The prevalence of pregnancy, substance abuse, violence, and delinquency among young people is unacceptably high. Interventions for preventing problems in large numbers of youth require more than individual psychological interventions. Successful interventions include the involvement of prevention practitioners and community residents in community-level interventions. The potential of community-level interventions is illustrated by a number of successful studies. However, more inclusive reviews and multisite comparisons show that although there have been successes, many interventions did not demonstrate results. The road to greater success includes prevention science and newer community-centered models of accountability and technical assistance systems for prevention.
Correspondence: Harry Severance, Division of Emergency Medicine, Department of Surgery, Department of Medicine, Duke University Medical Center, USA; (email: harry.severance@.duke.edu).
Bombings and other blast-related events place severe demands on pre-hospital and in-hospital systems. The resulting surge of victims can overwhelm the resources of any facility not prepared for such an event. The September 11 terrorist attacks underscore the urgency of our need for preparedness. The challenges become even more daunting when there is possible hazmat exposure as well; this means that adequate and rapid disposition of victims is even more critical in order to avoid contamination of hospitals systems or whole communities. Federal agencies have been designated and federal mandates have been issued to address mass casualty events, but federal or even regional systems cannot respond in time to address the massive and immediate needs generated by an explosion. Local communities must take the lead in developing incident command systems for initial management of such events. Hospital and pre-hospital providers play a key role in such planning. Ultimate management and disposition of large numbers of casualties, especially if contaminated, cannot follow standard patient management protocols; new protocols are needed. To avoid a total, overwhelming break down of in-hospital resources, hospitals need to assume a lead role in addressing such issues in their local communities.
National surveys have reported information on firearm ownership and storage practices, but primary care physicians question whether such information can be generalized to their communities and the patient populations they serve. In this study, an anonymous survey was distributed to 100 consecutive patients in 11 primary care clinics throughout Wisconsin. Demographic information and information on the patient's willingness to have firearm safety discussed as part of their routine care, firearm ownership in the household, firearm storage practices, and the patient's purpose for owning firearms were collected. The study found that patients were willing to answer anonymous survey questions about firearm ownership and storage in their homes. The most effective screening question on gun safety was whether firearms were kept in the home for personal protection. Patients at rural clinics were more likely to own firearms than patients in urban clinics. Keeping firearms for recreational purposes was more common than keeping them for personal protection, which was associated with unsafe storage practices. A majority of patients reported not wanting to receive information on firearm safety from their physician. Overall, the study found that it was not possible to generalize national information on firearm ownership and storage to surveyed patients of primary care clinics in Wisconsin.
The risk for the development of musculoskeletal disorders and associated conditions in clerical and office workers is well documented. The majority of work injury prevention programs for this population were single-faceted (education, workstation redesign, or task modification) and yielded both positive and negative findings. This pilot study was conducted with 16 full-time clerical and office workers at a small private college. In a randomized control trial, the intervention group received four hours of individualized training through a multi-faceted injury prevention program. Between group differences in musculoskeletal symptom frequency and intensity and perceived stress and energy levels existed, although were statistically insignificant. There was a statistically significant decrease in Lower Back ache/pain from pre to post measures for the intervention group.
See Item 1 under Risk Factor Prevalence, Injury Occurrence, and Costs
See Item 2 under Rural and Agricultural Safety Issues
Bicyclist and pedestrian injuries in collisions with vehicles in Japan were investigated based on national and in-depth accident data analyses and mathematical simulations. In an impact with a bonnet-type vehicle, a bicyclist slides over the bonnet of the vehicle, behavior that is not observed for pedestrians. As a result, the bicyclist's head tends to strike a bonnet-type vehicle at a more rearward location in comparison with pedestrians. The first contact position of a bicycle with a vehicle, the vehicle front-end geometry and the bicycle velocity affect whether the bicyclist's head strikes the vehicle or not. Due to the bent-knee posture of a bicyclist's legs, the types of leg injuries sustained by bicyclists and their causes differ from those seen for pedestrians. Component test procedures have been proposed for evaluating pedestrian safety, but some modifications of the head impact area and angle are necessary when applying these methods to bicyclists.
Correspondence: Mai-Britt Herslund, Centre for Traffic and Transport, Technical University of Denmark, Building 115, DK-2800, Lyngby, DENMARK; (email: mh@ctt.dtu.dk).
