Vehicle-related injuries are the major cause of death and injuries in Hualien County, and driving under the influence of alcohol plays a major role in such crashes. From December 1997 to May 1998, we determined the blood alcohol concentrations (BAC) of injured individuals from vehicle crashes at two emergency departments in Hualien. Nurses were asked to record whether the patient presented with an alcohol odor. The accuracy of detection by nurses was assessed from the BAC and groups with increased prevalence were identified for screening. Of 945 patients assessed, 505 (53.4%) tested positive by BAC and 320 (33.9%) were identified with an alcohol odor. With a BAC threshold of more than 50 mg/dL, detection sensitivity was 75.4%, specificity was 90.4%, and accuracy was 85.0% (95% confidence interval: 82.7, 87.3). Patients with an alcohol odor were significantly more likely to be men, aborigines, or head-injured patients. The accuracy of detection showed no significant difference by gender, head injury, or driver status. We suggest that detection of alcohol odor by nurses may be a feasible assessment of the role of alcohol in road traffic accidents. This may provide essential data for injury prevention strategies and programs.
Alcohol-related health disparities and treatment-related epidemiological findings among whites, blacks, and hispanics in the United States.
Correspondence: Raul Caetano, University of Texas School of Public Health, 5323 Harry Hines Boulevard, Dallas, TX, USA; (email: raul.caetano@utsouthwestern.edu).
This article briefly reviews the alcohol epidemiological evidence on health disparities across whites, blacks, and Hispanics. Compared with whites, Hispanic men have higher rates of alcohol-related problems, intimate partner violence, and cirrhosis mortality; black men have higher rates of intimate partner violence and cirrhosis mortality. All groups see treatment as an appropriate intervention to address alcohol problems, and there also is support for prevention.
Correspondence: Frederick P. Rivara, Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Avenue, Seattle, WA 98104 (email: fpr@u.washington.edu).
There is increasing unanimity on the need to base health interventions on scientific evidence of effectiveness. This movement to evidence-based medicine has expanded beyond the boundaries of traditional personal health care and now includes efforts in nursing, public health, the social sciences, health policy, and health management. In these fields, application of scarce resources to accomplish the greatest good demands that only effective interventions be implemented.
This is certainly true of the field of injury control. The magnitude of the problem is very large, and resources devoted to prevention, treatment, and rehabilitation of trauma are scarce. The argument that an intervention is worthwhile if it "can save just one life" is specious. The same resources applied to an effective intervention might save one hundred or one thousand lives. Moreover, the potential to do harm by implementing ineffective interventions is great. For example, the Cambridge-Somerville Project was an ambitious randomized controlled trial to prevent juvenile delinquency, violence, and injury. Social workers were assigned to visit families of intervention group participants monthly for a mean of 4.5 years to provide concrete services to high-risk boys and to act as their advocates with schools, courts, and other official agencies. When these boys were followed into adulthood, the rate of crime, violence, and untimely death in the intervention group was found to be higher than that in the control group. In another example, treatment of severe traumatic brain injury has traditionally included control of increased intracranial pressure through hyperventilation. However, when subjected to a randomized controlled trial, hyperventilated patients were found to have worse outcomes than patients not undergoing hyperventilation. The hazards of doing the wrong thing are great.
Unintentional Injury during Foreign Travel: A Review.
- McInnes RJ, Williamson LM, Morrison A. J Travel Med 2002; 9(6): 297-307.
Correspondence: Rhona J. McInnes, Midwifery Research Centre, School of Nursing & Midwifery, University of Glasgow, UNITED KINGDOM; (email: unavailable).
Unintentional injury is a global public health problem. In 1990, an estimated 5 million people worldwide died as a result of an injury or poisoning. This accounted for 10% of deaths from all causes that year, and over half of the estimated 900 million years of life lost in 1990 due to premature death.1 Although mortality rates for ischemic heart disease, cerebrovascular disease, and cancer are higher, the majority of people dying of these causes are elderly, with far fewer potential years of life to live. Reasons for the increasing public health importance of injury include the decline of infectious disease, the processes of urbanization, industrialization, motorization, and increased opportunities to travel.
Role of environmental interventions in injury control and prevention.
- Peek-Asa C, Zwerling C. Epidemiol Rev 2003; 25: 77-89.
Correspondence: Corinne Peek-Asa, University of Iowa Injury Prevention Research Center, 100 Oakdale Campus #114 IREH, Iowa City, IA 52242-5000, USA; (email: corinne-peek-asa@uiowa.edu).
Injuries result from transfer of energy to a human host. In the epidemiologic model of infectious disease, microbes are the "agents" of infection. Similarly, in the epidemiologic model of traumatic injury, energy is the "agent" of injury. This model provides a good basis for understanding the role of the environment in the causal pathway for injuries.
Transfer of energy to the host is the final step in the causal pathway for injuries, but many factors influence the nature of this exchange and its consequences. Energy that causes injuries can be in several forms, including kinetic, chemical, or thermal. For example, kinetic energy causes motor-vehicle-related injuries, and thermal energy causes burns. Lack of metabolic energy that occurs through external forces, such as during drowning or suffocation, can also be included in the definition of injuries. Energy can be transferred to a human host through vehicles (inanimate objects such as motor vehicles) or vectors (animate objects such as another human). Some injuries require both a vehicle and a vector, such as a gunshot wound that requires a firearm and ammunition (vehicles) and someone to shoot it (vector).
