OBJECTIVE: Inhalant misuse is the intentional inhalation of volatile substances in order to obtain euphoric, disinhibiting, and exciting effects. Solvents, glues, adhesives, paints, varnishes, paint removers, dry cleaning agents, spray paints, nail polish removers, typewriter correction fluids, and aerosol propellants are common sources of volatile substance abuse. In recent years the abuse of inhalant substances, not only among those who abuse other drugs but also in teenagers and younger children, has been reported. We reviewed retrospectively the cases of inhalant misuse reported to the Spanish Poison Control Center.
METHODS: Human intoxications from abuse of inhalant substances registered by our service from 1991 to 2000 were studied. Data analyzed were relative to age, gender, signs and symptoms, drug dependence antecedents, and severity of symptoms of the patients. The type of product and composition were also investigated.
FINDINGS: During the study period 109 cases of patients aged from 8 to 50 years were collected. A percentage of 36.6% was less or equal to 20 years old. Seventy percent corresponded to males. Of the patients, 11% presented dependence antecedents to other abuse drugs and 72.5% were symptomatic. In the symptomatic exposures clinical features affected the following systems: CNS (62.8%), gastrointestinal (8.1%), cardiovascular (8.1%), respiratory (2.9%), peripheral nervous system (1.1%), renal (1.1%), haematological (1.1%), hepatic (1.7%), and other (13.1%). The commercial products more frequently inhaled were solvents (34.9%) and glues/adhesives (22.9%). We noted the use of medicines with ethyl chloride-local anaesthetic (8.3%), three cases with aerosol bronchodilator (with fluorocarbons as propellants), and one case of xylazine inhalation. The composition most often involved was aromatic hydrocarbons (46.9%), halogenated hydrocarbons (16.5%), aliphatic hydrocarbons (11.4%), ketones (10.1%), local anaesthetic (ethyl chloride) (8.4%), ethers (2.5%), nitrous oxides (2.5%), and aliphatic nitrites (1.7%). The calls received were 59.6% from health care units and 22% from general public. Only 14% of cases were at home and 48% had moderate to severe clinical effects. Acute intoxications occurred in 82% of cases.
COMMENTS: Inhalation of volatile substance as abuse drugs has been detected in different age groups, including very young people. Although the principal source was industrial products, the use of drugs such as local anesthetics and aerosol broncodilators was also detected. Based on epidemiological studies in the Spanish population (essentially adolescents and childhood) together with the ability of a Poison Center to detect sentinel-events, the community and authorities should develop strategies to prevent these exposures and the later use of other substances of abuse. In fact, recently a Law on Drug Dependences and Other Addictive Alterations has been approved in Madrid in order to take precautionary measures.
This article describes a model and design for evaluating a comprehensive community health promotion initiative. The theoretically based model was designed by the authors to evaluate a countywide initiative based on developmental assets, a framework for healthy youth development promoted by the Search Institute in Minneapolis, Minnesota. The model includes the components of a typical logic model and incorporates concepts proposed by diffusion of innovations, social cognitive theory, and Search Institute's conceptual model for community change. The model highlights the priorities of local stakeholders and directs evaluation activities in multiple community sectors over time. The evaluation design is presented according to the Centers for Disease Control and Prevention framework for program evaluation in public health.
This study performed a preliminary investigation of the incidence and determinants of environmental-temperature injury among residents of Montreal Island, Quebec, Canada. Incidence rates, mortality rates and determinants of environmental-temperature injury were estimated for Montreal Island's 1,802,309 urban and suburban residents. Sources of information included coroner's reports, death certificates, hospital discharge summaries, and hospital chart reviews. The estimated incidence rate for environmental-temperature injury requiring hospitalization on Montreal Island was 3.1 per 100,000 person-years. The estimated mortality rate for all environmental-temperature injuries on Montreal Island was 0.3 per 100,000 person-years. The majority of hospitalizations and deaths were due to cold injury. Male gender, alcohol intoxication, psychiatric illness, older age, and homelessness were suggestive of important risk factors in cold injury. All deaths due to heat injury occurred in elderly females. Montreal Island's ambulance transport service, with its unique database, was identified as a novel surveillance design for environmental-temperature injury. Knowing more about the incidence and determinants of environmental-temperature injury may suggest priorities for interventions to decrease morbidity and mortality.
Mobile telephone use among Melbourne drivers: a preventable exposure to injury risk.
- McEvoy SP, Stevenson MR. Med J Aust 2004; 180(1): 43-45.
Correspondence: Suzanne P McEvoy, Injury Research Centre, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, AUSTRALIA; (email: scordova@sph.uwa.edu.au).
Letter to the editor: Taylor et al (see SafetyLit 4 August 2003) found that: "Mobile phone use is common among Melbourne metropolitan drivers despite restrictive legislation" and suggest that this constitutes "a preventable exposure to injury risk." This raises two questions:
Does mobile phone use while driving affect road safety? If so, do hands-free devices reduce the risk?
In their introduction, Taylor et al cited six publications to provide evidence that the use of a handheld mobile phone while driving increases the risk of a road crash. The studies by Lamble et al and McKnight and McKnight involved a hands-free device and examined driver impairment, not crash risk. The three papers by Violanti had significant limitations, including no phone billing information to demonstrate that drivers were using their phones at the time of the crash, reliance on police accident reports that may have involved more thorough investigations into fatal crashes than non-fatal ones, and small sample size with only 14 mobile phone users in one study. These limitations reduce the validity of the research.
The best of the epidemiological studies was a case-crossover study of 699 drivers in collisions involving property damage only. However, the oft-quoted four-fold increase in risk comes from the analysis of mobile phone use in a 10-minute hazard interval before the collision. This does not provide conclusive evidence that these drivers were on the phone at the time of their crash and indicates a statistical association only. Although shorter hazard intervals were also examined, one needs to be wary of the potential for misclassifying post-crash calls as pre-crash calls because the time of collision may be imprecise, mobile phone use is common following a crash and a call to the emergency services may not be the first call made after the event. If we conclude that the data are valid despite these limitations, then the fact that hands-free models did not reduce the risk must be noted.
Returning to our questions, although there is good evidence demonstrating driver impairment in laboratory-based studies, the epidemiological research has limitations that need to be dealt with to determine the real-world effect of mobile phone use while driving. We are currently undertaking two large epidemiological studies in Perth, involving about 2000 drivers over an 18-month period. The limitations have been addressed in the design of our studies. Furthermore, the evidence to date suggests that hands-free devices do not confer a safety advantage and this issue should not be ignored in driver education.
Mobile telephone use among Melbourne drivers: a preventable exposure to injury risk.
Letter to the editor: In the "In this issue" section of the Journal of 4 August 2003, you write regarding "Dialling drivers" that "the jury is still out on the health effects of mobile phones."
Well, the jury is back with a guilty verdict. In June 2003, the journal Injury Prevention quoted an evaluation by the Harvard Center for Risk Analysis that "the use of cell phones by drivers may result in about 2600 deaths, 330,000 moderate to critical injuries, 240,000 minor injuries and 1.5 million instances of property damage in America per year."
Taylor et al suggest, "Further interventions aimed at decreasing mobile phone use among drivers should be considered."
Occupational safety professionals consider that a worker not complying with the safe practices for using a tool should be offered remedial education. If education fails, they stop the worker using that tool.
