nomological network of contextual variables.
FINDINGS: Cross-sectional results revealed that safety consciousness and dangerous risk taking were the strongest predictors of reported injury at Time 1 and Time 2. Safety knowledge had an unexpected negative association with injury, albeit weak. As predicted, participating in safety activities was positively associated with safety consciousness, and time spent working was strongly associated with safety knowledge. Furthermore, self-esteem had both positive and negative safety outcomes, suggesting a more complex functioning. Males exhibited fewer safety cognitions than females as predicted. Longitudinal data also revealed that injury at Time 1 and dangerous risk taking were the strongest predictors of Time 2 injury.
COMMENTS: Results from this study emphasize the importance of assessing dangerous risk-taking perceptions when attempting to predict future injuries.
CONTEXT: Most injuries in school occur during sport.
OBJECTIVES: To explore the impact of sports injury in supervised school sport.
METHOD: A prospective study of sports injury in children of secondary school age presenting to the accident and emergency department. Each patient was identified on registration, matched with medical records after discharge, and contacted later by telephone to complete a structured interview. Patients were only included if their injury was sustained during supervised school sport.
FINDINGS: During the study period, 194 patients aged 11-18 attended the accident and emergency department with an injury, 51% of which occurred during school sport. Injuries occurred most commonly in rugby (43%), followed by physical education and games together (17.5%). Most injuries were x rayed (72%). Just over 12% of pupils lost no time from sport, most (71%) were back to sport within three weeks, and 2.7% were injured for more than eight weeks. Almost a third of parents needed to take time off from work to deal with the injured child.
COMMENTS: School sports injuries are important. They account for just over half of all injuries in secondary school children. They cause significant disruption to school and sport and have important implications for the wider family.
Youth safety education and injury prevention program.
Unintentional injury remains the leading cause of death in U.S. children. This article provides a case evaluation of a school based youth safety education program based on the Think First National Injury Prevention Program curriculum. Partners for the program included an urban elementary school, a school of nursing, a Safe Kids Coalition, a regional trauma center, and pediatric, community, and critical care nurses. A convenience sample of 140 second grade children in a mid-Atlantic elementary school participated in a 1 hour-a-week injury prevention class over the course of 6 weeks. The Think First National Injury Prevention Program served as the core curriculum and evaluation framework. At the end of the program, knowledge test scores increased an average of 35% over pre-test measures. Ninety-eight percent of the faculty, staff nurses, student nurses, children, and parents indicated a positive overall value of the program and the need for it to continue on an ongoing basis. Safety resources are provided for pediatric nurses to use in their diverse practice settings.
Life meaning and coping strategies were investigated as statistical predictors of suicidal manifestations in a sample of 298 university undergraduates. Participants completed measures of hopelessness, sense of coherence, purpose in life, coping for stressful situations, suicide ideation, prior suicide attempts, and self-reported likelihood of future suicidal behavior. Moderated multiple regression techniques examined the incremental validity of life meaning by coping interactions for predicting each suicide variable separately by gender. The interaction of sense of coherence and emotion-oriented coping made a unique, significant contribution to the statistical prediction of all suicide variables for women. For men, the interaction between sense of coherence and emotion-oriented coping contributed significantly to the statistical prediction of suicide ideation. All interactions remained significant when hopelessness was statistically controlled. The hypothesis that life meaning acts as a buffer between coping style and suicidal manifestations was partially supported. Implications for suicide prevention and intervention are discussed.
Analyses of adolescent suicide statistics in Hong Kong for the period 1980 to 2000 revealed several phenomena. First, while adolescent suicide rates (10-24 age group) in Hong Kong were relatively stable for the period under study, there was a gradual rising trend where adolescent suicide rates in the 1990s were higher than those in the 1980s. Second, suicide rates for adolescents aged 10-24 were lower than those of other adult age groups. Third, while adolescent suicide rates in Hong Kong were lower than those reported in some English-speaking countries and Mainland China, the figures were higher than those reported in Taiwan. Fourth, suicide rates among teenagers in early adolescence were lower than those among adolescents in late adolescence. Fifth, although male adolescent suicide rates were in general higher than female adolescent suicide rates (10-24 age group), gender differences in suicide rates appeared to be moderated by age. Sixth, there was a gradual rising trend in adolescent proportional mortality rates for suicide in the 1990s. Seventh, proportional mortality rates for suicide among teenagers in early adolescence were lower than those among adolescents in late adolescence. Finally, while jumping from a height was a common method of adolescent suicide, there was a rising trend of using other methods such as taking drugs, hanging and charcoal burning. The observed adolescent suicide phenomena are discussed with reference to the socio-cultural context of Hong Kong.
Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions.
- Wang SC, Bednarski B, Patel S, Yan A, Kohoyda-Inglis C, Kennedy T, Link E, Rowe S, Sochor M, Arbabi S. Annu Proc Assoc Adv Automot Med 2003; 47: 545-559.
Correspondence: Stuart C. Wang, Departments of Surgery and Radiology, Program for Injury Research and Education, University of Michigan Medical School, Ann Arbor, Michigan, USA; (email: unavailable).
The objective of this study was to determine the effect of differences in subcutaneous fat depth on adult injury patterns in motor vehicle collisions. Sixty-seven consecutive adult crash subjects aged 19-65 who received computed tomography of their chest, abdomen and pelvis as part of their medical evaluation and who consented to inclusion in the Crash Injury Research Engineering Network (CIREN) study were included. Subcutaneous fat was measured just lateral to the rectus abdominus muscle in a transverse section taken through the subject at the level of L4. Women had significantly greater subcutaneous fat depth than men. Increased subcutaneous fat depth was associated with significantly decreased injury severity to the abdominal region of females. A similar trend was noted in males although it did not reach statistical significance. Our findings suggest that increased subcutaneous fat may be protective against injuries by cushioning the abdominal region against injurious forces in motor vehicle collisions.
Performance of advanced air bags based on data William Lehman Injury Research Center and new NASS PSUs.
The Ryder Trauma Center is a Level I trauma center that treats only the most severely injured occupants of vehicle crashes as well as other severe cases of trauma. The center investigates these crashes through funding provided by the Alliance of Automobile Manufacturers and the U.S. Department of Transportation-sponsored Crash Injury Research and Engineering Network (CIREN) program. MAIS 3+ nonfatal and fatal injuries comprise approximately 2 percent of the total NASS/CDS cases. Among the Ryder trauma center cases, 50 percent are MAIS 3+ and 25 percent are fatal. If the MAIS 3+ fatal and nonfatal injuries were considered as "failures" and the remaining 98 percent with MAIS 2 or less as successes, this could be equated to the 75 percent failure rate (MAIS 3+ and fatal) in the trauma center cases for analysis purposes. The total database of frontal cases with no rollover consists of 147 drivers with first-generation airbags and 58 cases with second-generation airbags.
New Zealand drivers study: Developing a methodology for conducting a follow-up study of newly licensed drivers.
- Begg D, Brookland R, Hope J, Langley J, Broughton J. J Safety Res 2003; 34(3): 329-336.
Correspondence: Dorothy Begg, Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, P.O. Box 913, Dunedin, NEW ZEALAND; (email: dorothy.begg@ipru.otago.ac.nz).
CONTEXT: In recent years, there has been a significant reduction in traffic crash injury among young people, but they continue to be overrepresented in the traffic crash statistics. To improve this situation, sound scientific evidence is needed to develop effective policies and programs.
METHOD: The aim of the proposed study is to provide this evidence by examining early driving and driving-related experiences of newly licensed drivers as they progress through the learner-, restricted-, and full-license stages of the graduated licensing system and to determine the impact of these experiences on subsequent negative traffic-related outcomes (risky driving behavior, injury traffic crashes, noninjury traffic crashes, infringements, convictions). Given the size and complexity of the proposed study, a comprehensive pilot study was undertaken to determine the feasibility of conducting a New Zealand-wide cohort study of newly licensed drivers.
FINDINGS: This article describes the pilot study process and the methodology that has been developed for the New Zealand-wide study.
Graduated driver licensing evaluation results from early programs in the United States.
- Shope JT, Molnar LJ. Annu Proc Assoc Adv Automot Med 2003; 47: 536-538.
Correspondence: Jean T. Shope, University of Michigan Transportation Research Institute, 2901 Baxter Road
Ann Arbor, Michigan 48109-2150, USA; (email: jshope@umich.edu).