The potential for energy transfer exists just about everywhere, but certain environmental characteristics increase the potential for injury. If these characteristics can be understood, we may be able to modify the environment to remove or reduce energy transfer. Since humans have designed and constructed most of our environments, it is a logical but often forgotten premise that we can modify this environment to be safer.
The environment is a complex interaction of physical, social, economic, cultural, and demographic features. In this article, we focus primarily on the physical environment. Injury prevention strategies aimed at changing the physical environment are among the most successful injury control interventions. However, successful interventions must always consider the entire causal pathway; thus, the best approaches are multifaceted. This article describes some of the reasons for the success of environmental approaches and provides some examples that describe the many ways that the environment can be modified. We have concentrated on the epidemiologic and public health literature, but further evidence can be found in the engineering, policy, economic, and legal literature. Many more environmental approaches have been implemented than have been evaluated, and we also identify some promising areas of future impact. This article also discusses the difficulty in conducting research evaluations of environmental modifications.
Youth-Violence Prevention in the Aftermath of the San Diego East County School Shootings: A Qualitative Assessment of Community Explanatory Models.
- Palinkas LA, Prussing E, Landsverk J, Reznik V. Ambul Pediatr 2003; 3(5): 246-252.
Correspondence: Lawrence A. Palinkas, Departments of Family and Preventive Medicine, University of California, San Diego, CA, USA; (email: lpalinkas@ucsd.edu).
CONTEXT: In March, 2001, 2 separate incidents of school shootings occurred within the same school district in San Diego's East County.
OBJECTIVE: To examine community explanatory models of the causes of the school shootings and strategies for preventing such events.
DESIGN/METHODS: A qualitative study was undertaken in 4 East County communities over a 6-month period following the 2 events. Semistructured interviews were conducted with 85 community residents identified through maximum variation sampling. Interview transcripts were analyzed by coding consensus, co-occurrence and comparison, using NVivo text analysis software.
FINDINGS: Four sets of theories as to the cause of these events were identified, based on the following: 1) unique or idiosyncratic characteristics of the 2 shooters (newcomer to community who was a victim of bullying, victim of child abuse with a history of mental illness), 2) universal factors (culture of violence, violence in the media), 3) family-centered characteristics (single-parent households, dysfunctional relationships), and 4) community-specific characteristics (reputation for social intolerance, widespread access to guns). Beliefs in family-centered and community-centered theories of etiology were associated with optimism in preventing such events from occurring in the future through increased recognition and response to problem behaviors, while beliefs in idiosyncratic or universal determinants of youth violence were associated with pessimistic assessments of prevention.
COMMENTS: In this community, youth-violence-prevention programs that focus on taking responsibility for recognizing and responding to problem behaviors in at-risk youth are more likely to gain community support and participation than programs that focus on increased security, surveillance, or behavior change.
Home delivery of an injury prevention kit for children in four French cities: a controlled randomized trial.
- Sznajder M, Leduc S, Janvrin MP, Bonnin MH, Aegerter P, Baudier F, Chevallier B. Inj Prev 2003; 9(3): 261-265.
Correspondence: Marc S. Sznajder, Hopital Ambroise Pare, Service de Sante Publique et Information Medicale, 9 avenue Charles de Gaulle, 92100, Boulogne, FRANCE; (email: marc.sznajder@apr.ap-hop-paris.fr).
OBJECTIVES: Home delivery of counselling and safety devices to prevent child injuries could help parents to adopt safe behaviour. The aim of this study was to test a safety kit designed and used in Quebec (Canada). Design and subjects: One hundred families from four towns in the Paris suburbs were visited at home by nurses or doctors when their child reached 6-9 months. Selection criteria were: primipara, medical problem, psychological, and/or socioeconomic difficulties.
INTERVENTIONS: During the first visit, 50 families (group 1) received counselling and a kit including preventive devices and pamphlets about indoor injuries and ways to avoid them. The other 50 families (group 2) received counselling but not the kit. A second home visit was made 6-8 weeks later.
MAIN OUTCOME MEASURES: The number of safety improvements was calculated 6-8 weeks after a first home visit. Perceived usefulness of the kit was collected from families and from interviewers.
FINDINGS: Between the first and the second visits, safety improvement was significantly higher in the group with the kit. This was mainly related to the risk of fall (p<0.02), fire and burns (p<0.001), poisoning (p<0.01), and suffocation (p<0.001). For improvement related to devices provided in the kit, the difference between the groups was significant: 64.4% improvement in group 1 versus 41.2% in group 2 (p<0.01). The relative risk (RR) of safety improvement between groups was 1.56 (95% confidence interval (CI) 1.35 to 1.80). Even for improvements not related to the kit the difference remained significant: 31.2% in group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 (95% CI 1.22 to 1.93).
COMMENTS: Routine home visits by social services offer a good opportunity to tackle child injury prevention. Free delivery of prevention kits and counselling allow families to modify their behaviour and homes so as to reduce risks.
The prevalence and patterns of occupational injury among south Texas high school students.
- Weller NF, Cooper SP, Basen-Engquist K, Kelder SH, Tortolero SR. Tex Med 2003; 99(8): 52-57.
Correspondence: N.F. Weller, Center for Health Promotion and Prevention Research, University of Texas School of Public Health at Houston, USA; (email: unavailable).