Wise parents also consider taking away a child's toy until the child can learn to use it safely.
And so with mobile phones used while driving. Driver safety education is not very effective. Police have powers to impound items related to other offenses, and so should have powers to impound mobile phones used when driving. The driver could then claim it, say, four weeks later, from the police station on payment of a fee-for-service to the police that covers, at least, the relative value of the expenses of the police. The driver would also incur demerit points. Repeated offenses would mean they forfeit the phone or their licence.
Mobile telephone use among Melbourne drivers: a preventable exposure to injury risk.
- Chalker GJ, Joyner KH, Parkinson KS. Med J Aust 2004; 180(1): 43-45.
Correspondence: Kelly S. Parkinson, Health and Safety Committee, Australian Mobile Telecommunications Association, PO Box 4309, Manuka, ACT 2603. (email: kelly@kppr.com.au).
Letter to the editor: The claim made in the recent article (Taylor et al) that mobile phone use while driving is more dangerous than drink driving is misleading.
The 1997 study by Redelmeier is often misinterpreted and cited for the proposition that driving while using a mobile is the same as driving drunk. However, Redelmeier wrote to the New England Journal of Medicine to correct this inaccuracy, saying, "...alcohol circulates in the blood for hours, whereas a telephone call lasts only minutes. The cumulative risks associated with intoxication are greater than those associated with cellular telephones."
This is supported by a recent Australian study, which compared the blood alcohol levels of drivers involved in real car crashes, rather than driving simulators, and found the risk of an accident was increased by 25 times at a blood alcohol concentration of 0.08. Mobile phones have not been shown to present this level of risk in any research.
In 2002, in the United States, alcohol was a factor in about 41% of all fatal traffic crashes and in 6% of all crashes (National Highway Traffic Safety Administration). In comparison, data collected by about 20 state highway authorities show that mobile phones were a factor in an estimated one half of one percent of all accidents in the US last year.
Furthermore, mobile phone subscribers provide the extra eyes and voice for police in reporting aggressive, reckless or drunk drivers, accidents and other road hazards. Almost a third of all genuine calls to 000 are made from mobile phones.
A recent US survey found that at any given time only 3% of drivers are actively using their mobile phones, although it is legal to use a handheld phone in almost all states. Therefore, Taylor's overall result that less than 2% of Melbourne drivers use a handheld mobile phone, while illegal in Australia and undesirable, is not unexpected.
However, the unrelated and misleading comparison made with drink driving is not supported by the facts.
No one is questioning that mobile phone use imposes physical, visual, and cognitive demands on the driver. Although technology can help to address physical and visual factors, education is required to address cognitive factors. The Australian Mobile Telecommunications Association has developed 10 safety tips for mobile phones and driving (see www.amta.org.au) and, by adhering to these simple common-sense practices, drivers can make full, productive and safe use of mobile phones.
Mobile telephone use among Melbourne drivers: a preventable exposure to injury risk.
In reply: McEvoy and Stevenson raise some important issues. The first relates to the confusion between driver impairment and crash risk. Intuitively, this association seems valid, as any level of driver impairment could be expected to affect driving skill. However, they are correct to suggest that the two should not be used interchangeably without supporting evidence.
Secondly, I agree that the quality of evidence directly linking mobile phone use with crash risk is poor. This largely relates to the difficulty in confirming mobile phone use at the exact time of the crash. Reported direct observation is uncommon, billing records are inexact, and self-report may be subject to prevarication bias.
The use of hands-free devices was not examined in our study, mainly because of difficulties in detecting their use. There is anecdotal evidence of a trend towards the use of these devices while driving. However, while their use might avoid the need to physically hold the phone, they may not significantly diminish driver impairment resulting from distraction.
Many questions remain, and I encourage McEvoy and Stevenson in their endeavor to more clearly evaluate the real-world risk of mobile phone use, both handheld and hands-free, by drivers.
Chalker et al draw attention to the comparison of crash risk for mobile phone use while driving and drink driving. I acknowledge that interpretation of published studies is confusing. Redelmeier's statement that alcohol circulates for hours and that a telephone call may last for only minutes relates to individuals. From the highway perspective, when one driver completes a call, another is likely to be starting one and effectively assuming the increased collision risk. This concept is consistent with our findings. Almost 2% of drivers were using mobile phones when they passed our observation points, and were therefore at risk at that time. The exact extent of this risk awaits clarification. Chalker et al provide US alcohol and mobile phone related crash statistics. Unfortunately, the latter were not referenced and their value is therefore questionable.
Finally, Chalker et al are to be commended for publishing safety tips for mobile phone use while driving. However, their claim that common-sense practices can make mobile phone use safe is extraordinary and disregards emerging evidence. Indeed, this statement appears to contradict their first safety tip, which states "a hands free device can reduce the physical effort to make and receive calls; however, it alone doesn't make using a mobile phone while driving safer. (www.amta.org.au/?Page=49 [accessed Nov 2003])" At best, therefore, common-sense practices will not make mobile phone use while driving safe, only possibly safer.
OBJECTIVE: To describe washing machine related injuries in children in the United States.
METHODS: Injury data for 496 washing machine related injuries documented by the Consumer Product Safety Commission's National Electronic Injury Surveillance System and death certificate data files were analyzed. Gender, age, diagnosis, body part injured, disposition, location and mechanism of injury were considered in the analysis of data.
FINDINGS: The upper extremities were most frequently injured in washing machine related injuries, especially with wringer machines. Fewer than 10% of patients required admission, but automatic washers accounted for most of these and for both of the deaths. Automatic washer injuries involved a wider range of injury mechanism, including 23 children who fell from the machines while in baby seats.
COMMENTS: Though most injuries associated with washing machines are minor, some are severe and devastating. Many of the injuries could be avoided with improvements in machine design while others suggest a need for increased education of potential dangers and better supervision of children if they are allowed access to areas where washing machines are operating. Furthermore, washing machines should only be used for their intended purpose. Given the limitations of educational efforts to prevent injuries, health professionals should have a major role in public education regarding these seemingly benign household appliances.
Childhood injuries due to falls from apartment balconies and windows.
- Istre GR, McCoy MA, Stowe M, Davies K, Zane D, Anderson RJ, Wiebe R. Inj Prev 2003; 9(4): 349-352.
Correspondence: Gregory R Istre, Injury Prevention Center of Greater Dallas, 5000 Harry Hines Blvd, Suite 101, PO Box 36067, Dallas, TX 75235, USA; (email: unavailable).
BACKGROUND: Falls from balconies and windows are an important cause of childhood injury. This study investigated the circumstances around such falls and attempted to identify possible measures for their prevention.
POPULATION: Children <15 years living in Dallas County, Texas.
METHODS: Each child treated because of a fall from a building in 1997-99 had information about the injury collected, and a parent was contacted to obtain further information. For apartment related falls, an attempt was made to visit the apartment to measure windows and balcony rails.
FINDINGS: Ninety eight children were injured in falls from buildings during the three year period; 39 (40%) were admitted to hospital. Seventy five of the falls (77%) involved apartments, and most occurred around noon or evening meal times. Among apartment falls, 39 (52%) fell from windows, 34 (45%) from balconies, and two (3%) from unknown sites. For more than two thirds of balcony related falls, the child fell from between the balcony rails, all of which were spaced more than 4 inches (10 cm) apart. On-site measurement showed the rails were an average of 7.5 inches (19 cm) apart; all of these apartments were built before 1984. For more than two thirds of window related falls, the window was situated within 2 feet (61 cm) of the floor.