Danish studies of traffic accidents at priority intersections have shown a particular type of accidents. In these accidents a car driver supposed to give way has collided with a bicycle rider on the priority road. Often the involved car drivers have maintained that they did not see the bicycle until immediately before the collision even though the bicycle must have been clearly visible.Similar types of accidents have been the subject of studies elsewhere. In literature they are labelled "looked-but-failed-to-see", because it seems clear that in many cases the car drivers have actually been looking in the direction where the other parties were but have not seen (i.e. perceived the presence of) the other road user. This paper describes two studies approaching this problem.One study is based on 10 self-reported near accidents. It does show that "looked-but-failed-to-see" events do occur, especially for well experienced drivers. The other study based on Gap Acceptance shows that the car driver acceptance of gaps towards cyclists depends on whether or not another car is present. Hypotheses for driver perception and for accident countermeasures are discussed.
Assessing the Brazilian network of poison control centers
- Marques MB, Bortoletto Ml M, Bezerra MC, Santana RA. Cad Saude Publica 1995; 11(4): 560-578.
Correspondence: M.B. Marques, N cleo de Estudos em Ci ncia a Tecnologia, Centro de Informa o Cient lica a Tecnol gica, Funda o Oswaldo Cruz, Rio de Janeiro, RJ, 21041-210, BRAZIL; (email: unavailable).
General concern about increasing reports of emergencies caused by or attributed to the exposure of human beings to various toxic agents has created demand for assessing the informational performance of a Brazilian network of 34 poison control centers (PCCs), located in different regions of the country and pertaining to the National Poison Information System (SINITOX). The primary purpose of these PCCs is to inform the public, prevent cases of poisoning, and provide medical care. This paper analyzes the available resources for identifying cases of poisoning, preventing new occurences, and monitoring the consequences of toxic agents. This paper also analyzes data recorded front 1990 to 1992. The objective is to identify the main constraints to using health-data and management information as decision-making tools at the local level.
Behavioral aspects of trauma in children and youth.
- Spates CR, Waller S, Samaraweera N, Plaisier B. Pediatr Clin North Am 2003; 50(4): 901-918.
Correspondence: Richard Spates, Department of Psychology, Western Michigan University, 3500 Wood Hall, Kalamazoo, MI 49008, USA; (email: richard.spates@wmich.edu).
Trauma is prevalent in the lives of children. It derives from many sources, and, depending on its characteristics, can produce transient or enduring and devastating consequences. Early trauma, if left untreated, can set the stage for chronic deficits in the behavioral repertoires of affected children, and thus shape personality development. Additionally, when trauma is repetitive and chronic, the developing brain may be affected in ways that impede otherwise effective intervention. Yet diagnosing traumatic stress in children requires a departure from exclusively adult-like considerations and attention must be devoted to the ongoing developmental processes. Trauma-associated clinical features in children are sharply distinct from those that are associated with adult traumatization and must be taken into account from screening and diagnosis through treatment and outcome evaluation. We suggest that a learning foundation for symptom development will best assist the identification and selection of efficacious treatments. Pediatricians should make use of validated screening procedures that effectively identify affected children to facilitate timely referral and ongoing monitoring of treatment outcomes for their patients. A representative list of such instruments can be found in Table 1. With respect to hospital-based trauma work, we suggest the following recommendations: Professionals must be alert to the presence of acute stress symptoms in any child or parent after all injury incidents. These symptoms may occur in any injured child regardless of age, gender, injury severity, mechanism of injury, or length of time since injury. Certain mechanisms of injury, (ie, pedestrian versus motor vehicle collision), place the parent at higher risk for symptomatology. All family members, including parents and siblings, must be considered at risk for acute and long-term functional abnormalities. It is important to educate patients and family members that acute stress symptoms are common after an injury incident and are likely to resolve as the patient's injuries heal. Yet despite this, before discharge from the hospital, parents must be taught to evaluate their traumatized child's behavior, as well as their own, for any evidence of posttraumatic stress disorder. Health care providers must anticipate potential strain upon family relationships and financial resources. Parent's posttraumatic stress symptoms may result in deterioration of their own ability to support their injured child. And finally, reassessment of patient and family members should occur within the first days, at 1 to 2 weeks, 6 months, and 1 year following injury to ensure proper recovery and optimization of psychosocial function.
CONTEXT: Aim of the study was to elucidate epidemiological aspects and injury mechanisms in juvenile team handball.