High school students frequently work long hours during the school year, increasing their risk of injury. Few studies have examined the relation between work injury and weekly work hours. This paper describes injuries among students in South Texas, where economically disadvantaged Hispanic students are heavily represented. Anonymous surveys were collected from 3565 secondary students in 23 schools. Self-reported data included weekly work hours and type of injury and job when injured. A dose-response effect was observed: increasing weekly work hours were related to injury (1-10 hours, adjusted odds ratio [AOR] = 1.0; 11-20 hours, 1.4; 21+ hours, 1.5), P < .000. The AOR for restaurant work was 3.2; for construction, 3.0; for factory, office, or skilled labor, 2.9; for agriculture, 2.8; for yard work, 2.0; and for babysitting (1.0). Males (OR = 1.5) were more prone to injury. High-intensity weekly work increased the likelihood of injury. Prevention efforts should be targeted to youth to reduce work injuries.
Logging injuries for a 10-year period in Jilin Province of the People's Republic of China.
- Wang J, Bell JL, Grushecky ST. J Safety Res 2003; 34(3): 273-279.
Correspondence: Jingxin Wang, Division of Forestry, West Virginia University, P.O. Box 6125, 26506-6125, Morgantown, WV, USA; (email: jxwang@wvu.edu).
CONTEXT: Logging continues to be a major source of injuries in northeast China. This paper describes logging-related injuries in the Jilin Province of the People's Republic of China.
METHODS: Logging fatalities and nonfatal injuries were summarized from 1981 to 1990 in Jilin. Injury data from 1991 for the entire forestry sector in China were also analyzed.
FINDINGS: Fatalities were mainly from of head injuries and were caused by being struck by an object. Nonfatal injuries were most often to the lower extremities and the head and were normally caused by being struck by an object or a fall or slip. The majority of both fatal and nonfatal logging injuries occurred to workers with less than 1 year of employment and those under 35 years old. Most injuries occurred November through March in Jilin.
COMMENTS: Patterns of logging injury in Jilin of China were similar, but not identical, to those described in other studies of logging injuries worldwide. Methods found to be effective in reducing logging-related injuries in other parts of the world might be used in China to reduce the injuries associated with logging.
In England the use of bicycle helmets remains low as debate continues about their effectiveness. Time trend studies have previously shown an inverse association between helmet wearing rates and hospital admissions for head injury, but data on helmet wearing are often sparse and admission rates vary for numerous reasons. For the period of this study comprehensive data on helmet wearing are available, and pedestrians are used as a control to monitor trends in admission. Among cyclists admitted to hospital, the percentage with head injury reduced from 27.9% (n = 3070) to 20.4% (n = 2154), as helmet wearing rose from 16.0% to 21.8%. Pedestrian head injury admissions also declined but by a significantly smaller amount. The wearing of a cycle helmet is estimated to prevent 60% of head injuries.
Safety in numbers: more walkers and bicyclists, safer walking and bicycling.
OBJECTIVE: To examine the relationship between the numbers of people walking or bicycling and the frequency of collisions between motorists and walkers or bicyclists. The common wisdom holds that the number of collisions varies directly with the amount of walking and bicycling. However, three published analyses of collision rates at specific intersections found a non-linear relationship, such that collisions rates declined with increases in the numbers of people walking or bicycling.
DATA: This paper uses five additional data sets (three population level and two time series) to compare the amount of walking or bicycling and the injuries incurring in collisions with motor vehicles.
FINDINGS: The likelihood that a given person walking or bicycling will be struck by a motorist varies inversely with the amount of walking or bicycling. This pattern is consistent across communities of varying size, from specific intersections to cities and countries, and across time periods.
DISCUSSION: This result is unexpected. Since it is unlikely that the people walking and bicycling become more cautious if their numbers are larger, it indicates that the behavior of motorists controls the likelihood of collisions with people walking and bicycling. It appears that motorists adjust their behavior in the presence of people walking and bicycling. There is an urgent need for further exploration of the human factors controlling motorist behavior in the presence of people walking and bicycling.
COMMENTS: A motorist is less likely to collide with a person walking and bicycling if more people walk or bicycle. Policies that increase the numbers of people walking and bicycling appear to be an effective route to improving the safety of people walking and bicycling.
Urban Sprawl as a Risk Factor in Motor Vehicle Occupant and Pedestrian Fatalities
- Ewing R, Schieber RA, Zegeer CV. Am J Public Health 2003; 93(9): 1541-1545.
Correspondence: Reid Ewing, National Center for Smart Growth, Preimkert Field House, University of Maryland, College Park, MD 20742, USA; (email: unavailable).
OBJECTIVES: We sought to determine the association between urban sprawl and traffic fatalities.
METHODS: We created a sprawl index by applying principal components analysis to data for 448 US counties in the largest 101 metropolitan areas. Regression analysis was used to determine associations between the index and traffic fatalities.
FINDINGS: For every 1% increase in the index (i.e., more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% (P < .001) and pedestrian fatality rates fell by 1.47% to 3.56%, after adjustment for pedestrian exposure (P < .001).
COMMENTS: Urban sprawl was directly related to traffic fatalities and pedestrian fatalities. Subsequent studies should investigate relationships at a finer geographic scale and should strive to improve on the measure of exposure used to adjust pedestrian fatality rates.
Correspondence: David C. Schwebel, Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham, Alabama 35294, USA; (email: schwebel@uab.edu).