COMMENTS: Two factors are important in falls from apartment windows and balconies: balcony rails more than 4 inches (10 cm) apart, and windows positioned low to the floor. Current building codes do not apply to older apartments, where most of these falls occurred. Nevertheless, these factors may be amenable to environmental modifications that may prevent most of these falls.
Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: A case-control study.
- Chau N, Mur JM, Benamghar L, Siegfried C, Dangelzer JL, Francais M, Jacquin R, Sourdot A. Am J Ind Med 2004; 45(1): 84-92.
Correspondence: Nearkasen Chau, Inserm U420, Faculte de medecine, BP 184, 54505 Vandoeuvre-les-Nancy Cedex, FRANCE; (email: Nearkasen.Chau@nancy.inserm.fr).
BACKGROUND: There is little published about the role of individual characteristics in occupational injuries. Construction workers have a high rate of injury; we assessed 11 personal characteristics in this professional sector.
METHODS: A case-control study was conducted on 880 male workers who had at least one occupational injury during a 2-year period and 880 controls. A questionnaire was administered by an occupational physician. Statistical analysis was made via logistic regression method.
FINDINGS: Young age (<30 years), sleep disorders and current smoker influenced all the injuries combined. Sleep disorders and young age were common risk factors for several jobs. Physical disabilities and no sporting activity had a role in masons, and 5 years or less in present job in plumbers and electricians only. Sleep disorders influenced both the injuries with and without hospitalization; young age, current smoker, and physical disability influenced those without hospitalization only.
COMMENTS: Young age, sleep disorders, smoking, disabilities, sporting activity, and experience influenced the occupational injuries. The risk for each worker depended on his job. Occupational physicians could inform the workers of these risks and encourage them to take remedial action.
Occupational injury mortality surveillance in the United States: An examination of census counts from two different surveillance systems, 1992-1997.
Correspondence: Larry A. Layne, Division of Safety Research, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Morgantown, West Virginia 26505, USA; (email: LLayne@cdc.gov).
BACKGROUND: The surveillance of occupational injury mortality in the United States has evolved over the last century. Currently there are two different data sources used for the study of occupational injury mortality. Each system varies in methodology, leading to different census counts. We provide an overview and analysis of similarities and differences in these two systems.
METHODS: The National Traumatic Occupational Fatalities (NTOF) surveillance system and the Census of Fatal Occupational Injuries (CFOI) were examined for civilian deaths at work in the United States from 1992 to 1997.
FINDINGS: There were 31,643 occupational injury mortality cases according to NTOF and 37,023 from CFOI for civilian workers 16-years and older in the United States for the 6-year period of analysis. The annual average occupational injury mortality rates were 4.5 per 100,000 full time equivalent workers from NTOF and 5.2 from CFOI. The higher capture rate by CFOI was consistent across each of the 6 years. Similar patterns for demographics, industry, and occupation, and type of incident were seen for both systems.
COMMENTS: While NTOF provides more years of data dating back to 1980, CFOI (established in 1992) provides a more comprehensive capture of occupational injury mortality and provides greater detail of the mortality incidents. The overall injury mortality patterns, however, appear to be similar between the systems.
Occupational fatalities of Hispanic construction workers from 1992 to 2000.
- Dong X, Platner JW. Am J Ind Med 2004; 45(1): 45-54.
Correspondence: James W. Platner, The Center to Protect Workers' Rights, 8484 Georgia Ave., Suite 1000, Silver Spring, MD 20910, USA; (email: jplatner@cpwr.com).
BACKGROUND: Hispanic construction employment has dramatically increased, yet published data on occupational risk is lacking.
METHODS: Data from the Census of Fatal Occupational Injuries (CFOI) and current population survey (CPS) were examined from 1992 to 2000. Fatality rate, relative risk (RR), and risk index were calculated using CFOI fatality data and CPS data on hours worked, adjusted to full-time-equivalents (FTE). Data between 1996 and 2000 were combined to allow reliable comparisons of age and occupational groups. RR and 95% confidence intervals were calculated.
FINDINGS: In 2000, Hispanics constituted less than 16% of the construction workforce yet suffered 23.5% of fatal injuries. RRs were: helpers, construction trades, 2.31 (95% CI: 1.41-3.80); roofers 1.77 (95% CI: 1.38-2.28); carpenters 1.39 (95% CI: 1.08-1.79); and construction laborers 1.31 (95% CI: 1.17-1.46).
COMMENTS: Hispanic construction workers consistently faced higher RRs, for every year from 1992 to 2000 and for every age group. In 2000, Hispanic construction workers were nearly twice (1.84, 95% CI: 1.60-2.10) as likely to be killed by occupational injuries as their non-Hispanic counterparts.
BACKGROUND: Family characteristics have been described as risk factors for child pedestrian and motor vehicle collision. Research results come mainly from developed countries, where family relationships could be different than in developing ones.
OBJECTIVE: To examine family characteristics as risk factors for pedestrian injury in children living in Guadalajara City, Mexico.
METHODS: Case-control study of injuries among children 1-14 years of age involved in pedestrian-motor vehicle collisions. Cases resulting in death or injuries that required hospitalization or medical attention were included and identified through police reports and/or emergency room registries. Two neighborhood matched controls were selected randomly and compared with cases to estimate odds ratios (OR) and 95% confidence intervals (CI).
FINDINGS: Significant risk factors were: male (OR 2.3, 95% CI 1.2 to 4.4), number of siblings in household (two siblings, OR 3.2, 95% CI 1.4 to 6.6; three siblings, OR 4.5, 95% CI 1.9 to 11.0; four or more siblings, OR 3.7, 95% CI 1.1 to 12.9), and number of non-siblings/non-parents in household (four or more, OR 6.2, 95% CI 1.5 to 26.6). Children of a sole mother, working mother, or grandmother living in house did not show increased risk after adjusting for socioeconomic conditions.
COMMENTS: Household size has implications for child pedestrian and motor vehicle collision prevention efforts and is relatively easy to identify. Also, the lack of risk association with working mothers may indicate that grandmothers are not part of the social support network that cares for children of working mothers.
Correspondence: Frank LoVecchio, Department of Emergency Medicine, Good Samaritan Regional Medical and Poison Center, Maricopa Medical Center & Arizona Heart Hospital and Phoenix Children's Hospital, Phoenix, Arizona 85006, USA; (email: frank.lovecchio@bannerhealth.com).
BACKGROUND: Centruroides sculpturatus, also known as Centruroides exilicauda or bark scorpion, is the only scorpion native to the United States whose venom produces a potentially life-threatening illness, particularly in children.
OBJECTIVES: To describe the distribution of the severity grades following scorpion envenomations, the onset of clinical signs and symptoms, the time to deterioration, and side effects of antivenom treatment in children < or = 2 yrs of age.