METHOD: A standardized questionnaire was used to evaluate the injuries of 100 juvenile players (50 male, 50 female, year of birth 1982/83).
FINDINGS: A total of 130 injuries were recorded of 73 players. Most of the injuries (73.1 %) occurred between the age of 15 and 18. Approximately two thirds of the injuries (69.2 %) occurred in a competition and most of them in an offensive situa-tion. Backcourt players (29.0 %), line players (27.5 %), and goalkeepers (17.0 %.) were the player positions to be most injured. Female goalkeepers were three times more often injured than male ones at the same age. Most injuries applied to the foot and the ankle (32.0 %), followed by the finger joint (26.9 %) and the knee (24.6 %). The most frequent ankle injuries were ruptures of the lateral ankle ligaments. The knee joint was affected by the most severe injuries with the need of surgical therapy. The most common injury concerning the knee joint was rupture of the anterior cruciate ligament (ACL). Eleven ACL tears were recorded in the age between 15 and 18 years (12 - 14 years: 1; 8 - 12 years: 0). The most typical game situation at the point of injury was catching a ball (38.5 %), contact situation with the opponent (34.5 %), or landing after a jump (26.2 %).
COMMENTS: This study allows conclusions concerning prevention of injuries in juvenile team handball. There is apparently a difference in muscle strength and coordinative abilities of the youth handball player, especially at the age of 15 - 18 years, which has to be adressed. Therefore the authors recommend a proprioceptive training program as well as exercises to improve jumping techniques. Special strengthening training for the finger muscles might help to prevent finger injuries. The frequency of contact injuries underlines the importance of a "fair play" campaign among young players.
The sales of foot-propelled scooters in the United States has skyrocketed with a concomitant increase in emergency department visits related to injuries. It is estimated that more than 60% of injuries could be prevented or reduced in severity if protective gear had been worn. Pediatric nurses should support efforts to decrease scooter-related injuries in children by advocating for the usage of protective gear. Further research is indicated to assess knowledge of potential dangers in those with reported scooter-related injuries, the extent of injuries, and protective gear worn prior to injury occurrence.
Evaluation of North Carolina child care safety regulations.
- Kotch JB, Hussey JM, Carter A. Inj Prev 2003; 9(3): 220-225.
Correspondence: Jonathan Kotch, Department of Maternal and Child Health, CB# 7445, Rosenau Hall, University of North Carolina, Chapel Hill, NC 27599, USA; (email: jonathan_kotch@unc.edu).
CONTEXT: The goal of this study was to track any changes in injuries and injury hazards during the first 3.5 years of implementation of the North Carolina Child Care Commission's 1996 playground safety regulations.
METHODS: All reports (n=5402) of medically attended injuries in regulated child care settings in North Carolina during the period 1 January 1997 through 30 June 2000 were reviewed and analyzed. A total of 294 playground safety inspections were conducted in November and December 1998 in randomly selected North Carolina child care centers, and the playground safety inspections were repeated in 76 child care centers in August 2000. Finally, in 1999 a 1992 child care center director self assessment of safety features in classrooms was sent to the directors of 291 of the 294 centers.
FINDINGS: The annual rate of reported, medically attended injuries occurring in regulated child care facilities in North Carolina declined by 22% from 1997 to 1999. The playground safety inspections in the year 2000 revealed that, for nine of 10 playground concerns and 12 of 18 playground safety hazards, average ratings were equal to or better than those of 1998. Finally, the director surveys revealed no dramatic changes in classroom safety hazards since 1992.
COMMENTS: This study represents the first time that the authors are aware of that a significant decline in state-wide child care injury rates has been associated with improved regulation of playground safety in the US.
Population-based assessment of burn injury in southern Iowa: identification of children and young-adult at-risk groups and behaviors.
- Wibbenmeyer LA, Amelon MJ, Torner JC, Kealey GP, de Mola RM, Lundell J, Lynch CF, Aspelund T, Zwerling C. J Burn Care Rehabil 2003; 24(4): 192-202.
Correspondence: Lucy Ann Wibbenmeyer, College of Medicine, Department of Surgery, University of Iowa, Iowa City, Iowa 52242, USA; (email: unavailable).