OBJECTIVE: Unintentional injuries, the leading cause of pediatric mortality, are caused by a complex set of intrapersonal and environmental factors. The role of three critical variables- parental supervision, children's temperament, and estimation of children's physical abilities- was examined.
METHODS: Sixty-four 6- and 8-year-old children completed a laboratory experiment with a parent. Both children and parents judged the child's ability to complete reaching, stepping, and crouching tasks. Parents also completed a parent-report measure of children's temperament.
FINDINGS: Both children and parents overestimated children's ability, although children did so more than parents. Parents of temperamentally impulsive and undercontrolled children judged that their children could complete tasks that were actually beyond the child's ability. Temperament also affected children's judgments while parents were known to be present or absent: Temperamentally impulsive and undercontrolled children were more accurate in their judgments when parents were standing next to them than when parents were hidden from view behind a one-way mirror.
COMMENTS: The mechanism by which parental supervision might protect children from injury appears to be at least twofold: (a) Parents overestimate children's ability less frequently than children themselves, suggesting supervising parents could intervene to prevent children from attempting dangerous activities; and (b) children judge their physical abilities more cautiously when parents are present. Implications for temperament theory and for injury prevention are discussed.
Correspondence: James Johnson, USA Swimming National Team Physician, Southern Sports Medicine, 2021 Church Street, Suite 200, Nashville, TN 37203, USA; (email: jjohnson@southernsportsmed.com).
Illness and injury can significantly limit a swimmer's participation in training and competition. Catastrophic injuries to the neck and risk of drowning are life threatening. Infectious illness can cause significant time out of the water and an even longer convalescence. When injuries to the shoulder, back, and knee become chronic, these overuse injuries can affect performance despite continued cross-training. By identifying the risks for swimming injury and illness, and implementing prevention strategies, the physician can help keep swimmers in the water.
Oro-facial injury and mouthguard usage by athletes in Nigeria.
Correspondence: C.O. Onyeaso, Department of Preventive Dentistry, College of Medicine, University of Ibadan, Ibadan, NIGERIA; (email: Coonyeaso@yahoo.com).
OBJECTIVE: To determine the extent of awareness concerning mouthguard use for sports as well as the amount and type of oro-facial trauma associated with sporting activities among Nigerian athletes.
DESIGN: A questionnaire survey.
METHODS: A questionnaire was completed by 273 athletes (91% completion rate) who participated in the National Sports festival in May 2002 in Benin City, Nigeria. The sample was representative of all the 36 states in Nigeria including the Federal capital territory, Abuja. Descriptive statistics were employed and the data were further analysed using the chi-square test.
FINDINGS: Awareness concerning mouthguards was claimed by 226 (82.8%) of the athletes but significantly fewer athletes who claimed awareness of the devices were using them. Only 93 (41.2%) of this mouthguard-aware group knew of the three types of mouthguard available. Of all the respondents, 131 (48.0%) believed that wearing mouthguards would reduce the prevalence and/or severity of oro-facial injuries during sports. In all, 158 (57.9%) of them had one form of oro-facial injury or the other with contact sports accounting for most of them (78.5%) while 21.5% resulted from non-contact events. The prevalence of oro-facial injuries was significantly lower while wearing mouth protectors.
COMMENTS: Although the majority of the athletes claimed awareness of mouthguards, less than one-third used them. Over half of the athletes were not sure that mouthguards could reduce the prevalence and/or severity of oro-facial injuries. There is need to educate the athletes more concerning mouthguards.
Correspondence: Shauna Sherker, Monash University Accident Research Centre, PO Box 70A, Monash University, VIC 3800, AUSTRALIA; (email: shauna.sherker@general.monash.edu.au).
OBJECTIVES: To present the development of a novel multidisciplinary method to investigate physical risk factors for playground related arm fracture.
CONTEXT: Previous playground injury research has been limited in its ability to determine risk factors for arm fractures, despite their common and costly occurrence. Biomechanical studies have focused exclusively on head injury. Few epidemiological studies have quantified surface impact attenuation and none have investigated specific injury outcomes such as arm fracture.
DESIGN: An unmatched case-control study design was developed. An instrumented child dummy and rig were designed to simulate real playground falls in situ. Validated output from the dummy was used to quantify arm load. Other field measurements included equipment height, fall height, surface depth, headform deceleration, and head injury criterion.
DISCUSSION: Validated methods of biomechanics and epidemiology were combined in a robust design. The principle strength of this method was the use of a multidisciplinary approach to identify and quantify risk and protective factors for arm fracture in falls from playground equipment. Application of this method will enable countermeasures for prevention of playground related arm fracture to be developed.
A human model for road safety: from geometrical acquisition to model validation with radioss.
- Behr M, Arnoux PJ, Serre T, Bidal S, Kang HS, Thollon L, Cavallero C, Kayvantash K, Brunet C. Comput Methods Biomech Biomed Engin 2003; 6(4): 263-273.
Correspondence: M. Behr, Laboratoire de Biomecanique Appliquee (LBA) UMRT24 INRETS/Univ. Mediterranee Fac. Medecine Nord Bd. P. Dramard 13916 Marseille FRANCE; (email: unavailable).