METHODS: Prospective case-series with the following inclusion criteria of presumed scorpion envenomation, witnessed scorpion or signs and symptoms consistent with envenomation, patient age < or = 2 yrs, and the call was received by the poison center. After data were entered prospectively, a reviewer who was blinded as to the purpose of the study reviewed the charts. A second reviewer examined 10% of the charts for accuracy in coding. Envenomation severity grades were based on a previously described scorpion grading scale and were correlated with admission rates, clinical deterioration, and outcomes. Descriptive statistics (STATA & EXCEL) were used.
FINDINGS: Of the 491 charts, 483 (98%) had adequate information available. The mean age was 20.8 [range 2-24] months with 133 patients (27.5%) presenting to an emergency department (ED), 86 patients (17.8%) received antivenom, and 25 patients (5.2%) were admitted. The p-value for kappa and the 95% confidence interval (CI) for interobserver reliability kappa score was 0.69 with CI (0.44-0.95). The grade distributions were Grade I = 343 cases (71%), Grade II = 8 cases (1.7%), Grade III = 49 cases (10.1%), and Grade IV = 83 cases (17.2%). The mean time to advancement of grade was 14 min (95% CI [10.97,17.06], 99% CI [10.04,18.03]) and the median time was < 1 min (range 0-140 min). Twenty-five patients (5.2%) were admitted, of which 13 were Grade III and 12 were Grade IV. Three patients (0.6% of total), all Grade IV envenomations, were intubated (95% CI [0.0021-0.0181] or an upper limit of 8.7 patients). Antivenom was administered to 86 patients (17.8%). The mean time of abatement of symptoms following antivenom was 31 [95% CI 10-82] min vs. 22.2 h [95% CI 12-46]. There was one acute reaction (rash) to antivenom administration and 49 cases (57%) of serum sickness.
COMMENTS: Clinical progression following scorpion envenomation in children < or = 2 yrs old occurred on average within 14 min of envenomation with onset almost immediately. Serum sickness occurred in 57% of toddlers receiving antivenom and typically lasted less than 3 days. Admissions were less common among patients receiving antivenom.
Correspondence: Michael Cusimano, St Michaels Hospital, Injury Prevention Research Office, Division of Neurosurgery, 38 Shuter Street, Suite 2-018, Toronto, Ontario M5B 1A6, CANADA; (email: injuryprevention@smh.toronto.on.ca).
OBJECTIVE: The ThinkFirst Canada Smart Hockey program is an educational injury prevention video that teaches the mechanisms, consequences, and prevention of brain and spinal cord injury in ice hockey. This study evaluates knowledge transfer and behavioral outcomes in 11-12 year old hockey players who viewed the video.
METHODS: Randomized controlled design.
SETTING: Greater Toronto Minor Hockey League, Toronto Ontario.
SUBJECTS: Minor, competitive 11-12 year old male ice hockey players and hockey team coaches.
INTERVENTIONS: The Smart Hockey video was shown to experimental teams at mid-season. An interview was conducted with coaches to understand reasons to accept or refuse the injury prevention video.
MAIN OUTCOME MEASURES: A test of concussion knowledge was administered before, immediately after, and three months after exposure to the video. The incidence of aggressive penalties was measured before and after viewing the video.
FINDINGS: The number of causes and mechanisms of concussion named by players increased from 1.13 to 2.47 and from 0.67 to 1.22 respectively. This effect was maintained at three months. There was no significant change in control teams. There was no significant change in total penalties after video exposure; however, specific body checking related penalties were significantly reduced in the experimental group. CONCLUSION: This study showed some improvements in knowledge and behaviors after a single viewing of a video; however, these findings require confirmation with a larger sample to understand the socio-behavioral aspects of sport that determine the effectiveness and acceptance of injury prevention interventions.
Concussion in professional football: epidemiological features of game injuries and review of the literature - part 3.
Correspondence: Elliot J. Pellman, Mild Traumatic Brain Injury Committee, National Football League, New York, New York, and ProHEALTH Care Associates, Lake Success, New York, USA; (email: unavailable).
OBJECTIVE: A 6-year study was performed to determine the circumstances, causes, and outcomes of concussions in the National Football League.
METHODS: Between 1996 and 2001, the epidemiological features of concussions were recorded by National Football League teams with a standardized reporting form. Symptoms were reported and grouped as general symptoms, cranial nerve symptoms, memory or cognitive problems, somatic complaints, and loss of consciousness. The medical actions taken were recorded. In total, 787 game-related cases were reported, with information on the players involved, type of helmet impact, symptoms, medical actions, and days lost. Concussion risks were calculated according to player game positions.
FINDINGS: There were 0.41 concussions per National Football League game. The relative risk was highest for quarterbacks (1.62 concussions/100 game-positions), followed by wide receivers (1.23 concussions/100 game-positions), tight ends (0.94 concussion/100 game-positions), and defensive secondaries (0.93 concussion/100 game-positions). The majority of concussions (67.7%) involved impact by another player's helmet. The remainder involved impact by other body regions of the striking player (20.9%) or ground contact (11.4%). The three most common symptoms of mild traumatic brain injury were headaches (55.0%), dizziness (41.8%), and blurred vision (16.3%). The most common signs noted in physical examinations were problems with immediate recall (25.5%), retrograde amnesia (18.0%), and information-processing problems (17.5%). In 58 of the reported cases (9.3%), the players lost consciousness; 19 players (2.4%) were hospitalized. A total of 92% of concussed players returned to practice in less than 7 days, but that value decreased to 69% with unconsciousness.
COMMENTS: The professional football players most vulnerable to concussions are quarterbacks, wide receivers, and defensive secondaries. Concussions involved 2.74 symptoms/injury, and players were generally removed from the game. More than one-half of the players returned to play within 1 day, and symptoms resolved in a short time in the vast majority of cases.
- Langley JD, Dow N, Stephenson S, Kypri K. Inj Prev 2003; 9(4): 376-379.
Correspondence: John Langley, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, NEW ZEALAND; (email: john.langley@ipru.otago.ac.nz).
OBJECTIVES: (1) For crashes on a public road, to compare serious cyclist crashes involving a motor vehicle with cyclist crashes not involving a motor vehicle, in terms of threat to life and length of stay in hospital. (2) To determine the proportion of all serious crashes involving cyclists on public roads which are recorded by the police. (3) To determine the degree to which under-reporting of serious crashes involving cyclists and motor vehicles on public roads is associated with various demographic, environmental, and injury factors.
METHODS: Records for the period 1995-99, of cyclists seriously injured on a public road and hospitalized were linked to the traffic crash report (TCR) database maintained by Land Transport Safety Authority (LTSA).
FINDINGS: Of the 2925 cyclist crashes on public roads, only 652 (22%) could be linked to a TCR. Of the crashes involving motor vehicles (n = 1033), only 562 (54%) could be linked to the LTSA database. Age, ethnicity, injury severity, and cumulative length of stay were the only variables that predicted whether hospitalized cycle crash cases were more likely to have a corresponding TCR. There were substantial numbers of cyclist-only crashes which typically are not captured in the TCR database. Nine percent of these resulted in serious or worse injury (that is, International Classification of Diseases/abbreviated injury scale score of 3+) and 7% resulted in hospital stays greater than seven days.
COMMENTS: Greater effort and precision needs to be applied to routinely document the burden of cyclist crashes, especially cyclist only crashes.
Reporting of the incidence of hospitalized injuries: numerator issues.