Although nonfatal burn injuries vastly outnumber fatal injuries, their epidemiology is not well defined. We sought to determine the epidemiology of nonfatal burn injuries in a largely rural region of a midwestern state to target intervention efforts at populations and injury mechanisms at risk. Data were retrospectively collected on a population-based sample of medically treated burn injuries in 10 counties in southern Iowa from 1997 to 1999 using International Classification of Diseases, 9th Revision, Clinical Modification codes (ICD-9-CM, Ncode 940-949) to identify burn-related emergency room visits from computerized lists. A total of 1430 emergency room visits were identified, with 1382 records available for review. Injuries were grouped into etiology subcategories to better delineate common mechanisms and determine methods of prevention. Scald and hot-object contact and flame-related injuries were the leading causes of burn injury. Scald and contact injuries were subdivided into three major sets of scenarios, scald and contact injuries related to household food preparation and consumption, work-related scald and contact injuries. and injuries resulting from contact with nonfood and nonbeverage-related household objects. Children ages 0 to 4 had the highest population-based scald and hot-object contact injury rate of all age groups, with an average annual incidence rate of 35.9 per 10,000. Injuries in this age group were most commonly related to household objects (34.7%) followed by food preparation (25.3%). Children and young adults ages 5 to 24 were also the most likely to be injured by flame and fire-related causes secondary to open fires. Nonfatal burn injuries typically afflict children and young adults in definable patterns, suggesting intervention strategies. Future studies need to better delineate the contributing factors associated with these injuries to refine the intervention strategies.
Measures developed by the public health system to prevent accidents and violence in children and adolescents in Fortaleza, Cear , Brasil.
- Pordeus AM, Fraga Md Mde N, Fac Td Tde P. Cad Saude Publica 2003; 19(4): 1201-1204.
Correspondence: A.M. Pordeus, N cleo de Pesquisa, Centro de Ci ncias da Sa de, Universidade de Fortaleza, Fortaleza, CE, 60811-341, BRAZIL; (email: unavailable).
This article deals with measures developed by the public health system to prevent accidents and violence in children in Fortaleza, Cear State, Brazil. The program resulted from the need perceived by the authors in light of statistics on mortality from external causes in childhood and adolescence and the fact that there was apparently no preventive action being taken by the public health system. We conducted a questionnaire-based survey of health administrators in the six Regional Executive Secretariats (SERs) corresponding to the geographic districts in which the health system is divided in Fortaleza. According to the survey, existing preventive measures are limited in time and space, and there is no overall policy in this direction; the current measures are organized as health education campaigns focused on prevention of alcohol and drug abuse, violence, household accidents, and juvenile delinquency. SER-I was the only health district that had established partnerships with other sectors in developing such activities. We conclude that the public health system's agenda in Fortaleza needs to incorporate the prevention of childhood and adolescent accidents and violence, taking an inter-sectoral approach and joining efforts in order for the knowledge accumulated on such health problems to be transformed into effective action.
What works in prevention. Principles of effective prevention programs.
- Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane E, Davino K. Am Psychol 2003; 58(6-7): 449-456.
Correspondence: Maury Nation, Department of Human and Organizational Development, Vanderbilt University, Peabody College, #90, Nashville, TN 37203, USA; (email: maury.nation@vanderbilt.edu).
The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the authors identified 9 characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff. This synthesis can inform the planning and implementation of problem-specific prevention interventions, provide a rationale for multi-problem prevention programs, and serve as a basis for further research.
Cost of work-related injuries in insured workplaces in Lebanon.
- Fayad R, Nuwayhid I, Tamim H, Kassak K, Khogali M. Bull World Health Organ 2003; 81(7): 509-516.
Correspondence: Iman Nuwayhid, Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, LEBANON; (email: nuwayhid@aub.edu.lb).
OBJECTIVE: To estimate the medical and compensation costs of work-related injuries in insured workplaces in Lebanon and to examine cost distributions by worker and injury characteristics.
METHODS: A total of 3748 claims for work injuries processed in 1998 by five major insurance companies in Lebanon were reviewed. Medical costs (related to emergency room fees, physician consultations, tests, and medications) and wage and indemnity compensation costs were identified from the claims.
FINDINGS: The median cost per injury was US dollars 83 (mean, US dollars 198; range, US dollars 0-16,401). The overall cost for all 3748 injuries was US dollars 742,100 (76% of this was medical costs). Extrapolated to all injuries within insured workplaces, the overall cost was US dollars 4.5 million a year; this increased to US dollars 10 million-13 million when human value cost (pain and suffering) was accounted for. Fatal injuries (three, 0.1%) and those that caused permanent disabilities (nine, 0.2%) accounted for 10.4% of the overall costs and hospitalized injuries (245, 6.5%) for 45%. Cost per injury was highest among older workers and for injuries that involved falls and vehicle incidents. Medical, but not compensation, costs were higher among female workers.