In order to investigate injury mechanisms, and to provide directions for road safety system improvements, the HUMOS project has lead to the development of a 3D finite element model of the human body in driving position. The model geometry was obtained from a 50th percentile adult male. It includes the description of all compact and trabecular bones, ligaments, tendons, skin, muscles and internal organs. Material properties were based on literature data and specific experiments performed for the project. The validation of the HUMOS model was first achieved on isolated segments and then on the whole model in both frontal and lateral impact situations. HUMOS responses were in good agreement with the experimental data used in the model validation and offers now a wide range of applications from crash simulation, optimization of safety systems, to biomedical and ergonomics.
OBJECTIVE: To evaluate trends in hospitalization after injuries in the USA.
DESIGN: National Hospital Discharge Survey data from 1979 to 2000 were evaluated annually by age group, sex, injury severity score (ISS), length of stay, and discharge destination. Setting and subjects: National probability sample of hospitalized patients.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: Incidence, duration, outcome, and population based rates of hospital admission after injuries.
FINDINGS: The number of young males admitted to hospitals after injuries has decreased dramatically; older females are now the group most frequently admitted. Total days in the hospital have decreased in all age groups, but have declined less in the older population than in the younger population; furthermore, most patients aged 65 and over were formerly discharged home, but now most are discharged to long term care facilities. Overall hospitalization rates after injury have decreased in all age groups, but have declined less in the older population; furthermore, male and female hospitalization rates for serious injury (ISS at least 9, excluding isolated hip fracture) are decreasing in younger age groups while increasing in older age groups.
COMMENTS: Older patients comprise a growing proportion of injuries requiring hospitalization. Trauma systems must address this change, and preventing injuries in older people is increasingly important.
Injury and frequency of use of playground equipment in public schools and parks in Brisbane, Australia.
Correspondence: Jim Nixon, Department of Paediatrics and Child Health, Royal Childrens Hospital, Herston, QLD 4029, AUSTRALIA; (email: j.nixon@uq.edu.au).
OBJECTIVE: The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment.
METHODS: Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children's hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated.
FINDINGS: The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100 000 and 0.26/100 000 uses of equipment, respectively.
COMMENTS: This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100 000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.
Injuries among disabled children: a study from Greece.
- Petridou E, Kedikoglou S, Andrie E, Farmakakis T, Tsiga A, Angelopoulos M, Dessypris N, Trichopoulos D. Inj Prev 2003; 9(3): 226-230.
Correspondence: Eleni Petridou, Associate Professor Eleni Petridou, Department of Hygiene and Epidemiology, Athens University Medical School, 75 Mikras Asias str, Goudi, Athens 115-127, GREECE;
(email: epetrid@med.uoa.gr).
OBJECTIVE: To compare the differential implications of sociodemographic and situational factors on the risk of injury among disabled and non-disabled children.
DESIGN: Data from the Emergency Department Injury Surveillance System (EDISS) were used to compare, in a quasi case-control approach, injured children with or without disability with respect to sociodemographic, event and injury variables, and to estimate adjusted odds ratios for the injury in a disabled rather than a non-disabled child.
SETTING: Two teaching hospitals in Athens and two district hospitals in the countryside that participate in the EDISS.
PATIENTS: In the five year period 1996-2000, 110 066 children were recorded with injuries; 251 among them were identified as having a motor/psychomotor or sensory disability before the injury event.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: Mechanism of injury, type of injury, risk-predisposing socioeconomic and environmental variables, odds ratio for injury occurrence.
FINDINGS: Falls and brain concussion are proportionally more common among disabled children, whereas upper limb and overexertion injuries are less common among them. Urban environment, migrant status, and cold months are also associated with increased odds for injuries to occur among disabled rather than non-disabled children. The odds ratio for the occurrence of an injury among disabled children increases with increasing age.
COMMENTS: The results of the study provide the information for the targeting of trials of preventive measure in disabled children at increased risk of severe injuries.
Childhood fractures in Bergen, Norway: identifying high-risk groups and activities.
Correspondence: Christina Brudvik, Bergen Accident and Emergency Department and Dagger Haukeland University Hospital, Institute of Surgical Sciences, University of Bergen, Bergen, NORWAY; (email: christina.brudvik@kir.uib.no).
In 1998 the authors conducted a prospective registration of children younger than 16 presenting with a new traumatic fracture in the city of Bergen, Norway. In this epidemiologic study, the authors registered a total of 1.725 fractures in children; the fracture incidence was 245 per 10,000 children below the age of 16. One fifth needed reduction, and the distal radius was the most common fracture site (27%). Activities associated with fracture were mostly soccer and bicycling, but compared with the total number of injuries associated with each activity, we found a doubled risk of fractures during rollerblading/skating or snowboarding (60%) compared with playing soccer (38%) or bicycling (33%). Scaphoid fracture, an infrequent fracture in children, was seen in 9% of all fractures due to rollerblading/skating. There was a doubled risk of fracture in boys aged 13 to 15 compared with their female peers. To make fracture prevention more efficient, it should be targeted at this risk group and these high-risk activities. Protection of the wrist region might prevent the most common fractures.
OBJECTIVE: To describe the farm work patterns and the relationship between hours spent working on specific farm tasks and task specific work related injuries among women and men.
DESIGN: A cross sectional survey of farm operators and their spouses in an eight county area of Colorado was conducted. Personal interviews were conducted between 1993 and 1997. Interviews took between 45 minutes to two hours to complete, depending on the complexity of individuals' personal histories. Farms were selected using stratified random sampling technique.