- Boufous S, Williamson A. Inj Prev 2003; 9(4): 370-375.
Correspondence: Soufiane Boufous, Applied Science Building, Level 8, University of New South Wales, Sydney, NSW 2052, AUSTRALIA; (email: soufiane@unsw.edu.au).
OBJECTIVES: To examine and discuss the implications on the incidence of hospitalized injuries of selecting cases from principal diagnosis field only compared with considering all diagnosis fields, the inclusion compared with the exclusion of medical injuries, and the impact of identifying multiple admissions.
METHODS: Analysis of data from the 1999-2000 New South Wales Inpatient Statistics Collection, Australia, including an internal linkage of the same dataset.
FINDINGS: Approximately 27.5% of records with a non-injury primary diagnosis include a nature of injury diagnosis in a subsequent diagnostic field. This figure increased to more than half (53%) of discharges for medical injuries. The internal linkage showed that 6.5% of discharges were repeat admissions for the same International Classification of Diseases, 10th revision (ICD-10) injury code and that 13.8% were repeat admissions for any ICD-10 injury code. The proportions of repeat admissions varied according to the type and the mechanism of injury.
COMMENTS: Selecting hospitalized injury cases from the principal diagnosis alone would underestimate medical injury cases as well as other injuries occurring in hospital. Repeat admissions should always be considered particularly in the case of thermal injuries, self harm, and medical injuries. Due to the limitations of data linkage, alternative methods need to be developed to identify repeat admissions. Other areas in which further research would be beneficial to a more uniform reporting of injury hospitalizations include better identification of injuries occurring in hospital, a review of ICD-10 injury codes, and the development an ICD-10 based severity measure which can be readily used with hospital discharge data.
Correspondence: Demetrios Demetriades, Department of Surgery, Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA; (email: demetria@usc.edu).
Analysis of the epidemiology, temporal distribution, and place of traumatic hospital deaths can be a useful tool in identifying areas for research, education, and allocation of resources. Trauma registry-based study of all traumatic hospital deaths at a Level I urban trauma center during the period 1993 to 2002. The time and hospital location where deaths occurred were analyzed according to mechanism of injury, age, Glasgow Coma Score, and body areas with severe injury (Abbreviated Injury Scale [AIS] >/= 4). Logistic regression analysis was used to identify risk factors associated with death at various times after admission. During the study period there were 2,648 hospital trauma deaths. The most common body area with critical injuries (AIS >/= 4) was the head (43%), followed by the chest (28%) and the abdomen (19%). Overall, 37% of victims had no vital signs present on admission. Chest AIS >/= 4, penetrating trauma, and age greater than 60 years were significant risk factors associated with no vital signs on admission. Patients with severe chest trauma (AIS >/= 4) reaching the hospital alive were significantly more likely to die within the first 60 minutes than were patients with severe abdominal or head injuries (17% versus 11% versus 7%). In patients reaching the hospital alive, the time and place of death varied according to mechanism of injury and injured body area. Deaths caused by severe head trauma peaked at 6 to 24 hours, and deaths caused by severe chest or abdominal trauma peaked at 1 to 6 hours after admission. The temporal distribution and location of trauma deaths are influenced by the mechanism of injury, age, and the injured body area. These findings may help in focusing research, education, and resource allocation in a more targeted manner to reduce trauma deaths.
Comparison of urban and rural non-fatal injury: the results of a statewide survey.
- Leff M, Stallones L, Keefe TJ, Rosenblatt R, Reeds M. Inj Prev 2003; 9(4): 332-337.
Correspondence: Marilyn Leff, Colorado Injury Control Research Center, Colorado State University, Ft Collins, CO 80523-1676, USA; (email: marilyn.leff@colostate.edu).
OBJECTIVES: This study compared the epidemiology of non-fatal injury among urban and rural residents of Colorado.
METHODS: A stratified probability sample with random digit dial methods was used to survey Colorado residents by telephone regarding injuries experienced in the last 12 months. Questions on the cause of the injury, the activity at the time of the injury, and the place of injury were based on the Nordic Medico Statistical Committee's (NOMESCO) classification of external causes of injuries. A total of 1425 urban and 1275 rural Colorado residents aged 18 and older were interviewed.
FINDINGS: Age, gender, marital status, and rural residency were found to increase the odds of self reported injury. The adjusted odds ratio for self reported injury was 1.3 (95% confidence interval (CI) 1.01 to 1.68) for rural compared with urban residents. Rural residence (odds ratio 1.02, 95% CI 0.51 to 7.01) was not a risk factor for injury among the highest risk group, those who were single and never married. No differences in injury characteristics were found by urban-rural status.
COMMENTS: The increased odds of self reported injury among rural residents were not explained by differences in the causes of injury or other injury characteristics. The differences in the importance of rural residence in increased odds of injury by marital status warrants further understanding and may be important in the development of injury prevention programs. Based on comparison with a similar survey, the NOMESCO coding system appears to be a viable alternative survey tool for gathering information on injury characteristics.
Severity of injury and mortality associated with pediatric blunt injuries: Hospitals with pediatric intensive care units versus other hospitals.
Correspondence: Louise Szypulski Farrell, Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, E Campus 187, One University Place, Rensselaer, NY 12144-3456, USA; (email: lsf01@health.state.ny.us).
OBJECTIVE: To a) compare in-hospital mortality rates for pediatric (age <13 yrs) patients with blunt injuries in the New York State Trauma Registry based on hospital type (dedicated pediatric intensive care unit [PICU] and designated trauma centers and noncenters that do not have a dedicated PICU) for the purpose of determining whether there is a reduction in mortality at a specialty hospital and b) determine the extent to which high-risk patients are admitted to specialty hospitals.
METHODS: Data Source: Inpatient data for the years 1994-1998 in the New York State Trauma Registry. A total of 8,180 pediatric inpatients who suffered blunt injury were selected to examine where patients were treated (PICU, regional trauma center without PICU, area trauma center without PICU, or noncenter without PICU) as a function of injury severity. Data were extracted for inpatients aged <13 yrs who suffered blunt injury.
FINDINGS: The injury severity of inpatients treated at PICUs and regional centers without PICUs was significantly higher than at other hospitals. Risk factors that were independently related to survival of pediatric trauma inpatients were age <5 yrs, motor component of one to five, abnormal systolic blood pressure relative to age, and International Classification of Disease, Ninth Revision-Based Injury Severity Score. Of the total 136 deaths, 133 were among the patients <5 yrs old, motor score <6, and age-related abnormal systolic blood pressure. A total of 66.8% of these patients were treated at PICUs, and 9.9% were treated at regional centers without PICUs. No statistically significant differences in risk-adjusted mortality rates were found by hospital type, but rates at PICUs were lower than for other types of hospitals except for noncenters without PICUs, whose patients were considerably less severely injured.
COMMENTS: There is significant triaging of the most seriously injured pediatric trauma inpatients to PICUs, and there is evidence that this policy is effective.
Influence of demographics and inhalation injury on burn mortality in children.
- Barrow RE, Spies M, Barrow LN, Herndon DN. Burns 2004; 30(1): 72-77.
Correspondence: Robert E. Barrow, Department of Surgery, Shriners Hospitals for Children, The University of Texas Medical Branch, 815 Market Street, 77550, Galveston, TX, USA; (email: rbarrow@utmb.edu).