COMMENTS: The computed costs of work injuries--a fraction of the real burden of occupational injuries in Lebanon--represent a considerable economic loss. This calls for a national policy to prevent work injuries, with a focus on preventing the most serious injuries. Options for intervention and research are discussed.
Risk factors associated with hospitalization for unintentional falls: Wisconsin hospital discharge data for patients aged 65 and over.
Correspondence: Clare E. Guse, Department of Family and Community Medicine and Injury Research Center, Medical College of Wisconsin, Milwaukee, Wis 53226, USA; (email: cguse@mcw.edu).
OBJECTIVE: To identify risk factors associated with hospitalizations for falls in Wisconsin in patients aged 65 and older.
METHODS: This study was a cross-sectional study of year 2000 hospital inpatient discharge records for patients aged 65 and older who did not have a diagnosis-related group code indicating rehabilitation, obtained from the Wisconsin Bureau of Health Information. The database includes all discharges from all non-federal Wisconsin hospitals.
FINDINGS: Of 223,085 discharged older adults, 6.9% had an unintentional fall diagnosis. Independent predictors of an unintentional fall diagnosis were age, sex, time of year of discharge, region of residence, alcohol-related problems, dementia, Parkinson's disease, mechanical and motor problems, altered consciousness, convulsions/epilepsy, anemia, and glaucoma.
COMMENTS: Alcohol-related problems and mechanical and motor problems significantly increased the risk of a fall diagnosis in hospitalized patients aged 65 and over.
- Alexe DM, Petridou E, Dessypris N, Skenderis N, Trichopoulos D. J Agric Saf Health 2003; 9(3): 233-240.
Correspondence: D. M. Alexe, Department of Hygiene and Epidemiology, Athens University Medical School, 75 M. Asias Street, Goudi, P.O. Box 115 27, Athens, GREECE; (email: unavailable).
OBJECTIVES: To assess the characteristics of occupational and leisure farm injuries in Greece.
METHODS: During a five-year period (1996-2000), 4,326 unintentional farm injuries have been recorded by the Emergency Department Injury Surveillance System in Greece. Data concerning demographic variables, accident conditions, and injury characteristics were collected by in person interviews. The data were analyzed by simple cross-tabulation and hierarchical cluster analysis.
FINDINGS: Injuries from falls on the same level are mainly lower-limb fractures and occur during the winter among older women. Falls from higher level concern migrant workers, who also tend to suffer severe multiple injuries, including concussions, particularly during autumn. Injuries resulting from cutting and piercing instruments, as well as from machinery, are generally open wounds in the upper-limbs, suffered by young migrant workers. Head injuries resulting from striking against an object are more generally spread across socio-demographic variables. Overexertion is the dominant mechanism for dislocations and sprains in the lower limbs. Snake and insect bites are common among younger migrant workers during summer, and they affect the upper limbs during manual work close to the ground. Non-traffic injuries from vehicles are frequently severe, involving head concussion of generally young individuals.
COMMENTS: In Greece, farm injuries are frequently serious and require hospitalization. These injuries show distinct patterns among older women (lower-limb fractures), young individuals (non-traffic vehicle-related injuries) and migrant workers (injuries from cutting and piercing instruments, falls from high level, and bites). Prevention strategies should give priority to these population groups. These prevention strategies should include guidance for poorly educated workers, including migrants, enforcement of safety regulations concerning farming machinery, and discouragement of risky farming activities among elderly individuals, particularly women.
Evaluation of an occupational injury intervention among Wisconsin dairy farmers.
- Chapman LJ, Taveira AD, Josefsson KG, Hard D. J Agric Saf Health 2003; 9(3): 197-209.
Correspondence: L.J. Chapman, Department of Biological Systems Engineering, 460 Henry Mall, University of Wisconsin, Madison, WI 53706, USA; (email: ljchapma@facstaff.wisc.edu).
OBJECTIVES: Dairy farming injury rates are high. Previous agricultural research has shown that better information flow can speed adoption of more profitable practices. We conducted and evaluated an intervention to increase voluntary adoption of three production practices that were safer and more profitable than typical practices: barn lights, bag silos, and a mixing site for calf feed.