SETTING: Eight counties in Northeastern Colorado representing 47% of agricultural production in the state.
PARTICIPANTS: A total of 301 women and 459 men who were farm residents and involved in farm work were recruited.
OUTCOME MEASURE: Self reported injuries resulting in medical attention or treatment other than first aid, or inability to do normal work activities, or loss of consciousness, or transfer to another job were assessed in relationship to the specific job task being performed at the time of the injury.
FINDINGS: Women were at higher risk for injury than men when involved with other farm chores (rate ratio 8.18). For all other task related injuries, men and women were at similar risk when compared using hours of exposure to the farm tasks.
COMMENTS: Farm safety training and injury prevention programs need to include women working on farms.
Identification of risk factors for non-fatal child injury in a rural area: Keokuk County Rural Health Study.
Correspondence: David L Nordstrom, Department of Family Medicine, University of Wisconsin-Madison Medical School, 777 S Mills Street, Madison, WI 53715, USA; (email: dnordstr@fammed.wisc.edu).
OBJECTIVE: To identify risk factors for non-fatal injury among rural children.
DESIGN: Cross sectional health interview survey, 1994-98.
SETTING: A rural Iowa county, not adjacent to a metropolitan area.
SUBJECTS: Stratified, random sample of households, including all resident children and adults.
MAIN OUTCOME MEASURES: Injury episodes in the past 12 months among children aged 0-17 years and the parental and child characteristics associated with these episodes.
FINDINGS: Of the 621 children in participating households, 137 or 22.1% were injured during the past 12 months. Children age 5-17 on a sports team were 1.88 times (95% confidence interval (CI) 1.07 to 3.31) more likely than other children to be injured. Children age 12-17 who binge drink were 3.50 times (95% CI 1.31 to 9.50) more likely than other children to be injured. Compared with children not on sports teams, girls on teams were 2.26 times (95% CI 1.02 to 5.13) more likely while boys on teams were 1.60 times (95% CI 0.71 to 3.68) more likely to have an injury episode. Compared with children who did not binge drink, girls binge drinking were 8.11 times (95% CI 1.52 to 43.33) more likely while boys binge drinking were 2.19 times (95% CI 0.70 to 6.84) more likely to have an injury episode.
COMMENTS: Local studies such as this can provide useful clues regarding the etiology of injury. Some known and some new potential risk factors including behavioral aspects for childhood non-fatal injury in a very rural area were investigated. It is planned to address these cross sectional findings in future longitudinal follow up of this population.
School sport is a major cause of injury in the post-primary age group. The importance of primary prevention in sport has been identified; however secondary prevention of school related sport injury has not been described in Ireland. A random sample of 450 schools in Northern Ireland and the Republic of Ireland was studied using a postal questionnaire. Current management of sport injury, with particular interest in the expertise and training of teachers and coaches, was explored. Replies were received from 333 (74%) schools. There was no physical education teacher with up to date first aid training in 37% schools. Immediate care in terms of mechanisms and equipment to deal with injury was available in 35%-81% of schools responding. Correct response ranged from 65%-90% to four scenarios: commonly presenting yet potentially serious management problems. This study demonstrated deficiencies in sport injury care. In addition to concern about current training, a need for basic life support training is highlighted. These findings have implications for the prevention of school sports injuries.
Design and implementation of injury prevention curricula for elementary schools: lessons learned.
- Azeredo R, Stephens-Stidham S. Inj Prev 2003; 9(3): 274-278.
Correspondence: Ruth Azeredo, Injury Prevention Service, Oklahoma State Department of Health, 1000 NE 10th Street, Oklahoma City, OK 73117, USA; (email: rutha@health.state.ok.us).
OBJECTIVES: Project objectives were to: (1) design and produce an easy-to-use, replicable comprehensive injury prevention curriculum for elementary schools; (2) pilot the program to determine instructors' ease in teaching the material and its usefulness in enhancing student knowledge and behavior change; (3) present material in subject-integrated, grade-specific lessons that would meet state and national student learning objectives; and (4) submit and obtain adoption of the curriculum by the State Department of Education.
METHODS: A pilot program was developed, implemented, and evaluated in six intervention and six control schools. The curriculum was revised and implemented in five other schools and finalized according to evaluation results and teachers' and parents' suggestions. Community resources such as police, fire, and county health departments participated in program implementation.
FINDINGS: The program showed a significant increase from 21% to 36% in seatbelt use during the school year in program schools compared with a 1% decrease in control schools. Bicycle helmet use increased from 0% to 10% in the program schools. Pre-test and post-test results showed significant differences in student knowledge, attitudes, and behaviors within the program schools, and in comparing the program and control schools. On a Likert scale of 1 (poor) to 7 (excellent), teachers rated lesson content, exercises, and the usefulness of materials and resources as 5.8, 5.5, and 5.4, respectively. Evaluations for the revised curricula ranged from 5.7 to 6.2.
COMMENTS: The favorable evaluation results resulted in the adoption of the curriculum as a state textbook, and widespread teaching of the curriculum. The product is appropriate and efficacious in these elementary schools and their communities.
Suicidal behaviour and risk factors in children and adolescents in Jamaica.
- Pottinger AM, Milbourn PE, Leiba J. West Indian Med J 2003; 52(2): 127-130.