BACKGROUND: Pulmonary failure has emerged as one of the leading causes of mortality in burned children due, in part, to the success in reducing the incidence of sepsis, early surgery and fluid resuscitation, and new advances in nutritional support. To evaluate the effect of pulmonary injury, age, gender, race, and burn size on mortality, the records of 3179 burned children admitted to our burn center from 1985 to 2001 were reviewed. In this population, 1246 were admitted within 14 days of injury with burns greater than 20% of their total body surface area (TBSA).
METHODS: Lethal burn areas (LAs) for a thermal injury only or burn plus inhalation injury were estimated from best fit probit curve within 95% confidence limits. Data analysis was by chi(2)-test, t-test, or Fisher's exact test where appropriate.
FINDINGS: The lethal burn area for a 10% mortality rate with and without concomitant inhalation injury was a 50 and 73% TBSA burn, respectively. Children up to the age of 3 with >/=20% TBSA burns had a higher rate of mortality (9.9%) compared to those 3-12 years of age (4.9%) and 13-18 years of age (4.2%). Children with 21-80% TBSA burns showed a significant difference in mortality (P<0.05) between those with burn plus inhalation injury (13.9%) and burn only (2.9%), while those with 81-100% TBSA burns showed no significant difference between burn only and burn plus inhalation injury.
COMMENTS: Inhalation injury remains one of the primary contributors to burn mortality. Children under the age of 3 years, however, are at a higher risk both with and without inhalation injury.
Correspondence: David Fergusson, Christchurch Health and Development Study, Christchurch School of Medicine, PO Box 4345, Christchurch, NEW ZEALAND; (email: david.fergusson@chmeds.ac.nz).
OBJECTIVES: This research aimed to examine the prevalence of risky driving behavior among young people, the characteristics of those who engage in risky driving behavior, and the association between risky driving behaviors and accident risk.
METHODS: Data were gathered during the course of the Christchurch Health and Development Study. As part of this longitudinal study, data were gathered on self-reported risky driving behaviors (18-21 years), traffic accidents (18-21 years) and a variety of individual characteristics for 907 participants who reported having driven a motor vehicle.
FINDINGS: More than 90% of drivers engaged in some form of risky driving behavior. Those most likely to engage in frequent risky driving behaviors were: males (p < 0.0001), who exhibited alcohol (p < 0.0001) or cannabis abuse (p < 0.001) in adolescence, who were involved in violent/property crime (p < 0.01) and who affiliated with delinquent or substance-using peers (p < 0.05). There was a strong (p < 0.0001) association between the extent of risky driving behavior and traffic accident risk.
COMMENTS: Risky driving behaviors are common among young people, particularly among young males prone to externalizing behaviors (substance abuse, crime and affiliations with deviant peers). Risky driving is strongly linked to traffic accident risk. There is a continued need to target risky driving behaviors among young people. Efforts to reduce risky driving should be targeted in particular at the high-risk group of young males prone to externalizing behaviors. More generally, the results suggest the need for a multistrategy approach to the reduction of traffic accidents that focuses on the full spectrum of risky driving behaviors.
OBJECTIVE: To use national surveillance data in Canada to describe gender differences in the pattern of farm fatalities and severe injuries (those requiring hospitalization).
METHODS: Data from the Canadian Agricultural Injury Surveillance Program (CAISP) included farm work related fatalities from 1990 to 1996 for all Canadian provinces and abstracted information from hospital discharge records from eight provinces for the five fiscal years of 1990 to 1994. Gender differences in fatalities and injuries were examined by comparison of proportions and stratified by sex, injury class (machinery, non-machinery), and age group.
FINDINGS: Over the six year period of 1990 to 1996 there were approximately 11 times as many agriculture related fatalities for males compared to females (655 and 61, respectively). The most common machinery mechanisms of fatal injuries were roll-over (32%) for males and run-over (45%) for females. Agricultural machinery injuries requiring hospitalization showed similar patterns, with proportionally more males over age 60 injured. The male:female ratio for non-machinery hospitalizations averaged 3:1. A greater percentage of males were struck by or caught against an object, whereas for females, animal related injuries predominated.
COMMENTS: Gender is an important factor to consider in the interpretation of fatal and non-fatal farm injuries. A greater number of males were injured, regardless of how the occurrence of injury was categorized, particularly when farm machinery was involved. As women increasingly participate in all aspects of agricultural production, there is a need to collect, interpret, and disseminate information on agricultural injury that is relevant for both sexes.
See item 2 under Risk Factor Prevalence, Injury Occurrence and Costs
Correspondence: Christopher J. Schreck, Department of Criminal Justice Sciences, Illinois State University, Normal, IL, 61790-5250, USA; (email: cjschre@ilstu.edu).
While policymakers have granted a substantial commitment of resources in order to reduce fear of crime among U.S. school students, the research literature on fear of crime at school is in its infancy. This study investigates whether school security techniques reduce or exacerbate fear of crime among students, net of community and school disorder and student characteristics. Ferraro's (1995) theory of incivilities suggests that students might perceive highly visible security as an incivility, which might increase their fear of crime. Using a nationally representative sample of American school children from the 1993 National Household Education Survey: School Safety and Discipline Component NHES-SSD), we found that while school security efforts do not predict student fear as well as school disorder and individual student traits, many types of security correspond with a significantly greater likelihood that a student will be worried about crime while none reduce feelings of worry.
Elementary teachers' attitudes, perceptions and practices towards the implementation of a violence-prevention curriculum: Second Step.
This ethnographic study's intent was to understand and interpret elementary teachers' evolving attitudes, perceptions and practices towards non-violence curriculum, the Second Step violence-prevention program, and a project model utilizing consultants to implement instruction. Findings included that the curriculum was not implemented as intended and that there was a wide range of attitudes and practices reflecting difference in knowledge, cultural experience, and acceptance of the program and project. Recommendations for the future use of violence prevention curricula are presented.
CDC school health guidelines to prevent unintentional injuries and violence.
- Barrios LC, Sleet DA, Mercy JA. Am J Health Educ 2003, 34(5 Suppl): s18-s22.
Correspondence: Lisa C. Barrios, Division of Adolescent and School Health, National Center for Chronic Disease Prevention & Health Promotion, US Centers for Disease Control, 4770 Buford Highway NE, Mailstop K-12, Atlanta, GA 30341-3717, USA; (email: lbarrios@cdc.gov).
(Published by American Association for Health Education)
Approximately two-thirds of all deaths among children and adolescents aged five to 19 years results from injury-related causes: motor-vehicle crashes, all other unintentional injuries, homicide, and suicide. Schools have a responsibility to prevent injuries from occurring on school property and at school-sponsored events. In addition, schools can teach students the skills needed to promote safety and prevent unintentional injuries, violence, and suicide while at home, at work, at play, in the community, and throughout their lives. The school health recommendations for preventing unintentional injury, violence, and suicide summarized here were developed by the Centers for Disease Control and Prevention (CDC) in collaboration with experts from universities and from national, federal, state, local, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in unintentional injury, violence, and suicide prevention; health education; and pubic health. The guidelines include recommendations related to the following eight aspects of school health efforts to prevent unintentional injury, violence, and suicide: a social environment that promotes safety; a safe physical environment; health education curricula and instruction; safe physical education, sports and recreational activities; health, counseling, psychological and social services for students; appropriate crisis and emergency response; involvement of families and communities; and staff development.