METHODS: Print mass media, public events, university Extension, and dairy farmers already using the practices were all enlisted to disseminate information to 4,300 northeast district Wisconsin dairy farmers. Evaluation questionnaires were mailed to independent samples of farm managers before (n = 582) and after (n = 572) the 12 month long intervention.
FINDINGS: After the intervention, more managers reported getting information about barn lights from public events (12% vs. 23%) and private consultants (8% vs. 17%) and about silo bags from print media (79% vs. 87%) and private consultants (9% vs. 14%). More managers were aware of barn lights (48% vs. 72%) and the calf feed mixing site (44% vs. 56%). There was a nonsignificant tendency for more managers to report adopting barn lights (12% vs. 23%).
COMMENTS: Improving information flow to operation managers about safer, more profitable production practices may be a relatively easy way to supplement conventional injury control efforts in high-hazard industries.
Violence in adolescence has seen an increase since the 1990s with dramatic statistics on violent death and risk behaviors. School violence has been focused upon by a huge media coverage of especially violent cases that could have had some endemic consequences worldwide. We present a case of a 14 year old white male with change in school behavior, strategies for the case investigation, its results, and long term prevention. Other research has shown that preventive measures during pregnancy, infancy and childhood can prevent adolescent and adult delinquency.
Peer victimization during early adolescence: an injury trigger, an injury mechanism and a frequent exposure in school.
Correspondence: L. Laflamme, Karolinska Institute, Department of Public Health Sciences, Division of Social Medicine, National Institute of Public Health, Stockholm, SWEDEN; (email: lucie.laflamme@phs.ki.se).
There is a documented effect of peer victimization in school as an injury trigger, but the question of differences between children according to age and sex remains unexplored. Nor do we know the role played by school peer victimization as a direct injury mechanism.
OBJECTIVE: The study considered age and sex differences with regard to peer victimization's triggering effect on physical injury, its direct relation to injury (i.e. physical violence), and its age- and gender-specific frequency and manner of occurrence.
METHOD: Data were gathered through structured interviews with children aged 10-15 years, residing in Stockholm County in Sweden during two consecutive school years, and who had been hospitalized due to injury (n = 592).
FINDINGS: Peer victimization operated on injury risk-both indirectly as a trigger of injurious events (most of which are unintentional), and directly as a causal mechanism in relation to intentional physical harm. Further, intentionally injured children frequently knew their offender(s)--often from school--and, in those instances, had been previously victimized by them. There is a quantitative and a qualitative difference in the manner in which occasional and frequent victims are victimized by their peers.
COMMENTS: Peer victimization impacts on children's safety and is a common element in the school background of many children. Differences between occasional and frequent victims in forms and consequences of victimization are more remarkable than those based on sex and age of the child, with the exception of victimization as a direct cause of injury.
The authors give an actual survey about suicides and suicide rates in Germany, Bavaria and Upper Frankonia. Their special interest are significant trends in the last years. These trends will be shown and shortly described.
Correspondence: Michael A. Gebers, California Department of Motor Vehicles, Research and Development Branch, 2415 1st Avenue, 95818, Sacramento, CA, USA; (email: mgebers@dmv.ca.gov).
One of the primary missions of the California Department of Motor Vehicles is to protect the public from drivers who represent unacceptably high accident risks. Optimum fulfillment of this objective requires the development and implementation of strategies for identifying high-risk drivers. One such system in California is the department's negligent operator point system. This system assigns points to moving violations and accidents and authorizes the department to take driver control actions against drivers who meet the prima facie definition of a negligent operator. The present study explored the viability of predicting accidents from equations constructed to predict convictions for the general driving population. Equations or models that better identify drivers at increased risk of future accident involvement would increase the number of accidents prevented through post license control actions. Although the results did not support prior findings that equations keyed to citations do as well as or better than equations keyed to accidents in predicting subsequent accident involvement, a canonical correlation approach considering subsequent accident and citation rates simultaneously produced a 14.9% improvement in the classification accuracy or "hit rate" for identifying accident-involved drivers.
Traffic calming for the prevention of road traffic injuries: systematic review and meta-analysis.
- Bunn F, Collier T, Frost C, Ker K, Roberts I, Wentz R. Inj Prev 2003; 9(3): 200-204.
Correspondence: Frances Bunn, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB, UK; (email: F.bunn@herts.ac.uk).