Correspondence: A.M. Pottinger, Department of Obstetrics, Gynaecology and Child Health, University of the West Indies, Bustamante Hospital for Children, Kinston, Jamaica, WEST INDIES; (email: pottsie@cwjamaica.com).
Suicidal attempts and ideation were examined in children attending child and adolescent mental health clinics in the Kingston Metropolitan Area during October 1998 to September 1999. The case records of fifty-seven 6-18 year-olds were selected for review in order to identify social and familial factors that place Jamaican children and adolescents at risk for suicidal behaviour. In addition, in order to examine the consistency of risk factors, data from child and adolescent mental health clinics were compared over a ten-year period between 1989 and 1999. The results indicated that having a poor relationship with the primary caregiver was significantly associated with suicidal behaviour (p < 0.01) as well as experiencing abuse (p < 0.05). These children also tended to externalize their behaviours (p < 0.01). The findings suggest that, over the ten-year period, Jamaican children seem to be more readily talking about, contemplating and attempting, suicide. The importance of managing intrafamilial issues affecting children is highlighted.
Staff knowledge and attitudes towards deliberate self-harm in adolescents.
- Crawford T, Geraghty W, Street K, Simonoff E. J Adolesc 2003; 26(5): 619-629.
Correspondence: Tanya Crawford, Department of Child and Adolescent Psychiatry, Guy's, King's and St. Thomas' Medical School and Institute of Psychiatry, King's College, London, UK; (email: tanya.crawford@kcl.ac.uk).
This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm. A questionnaire survey was completed by 126 health professionals working with adolescents who harm themselves. The main outcome measures were a knowledge measure and three attitude measures (generated using factor analysis). The mean percentage of correctly answered knowledge questions, across all professional groups, was 60%. With regard to knowlege, over three-quarters of participants were unaware that homosexual young men and those who had been sexually abused are at greater risk of DSH, whilst one third of staff were unaware that adolescents who self-harm are at increased risk of suicide. Staff who felt more effective felt less negative towards this group of patients (B=-0.21, p=0.03). Forty-two per cent of the participants wanted further training in DSH amongst adolescents.
OBJECTIVES: Latino children are more likely to be unrestrained passengers in motor vehicles than non-Latino children, but little is known about the use of booster seats in Latino families. This study investigates Latino parents' knowledge, attitudes and beliefs about booster seats, barriers to booster seat use, and effective strategies for message delivery in the Latino community.
METHODS: Two focus groups were conducted with Spanish speaking parents. Information was obtained through a written survey and moderated discussions.
FINDINGS: Parents were widely misinformed about recommended guidelines for booster seat use, and the majority of participants did not own a booster seat. Parents identified a lack of information, the cost of booster seats, resistance to use by the child or the father, limited space in the vehicle, and unavailability of shoulder belts as barriers to booster seat use. Participants felt that learning more about the new Washington state booster seat law and its consequences would increase booster seat use. Public health messages felt to be effective were those in Spanish, delivered by credible spokespeople such as physicians and teachers, and utilizing the Spanish media.
COMMENTS: Campaigns to promote booster seats in the Latino community should be culturally specific, and clear guidelines for booster seat use should be given in Spanish. Legislation may be an important incentive for using booster seats, though reducing their cost and providing strategies to address child resistance and physical constraints of some vehicles are also important.
Adolescent driver risk taking and driver education: Evidence of a mobility bias in public policymaking.
CONTEXT: Road traffic injury is the leading cause of death among adolescents in high-income countries. Researchers attribute this threat to driver risk taking, which driver education (DE) attempts to reduce. Many North American authorities grant DE graduates earlier access to unsupervised driving despite no evidence of this being a safety benefit. This theoretical article examines risk taking and DE in relation to an apparent mobility bias (MB) in policymaking.
METHOD: The MB is defined, the history and sources of driver risk taking are examined, and the failure of DE to reduce collision risk is analyzed in relation to a potential MB in licensing policies.
COMMENTS: The author argues that DE's failure to reduce adolescent collision risk is associated with a MB that has produced insufficient research into DE programs and that influences public policymakers to grant earlier licensure to DE graduates. Recommendations are made regarding future research on DE and risk taking, coordinated improvements to DE and driver licensing, and a plan to reduce collision risk by encouraging parental supervision after adolescent licensure.
IMPACT ON INDUSTRY: Research on adolescent driver risk taking would have direct applications in DE curricula development, driver's license evaluation criteria, graduated licensing (GDL) policies, as well as other aspects of human factor research into the crash-risk problem.
Nighttime driving, passenger transport, and injury crash rates of young drivers.
Correspondence: Thomas M Rice, Southern California Injury Prevention Research Center, University of California, Los Angeles, School of Public Health, 10911 Weyburn Avenue, Suite 200, Los Angeles, CA 90024, USA; (email: tr@ucla.edu).
OBJECTIVE: This study examines the association of nighttime driving and the carrying of passengers with the rate of motor vehicle crashes that resulted in severe or fatal injury to young drivers in California before the implementation of a graduated licensing system.
METHOD: Passenger vehicle drivers aged 16 or 17 involved in injury crashes in California from 1 January 1993 to 30 June 1998 were identified through a police crash database. An induced exposure method was used to estimate driving exposure. Odds ratios for driver injury crashes were estimated with logistic regression.
FINDINGS: Driving at night, driving without adult supervision, driving with passengers, using alcohol, being 16, and being male were associated with high rates of driver injury crash.