Correspondence: Susan P. Limber, Institute on Family and Neighborhood Life, 158 Poole Agricultural Center, Clemson University, Clemson, SC 29634, USA; (email: slimber@clemson.edu).
(Published by American Association for Health Education)
Bullying among children and youth has received considerable recent attention by
educators, policy makers, health and mental health professionals, the media, and the
general public. Recent legislation pertaining to bullying is reviewed, and current school-based bullying prevention and intervention strategies are described and critiqued. A number of common misdirections in efforts to address bullying are presented. Research to date suggests that comprehensive bullying prevention efforts, which involve the entire school community, hold the most promise for changing the norms for behavior and ultimately the prevalence of bullying in schools.
Correspondence: A.M. Bisantz, Department of Industrial Engineering, University at Buffalo, The State University of New York, Amherst, New York 14020, USA; (email: bisantz@buffalo.edu).
Methodologies for assessing human judgment in complex domains are important for the design of both displays that inform judgment and automated systems that suggest judgments. This paper uses the n-system lens model to evaluate the impact of displays on human judgment and to explicitly assess the similarity between human judgments and a set of potential judgment algorithms for use in automated systems. First, the need for and concepts underlying judgment analysis are outlined. Then the n-system lens model and its parameters are formally described. This model is then used to examine a previously conducted study of aircraft collision detection that had been analyzed using standard analysis of variance methods. Our analysis found the same main effects as did the earlier analysis. However, n-system lens model analysis was able to provide greater insight into the information relied upon for judgments and the impact of displays on judgment. Additionally, the analysis was able to identify attributes of human judgments that were--and were not--similar to judgments produced by automated systems. Potential applications of this research include automated aid design and operator training.
Why does the gaze of others direct visual attention?
- Downing PE, Dodds CM, Bray D. Vis Cogn 2004; 11(1): 71-79.
Correspondence: Paul E. Downing, School of Psychology, University of Wales, Bangor, UK; (email: p.downing@bangor.ac.uk).
Viewing another person directing his or her gaze can produce automatic shifts of covert visual attention in the same direction. This holds true even when the task-relevant target is much more likely to occur at the uncued location. These findings, along with other evidence, have been taken to suggest that gaze represents a "special" stimulus--the foundation of a social cognition system that can make inferences about the mental states of other people. However, gaze-driven cueing effects could simply be due to spatial compatibility between cue and target. We compared the attentional effects of gaze shifts to a face with the tongue extended laterally to the left or right. When tongue direction was a nonpredictive cue, we found cueing effects from tongues that were indistinguishable from those produced by gaze. However, in contrast to previous findings with gaze, tongue cues did not overcome a validity manipulation in which targets were four times more likely to appear at the uncued location. We conclude that simple attentional cueing effects from gaze may be better explained by spatial compatibility, and that more complex, unique features of cueing from gaze may be better indices into perceptual systems specialized for social cognition.
(Published by American Association for Health Education)
In the United States, almost 12 percent of deaths to youth and young adults aged 10 to 24 years result from suicide. Schools have an important role to play in prevention. While most school systems recognize this, most struggle with how to effectively address suicide prevention. A number of principles of suicide prevention effectiveness are described, as well as recommendations for school efforts to prevent suicide. School health education should include training for students on: 1) identifying troublesome feelings; 2) sources of help for these feelings; 3) identifying signs or symptoms of depression; 4) strategies for preventing and dealing with depression; 5) sources of help for depression; and 6) potential signs and symptoms of depression and troublesome feelings. School systems and individual schools should: 1) provide training for teachers and staff to help identify students with depression or exhibition of pre-suicidal behaviors; 2) establish a mechanism of identification and referral of pre-suicidal students; 3) train parents to help them identify when their children are experiencing depression or are exhibiting pre-suicidal behaviors; 4) designate a staff person to coordinate programs for youth who are depressed; 5) develop a plan to respond to suicide among students -- a plan that represents best practices regarding prevention of subsequent or cluster suicides; and 6) avoid reliance on only one program or strategy.
Suicide attempts among sexual-minority male youth.
Correspondence: Ritch C. Savin-Williams, Department of Human Development, MVR Hall, Cornell University, Ithaca, NY 14853, USA; (email: rcs15@cornell.edu).
The purpose of this study was to provide data addressing Diamond's (this issue) 4 problem areas in sexual orientation research by comparing gay, bisexual, and questioning male youth who report attempting suicide with those who do not. Secondary analyses were conducted with 2 datasets, 1 with a gay support group (n = 51) and the other with online youth (n = 681). Reported suicide attempts ranged from 39% among support-group youth, to 25% among Internet gay support group youth, to 9% among Internet non-support group youth. Sexual orientation, behavior, and identity did not predict suicidal attempt status, but suicide attempters experienced higher levels of both generic life stressors (low self-esteem, substance use, victimization) and gay-related stressors, particularly those directly related to visible (femininity) and behavioral (gay sex) aspects of their sexual identity. Support-group attendance was related to higher levels of suicidality and life stressors, as well as certain resiliency factors. Results suggest that there exists a minority of sexual-minority youth who are at risk but that it would be inappropriate to characterize the entire population as such.
Correspondence: Samuel N. Forjuoh, Texas A&M University System, Health Science Center, College of Medicine, Scott & White Memorial Hospital, Temple, TX, USA; (email: sforjuoh@swmail.sw.org).
Traffic-related injuries have become a major public health concern worldwide. However, unlike developed or high-income countries (HICs), many developing or low-income countries (LICs) have made very little progress towards addressing this problem. Lack of the progress in LICs is attributable, in part, to their economic situation in terms of their governments' lack of resources to invest in traffic safety, cultural beliefs regarding the fatalism of injuries, competing health problems particularly with the emergence of HIV/AIDS, distinctive traffic mixes comprising a substantial number of vulnerable road users for whom less research has been done, low literacy rates precluding motorists to read and understand road signs, and peculiar political situations occasionally predominated by dictatorship and non-democratic governments. How then can LICs tackle the challenge of traffic safety from the experiences of HICs without reinventing the wheel? This paper reviews selected interventions and strategies that have been developed to counter traffic-related injuries in HICs in terms of their effectiveness and their applicability to LICs. Proven and promising interventions or strategies such as seat belt and helmet use, legislation and enforcement of seat belt use, sidewalks, roadway barriers, selected traffic-calming designs (e.g., speed ramps/bumps), pedestrian crossing signs combined with clearly marked crosswalks, and public education and behavior modification targeted at motorists are all feasible and useable in LICs as evidenced by data from many LICs. While numerous traffic-related injury policy interventions and strategies developed largely in HICs are potentially transferable to LICs, it is important to consider country-specific factors such as costs, feasibility, sustainability, and barriers, all of which must be factored into the assessment of effectiveness in specific LIC settings. Almost all interventions and strategies that have been proven effective in HICs will need to be evaluated in LICs and particular attention paid to the effectiveness of enforcement measures. It behooves LIC governments, however, to ensure that only standard, approved safety devices like helmets are imported into their countries. Additionally, LICs may need to improvise and innovate in the traffic safety technology transfer.
Pattern of road traffic injuries in Ghana: implications for control.