Graduated driver licensing (GDL) allows young novice drivers to gain experience and maturity under conditions of low risk before progressing to more risky driving situations. GDL addresses youthful risk taking by limiting access to driving privileges and providing serious consequences for driving infractions. Although a comprehensive approach to GDL was proposed as early as the 1970s (Waller, 1977), only recently has the concept gained widespread acceptance in the United States, with many of the legislative initiatives having been undertaken in the late 1990s. Thirty-six U.S. jurisdictions now have adopted three-stage GDL systems, and 48 U.S. jurisdictions have one or more elements of GDL. Early evaluation results for the six states that had comprehensive GDL programs in place long enough to evaluate (California, Florida, Michigan, North Carolina, Ohio, and Pennsylvania), and for which at least preliminary evaluation results were available, are reported here. Results from a recent evaluation update of Michigan's GDL program also are reported.
See Item 1 Under Pedestrian and Bicycle Issues
See Item 1 Under Risk Factor Prevalence, Injury Occurrence, and Costs
CONTEXT: American and Australian studies indicate that domestic violence is common among patients attending for emergency care. It is not clear whether this applies to patients attending emergency departments in the UK.
METHODS: A single centre cross sectional study. Adult patients attending the emergency department of Addenbrooke's Hospital, Cambridge were interviewed in randomly allocated time blocks, using validated questions from a US study. Potential participants were excluded if they (1) were unwilling (2) had an altered mental status (3) had a companion who refused to leave (4) were too ill (5) were unable to speak English (6) personal contacts of the interviewer.
FINDINGS: 256 completed interviews were returned out of a possible 307 (84.8%). The incidence of domestic violence was 1.2% (95% CI 0.2% to 3.4%). The lifetime prevalence of domestic violence was 22.4% (95% CI 15.6% to 30.4%) among men and 22.1% (95% CI 15.1% to 30.5%) among women. The incidence and prevalence rates of domestic violence were considerably lower than in the US study, but similar to prevalence rates recorded in British community surveys. A significant association was found between reported domestic violence and reported deliberate self harm in women (odds ratio 75.4 95% CI 13.1% to 433.7). There was no significant association between higher use of medical care and domestic violence.
COMMENTS: Domestic violence is common among patients attending for emergency care in the UK. There is a significant association between domestic violence and deliberate self harm in women, further work is required to see if this association is causal. Larger emergency department surveys are required to confirm these results.
Physical child abuse and social change. Judicial intervention in families in the Netherlands, 1960-1995.
Correspondence: Mieke Komen, Department of Criminology, Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Janskerkhof 16, 3512 BM, Utrecht, THE NETHERLANDS; (email: M.Komen@law.uu.nl).
OBJECTIVE: To show changes in the way juvenile judges and judicial child protection workers deal with physical child abuse in the period 1960-1995 in the Netherlands.
METHOD: The study is based on an analysis of files on adolescent and younger children placed by juvenile judges in the Dutch judicial child protection system during the 1960s, 1970s, 1980s, and 1990s.
FINDINGS: The prevalence of very severe physical violence against children was lower in the recent files than in the older files. Spanking and other minor violence acts were noted more often than in the older files. In the 1960s files, the parents talked still rather openly about the physical punishments they used in child rearing. In spite of the growing attention for and increasing concern about child abuse among professionals, judicial child protection workers intervened less harshly in recent cases of physical child abuse than in the 1960s.
COMMENTS: The decrease in severe physical child abuse may indicate that physical child abuse is actually becoming a less serious problem in the Dutch judicial child protection system. But that may not be the case because of the increased reluctance of parents to report and changes in intervention practices. Other than expected, the growing sensibility for child abuse did not mean more effective control by judicial child protection workers. Possible reasons for these changes are discussed, including the strengthening of the position of perpetrators in law proceedings and the emancipation of children and women in society.
Correspondence: B.D. Bhana, Department of Forensic Medicine University of Pretoria Institute of Pathology PO Box 2034 Pretoria 0001 SOUTH AFRICA; (email: babita@med.up.ac.za).