COMMENTS: The injury crash rate for drivers aged 16 or 17 increases during nighttime hours and in the absence of adult supervision, with or without other passengers. Driving between 10 pm and midnight is particularly dangerous for young drivers. Nighttime driving restrictions that begin at 10 pm or earlier and restrictions on carrying passengers at any hour may increase the effectiveness of graduated licensing systems.
CONTEXT: Migration, particularly when associated with exposure to organized violence, can seriously affect mental and physical health in ways that are not obvious. This study considers the clinical impact of organized violence on emotional and somatic problems encountered in the course of primary health care.
METHODS: Migrant patients from Bosnia (n=36) and Turkey (n=62) in primary care were recruited into the study and divided into two groups: male and female migrants of both countries who reported experience of organized violence and those who did not. Symptom profiles and patterns of distress were compared between those with and without experience of organized violence.
FINDINGS: Somatic and emotional problems, such as diffuse pain, numbness in arms and legs, stress, flashbacks, disturbed sleep and nightmares were reported significantly more often by violence survivors than by the control group. Also associated with experience of organized violence were higher frequencies of reported emotional problems, such as feeling out of balance in the previous months, extreme sadness and difficulties settling in Switzerland. Among the men, more than 62% of the violence survivors reported thoughts of self-harm compared with 11% of the control group whereas thoughts of self-harm among the women were more associated with the uncertain legal status in Switzerland than with violence experience.
COMMENTS: Exposure to organized violence contributed to increased health problems of these migrant patients who were presenting in primary care. A useful feature of this research should also be incorporated into clinical practice. Consideration of relevant aspects of patients' social experience, including victimization by violence, requires attention not only to spontaneous accounts in the course of history taking but also focused queries to clarify such questions.
Impact of police-reported intimate partner violence during pregnancy on birth outcomes.
Correspondence: Sherry Lipsky, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA; (email: lipsky@u.washington.edu).
To examine the relationship of police-reported intimate partner violence during pregnancy and adverse birth outcomes. We conducted a population-based, retrospective, cohort study in Seattle, Washington, using Seattle police data and Washington State birth certificate files from January 1995 through September 1999. Exposed subjects were women with an intimate partner violence incident reported to police during pregnancy and who subsequently had a singleton live birth or fetal death registered in the state of Washington. Unexposed subjects were randomly selected Seattle residents with a singleton live birth or fetal death in the same time period and who did not report an incident. The main outcome measures were low birth weight (LBW less than 2500 g), very LBW (VLBW less than 1500 g), preterm birth (20-36 weeks' gestation), very preterm birth (20-31 weeks), and neonatal death (before discharge).Women reporting any partner violence during pregnancy were significantly more likely to have a LBW infant (adjusted odds ratio [aOR] 1.70; 95% confidence interval [CI] 1.20, 2.40), a VLBW infant (aOR 2.54; 95% CI 1.32, 4.91), a preterm birth (aOR 1.61; 95% CI 1.14, 2.28), a very preterm birth (aOR 3.71; 95% CI 1.80, 7.63), and a neonatal death (aOR 3.49; 95% CI 1.43, 8.50).Police-reported partner violence during pregnancy is significantly associated with an increased risk of adverse birth outcomes. There is a critical need to identify pregnancy among women with reported incidents and to provide women health and social service information and referrals, particularly referrals to high-risk pregnancy programs.
In recent years suicide bombings have became a part of life in Israel. Adolescents seem to be more vulnerable to the issues of life and death since they have to choose psychologically whether to live or die ("the fourth organizer"). The reaction to terrorism in this age group is unique. After September 11th, a great interest on the subject has arisen in the United States and some new data has been gathered. One of the important messages is that terrorism does not simply equal trauma. The aim of this article is to review current literature on emotional reaction, impact, and therapeutic strategies to terrorism in the adolescent population.
Severity of violence against women correlates with behavioral problems in their children.
- Lemmey D, Malecha A, McFarlane J, Willson P, Watson K, Gist JH, Fredland N, Schultz P. Pediatr Nurs 2001; 27(3): 265-270.
Correspondence: D. Lemmey, Lakeland Community College, Painesville, OH, USA; (email: unavailable).
In order to examine the type and severity of violence against women by intimate partners and the associated behavioral problems of their children, 83 abused women were interviewed when they presented to the criminal justice system for protective orders or to file assault charges. Two questionnaires were administered: (a) the 46-item Severity of Violence Against Women Scale (SVAWS) measured threats of abuse and actual physical violence, and (b) the 118-item Child Behavior Checklist (CBCL) measured child behavior problems for children between the ages of 4 and 18.
Correspondence: J. Merrick, National Institute of Child Health and Human Development, Division of Community Health, Zusman Child Development Center, Ben Gurion University, Beer-Sheva, ISRAEL; (email: jmerrick@intranet-zahav.net).
Adolescent or youth violence is a very visible violence in modern society and in 1996 the World Health Assembly declared violence a leading public health issue. In order to understand the scope of the problem, we looked at the epidemiology of global adolescent violence. In 2000 it was estimated that 199,000 adolescent homicides (9.2 per 100,000) occurred globally or about 565 adolescents died each day due to interpersonal violence with variations around the globe. One type of prevention program that has proven effective is prenatal and early childhood home visitation with long-term follow-up that has shown to be cost effective.