OBJECTIVE: To assess whether area-wide traffic calming schemes can reduce road crash related deaths and injuries. DESIGN: Systematic review and meta-analysis.
DATA SOURCES: Cochrane Injuries Group Specialised Register, Cochrane Central Register of Controlled Trials, Medline, EMBASE, Sociological Abstracts Science (and social science) citation index, National Technical Information service, Psychlit, Transport Research Information Service, International Road Research Documentation, and Transdoc, and web sites of road safety organisation were searched; experts were contacted, conference proceedings were handsearched, and relevant reference lists were checked.
INCLUSION CRIERIA: Randomised controlled trials, and controlled before/after studies of area-wide traffic calming schemes designed to discourage and slow down through traffic on residential roads.
METHODS: Data were collected on road user deaths, injuries, and traffic crashes. For each study rate ratios were calculated, the ratio of event rates before and after intervention in the traffic calmed area divided by the corresponding ratio of event rates in the control area, which were pooled to give an overall estimate using a random effects model.
FINDINGS: Sixteen controlled before/after studies met our inclusion criteria. Eight studies reported the number of road user deaths: pooled rate ratio 0.63 (95% confidence interval (CI) 0.14 to 2.59). Sixteen studies reported the number of injuries (fatal and non-fatal): pooled rate ratio 0.89 (95% CI 0.80 to 1.00). All studies were in high income countries.
COMMENTS: Area-wide traffic calming in towns and cities has the potential to reduce road traffic injuries. However, further rigorous evaluations of this intervention are needed, especially in low and middle income countries.
Effect of Italy's motorcycle helmet law on traumatic brain injuries.
- Servadei F, Begliomini C, Gardini E, Giustini M, Taggi F, Kraus J. Inj Prev 2003; 9(3): 257-260.
Correspondence: Franco Servadei, WHO Neurotrauma Collaborating Centre and Division of Neurosurgery, Ospedale "M Bufalini", 47023 Cesena, ITALY; (email: francoservadei@libero.it).
OBJECTIVES: To evaluate the impact of a revised Italian motorcycle-moped-scooter helmet law on crash brain injuries.
DESIGN: A pre-post law evaluation of helmet use and traumatic brain injury (TBI) occurrence from 1999 to 2001.
SETTING: Romagna region, northeastern Italy, with a 2000 resident population of 983 534 persons.
PARTICIPANTS: Motorcycle-moped rider survey for helmet use compliance and all residents in the region admitted to the Division of Neurosurgery of the Maurizio Bufalini Hospital in Cesena, Italy for TBI.
OUTCOME MEASURES: Helmet use compliance and change in TBI admissions and type(s) of brain lesions.
FINDINGS: Helmet use increased from an average of less than 20% to over 96%. A comparison of TBI incidence in the Romagna region shows that there was no significant variation before and after introduction of the revised helmet law, except for TBI admissions for motorcycle-moped crashes where a 66% decrease was observed. In the same area TBI admissions by age group showed that motorcycle mopeds riders aged 14-60 years sustained significantly fewer TBIs. The rate of TBI admissions to neurosurgery decreased by over 31% and epidural hematomas almost completely disappeared in crash injured moped riders.
COMMENTS: The revised Italian mandatory helmet law, with police enforcement, is an effective measure for TBI prevention at all ages.
The aim of this review is to discuss the biological basis for the pharmacotherapy of violence in adolescents. The current and updated views on the etiology, biochemistry and neuroanatomy of violence in youth are presented. Concepts in the treatment and the pharmacological agents that are used both in short and long term are discussed and we conclude with some of recent findings in the exciting field of genetics of violence. The review emphasizes that treatment should always combine a socio-psycho-biological and multi-disciplinary approach, because any single treatment for violence cannot stands on its own.
The role of family, peers and school perceptions in predicting involvement in youth violence.
This study explored the relative importance of family, peers and school in predicting youth violence. The analysis was done on a nationally representative sample included 8,394 students from grade 6th-10th in Israel. Measures of youth violence included bullying, physical fights and weapon carrying. The findings suggested that all three social systems had significant relations with youth violence, respectively. Variables found to predict violence were: Family-lack of parental support regarding school; Peers-Lack of social integration or too many evenings out with friends; School-feeling of school alienation, low academic achievement and perceptions of frequent acts of violence in school. School perceptions had the strongest predicting power. Findings emphasized the importance of focusing on improving the daily school experience in reducing youth violence.