Firearm-related injuries are a leading cause of morbidity and mortality in South Africa. This retrospective autopsy study included all firearm-related fatalities seen at a central mortuary in Durban. These cases had initially been assessed by a clinician before death, from July 1998 to June 1999.A total of 322 cases of fatal gunshot wounds were reviewed. Medical records and postmortem findings were compared by data capture onto a spreadsheet. Twenty-eight cases were excluded because of surgical alteration of the wounds, making autopsy evaluation impossible. In 50.7% of cases, the number of wounds was correctly identified and in 55.1% the position was correctly identified. In only 36.1% of cases were the entry and exit wounds correctly identified. The total number of missed wounds was 504 (48.3% of cases). The majority of missed wounds were on the upper limbs (25%), with the anterior trunk (21.8%) and lower limbs (18.5%) making up the remainder.This study demonstrates that physicians in South Africa do not adequately document and interpret gunshot wounds, which may influence the treatment of the patient and have medicolegal consequences. Emphasis should be placed on undergraduate and postgraduate teaching for physicians to correctly identify, interpret, and document firearm wounds.
Homicide by blunt force in 2 Scandinavian capitals.
In the Oslo and Copenhagen areas, 77 instances of blunt force homicides were committed from 1985-1994, accounting for 18% of all homicides in that 10-year period. Fifty-four (70%) of the victims were male, often killed by an acquaintance during a fight. Almost 70% of the female victims were killed in their own home, whereas that was the case for only 30% of the male victims. The majority of the victims (of both sexes) had been hit in more than 1 region of the body. A female offender was encountered in 4 instances; none of their victims were children. Of the 3 children in the blunt force victim group, 2 were battered children. Many of the victims with a blood alcohol level of 0 turned out to have lived for some time after the injury.
Longitudinal effect of intimate partner abuse on high-risk behavior among adolescents.
Correspondence: Timothy A. Roberts, Division of Adolescent Medicine, Department of Pediatrics and the Division of Epidemiology, University of Rochester School of Medicine, Rochester, NY 14642, USA; (email: timothy_roberts@urmc.rochester.edu).
CONTEXT: To determine the longitudinal effect of abuse by an intimate partner on risk behavior among adolescents.
PARTICIPANTS: Linear regression analyses of longitudinal data from 4443 adolescents surveyed in 1995 (Wave I) and 1996 (Wave II) from the National Longitudinal Study of Adolescent Health Public Use Dataset.
MAIN OUTCOME MEASURES: Abuse was assessed using a 5-point scale measuring if the subject had been insulted in public, sworn at, threatened with violence, pushed or shoved, or had something thrown at them by an intimate partner. The primary outcome measures were changes between Waves I and II in each of the following 5-risk behaviors: illicit substance use, antisocial behavior, violent behavior, suicidal behavior, and depression.
FINDINGS: Abuse between Waves I and II was associated with higher rates of all 5 risk behaviors at both Waves I and II among both sexes. After adjusting for sociodemographic factors, number of intimate partners, time between interviews, baseline risk behavior scores, and the most abusive relationship experienced prior to Wave I, more severe abuse having occurred between Waves I and II was significantly associated with increased levels of depression in both sexes and increased involvement in illicit substance use, antisocial behavior, and suicidal behavior among female adolescents.
COMMENTS: Abuse by an intimate partner is associated with higher levels of risk behavior in both sexes and incident abuse is associated with increased depression in both sexes and increased illicit substance use, antisocial behavior, and suicidal behavior among females. Intimate partner violence interventions should address the negative behaviors associated with abuse, particularly among female adolescents.
Te contaria mi vida: I would tell you my life, if only you would ask.
Universal screening for domestic violence is recommended in many health care settings. This qualitative study was undertaken to explore the thoughts and feelings of Mexican American women regarding being asked questions about domestic violence by a health care provider. We wanted to further explore what characteristics about a nurse, or other health care provider, would give a woman confianza, the trust necessary to discuss this issue. Seven women, who self identified as abused or formerly abused, were recruited from a pool of Spanish-speaking women receiving services from a rural domestic violence agency in the midwestern United States. The researchers found that, given certain characteristics and actions of the health care provider, women welcome the opportunity to discuss this issue. The implications for practice are these: be sincerely present for the client, ask about her life, listen to her response, and when necessary assist her to connect with appropriate domestic violence community services.