Road traffic injuries and fatalities are increasing in Ghana. Police-collected crash and injury data for the period 1994-1998 were aggregated and analyzed using the MAAP5 accident analysis package developed by the Transport Research Laboratory, U.K. Published results of recent transport-related epidemiological and other surveys provided an additional data source. According to the 1994-1998 police data, road traffic crashes were a leading cause of death and injuries in Ghana. The other leading causes of death and injuries are occupational injuries which involve non-mechanized farming and tribal conflicts. The majority of road traffic fatalities (61.2%) and injuries (52.3%) occurred on roads in rural areas. About 58% more people died on roads in the rural areas than in urban areas, and generally more severe crashes occurred on rural roads compared with urban areas. Pedestrians accounted for 46.2% of all road traffic fatalities. The majority of these (66.8%) occurred in urban areas. The second leading population of road users affected was riders in passenger-ferrying buses, minibuses and trucks. The majority of these (42.8%) were killed on roads that pass through rural areas. Pedestrian casualties were overrepresented (nearly 90%) in five regions located in the southern half of the country. Efforts to tackle pedestrian safety should focus on the five regions of the country where most pedestrian fatalities occur in urban areas. Policies are also needed to protect passengers in commercially operated passenger-ferrying buses, minibuses and trucks because these vehicles carry a higher risk of being involved in fatal crashes.
Vehicle year and the risk of car crash injury.
- Blows S, Ivers RQ, Woodward M, Connor J, Ameratunga S, Norton R. Inj Prev 2003; 9(4): 353-356.
OBJECTIVE: To quantify the association between vehicle age and risk of car crash injury.
METHODS: Data from a population based case-control study conducted in the Auckland region in 1998/99 was used to examine the adjusted risk of car crash injury or death due to vehicle age, after controlling for a range of known confounders. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and controls were randomly selected cars on Auckland roads. The drivers of the 571 case vehicles and 588 control vehicles completed a structured interview.
MAIN OUTCOME MEASURE: Hospitalization or death of a vehicle occupant due to car crash injury.
FINDINGS: Vehicles constructed before 1984 had significantly greater chance of being involved in an injury crash than those constructed after 1994 (odds ratio 2.88, 95% confidence interval (CI) 1.20 to 6.91), after adjustment for potential confounders. There was also a trend for increasing crash risk with each one year increase in vehicle age after adjustment for potential confounders (odds ratio 1.05, 95% CI 0.99 to 1.11; p = 0.09).
COMMENTS: This study quantifies the increased risk of car crash injury associated with older vehicle year and confirms this as an important public health issue.
Examining child restraint use and barriers to their use: lessons from a pilot study.
Correspondence: Jean C Simpson, Injury Prevention Research Unit, University of Otago, PO Box 913, Dunedin, NEW ZEALAND; (email: jean.simpson@ipru.otago.ac.nz).
OBJECTIVE: To determine the suitability of four research methods to measure the rate of child restraint device (CRD) use and incorrect use in New Zealand and obtain data on barriers to CRD use.
DESIGN AND SETTING: To assess the rates of CRD use among vehicles carrying children 8 years of age and under, two methods were piloted-namely, an unobtrusive observational survey and a short interview and close inspection. A self administered questionnaire and focus group interviews were also piloted to assess CRD use, reasons for use and non-use, and to obtain information on barriers to their use. Respondents to all methods except the focus groups were approached in supermarket car park sites at randomly selected times. Focus groups were established with parents identified through early childhood organizations. All methods were assessed on criteria related to efficiency, representativeness, and ability to obtain the necessary data.
FINDINGS: The observational survey provided a simple method for identifying rates of CRD use, while the self administered questionnaire obtained data on demographic characteristics and reported the installation and use/non-use of CRDs. The interview/inspection addressed all the questions of both the above methods and enabled incorrect CRD use to be examined. The focus groups provided the most meaningful information of all methods on barriers to CRD use.
COMMENTS: and conclusion: Advantages and limitations of these methods are discussed and some refinements of the original instruments are proposed. The interview/inspection and focus group methods were identified as being more appropriate for efficiently obtaining reliable data on CRD use and identification of barriers to CRD use.
Increases in booster seat use among children of low income families and variation with age.
- Apsler R, Formica SW, Rosenthal AF, Robinson K. Inj Prev 2003; 9(4): 322-325.
Correspondence: Robert Apsler, 84 Mill Street, Lincoln, MA 01773-1706, USA; (email: rapsler@mail2.gis.net).
OBJECTIVES: To increase booster seat use among low income parents. Design/methods: A pre-test/post-test design conducted in nine day care centers with post-test observations four to eight weeks after the intervention.
INTERVENTION: Parents who participated in an educational training received free seats, educational programs were provided to all day care staff and children, and signs in parking lots informed parents about child restraints. At seven centers, new policies recommended compliance with state restraint laws. Parents at four centers randomly chosen from the seven received financial incentives if observed using booster seats.
MAIN OUTCOME MEASURE: The percent of children aged 4-8 riding in booster seats.
FINDINGS: Pre-test observations of 185 4-8 year olds found 56% riding unrestrained and fewer than 3% riding in booster seats. After the intervention, observation of 146 children found the number riding in booster seats increased to 38% and the number observed without restraints decreased to 26%. Most booster seat use occurred with 4 and 5 year olds. No 7 or 8 year olds rode in booster seats. Changing center policies to recommend compliance with state restraint laws and an offer of financial incentives appeared to have no additional impact.
COMMENTS: Booster seat usage among low income families can be increased dramatically, though use decreases with age. Providing free seats accompanied by training may be sufficient without the need for additional intervention.
See items under Distraction and Attentional Issues
Unintentional and undetermined firearm related deaths: a preventable death analysis for three safety devices.
- Vernick JS, O'Brien M, Hepburn LM, Johnson SB, Webster DW, Hargarten SW. Inj Prev 2003; 9(4): 307-311.
Correspondence: Jon S Vernick, Johns Hopkins Bloomberg School of Public Health, Center for Gun Policy and Research, 624 N Broadway, Baltimore, MD 21205, USA; (email: JVernick@jhsph.edu).
OBJECTIVE: To determine the proportion of unintentional and undetermined firearm related deaths preventable by three safety devices: personalization devices, loaded chamber indicators (LCIs), and magazine safeties. A personalized gun will operate only for an authorized user, a LCI indicates when the gun contains ammunition, and a magazine safety prevents the gun from firing when the ammunition magazine is removed.
METHODS: Information about all unintentional and undetermined firearm deaths from 1991-98 was obtained from the Office of the Chief Medical Examiner for Maryland, and from the Wisconsin Firearm Injury Reporting System for Milwaukee. Data regarding the victim, shooter, weapon, and circumstances were abstracted. Coding rules to classify each death as preventable, possibly preventable, or not preventable by each of the three safety devices were also applied.
FINDINGS: There were a total of 117 firearm related deaths in our sample, 95 (81%) involving handguns. Forty three deaths (37%) were classified as preventable by a personalized gun, 23 (20%) by a LCI, and five (4%) by a magazine safety. Overall, 52 deaths (44%) were preventable by at least one safety device. Deaths involving children 0-17 (relative risk (RR) 3.3, 95% confidence interval (CI) 2.1 to 5.1) and handguns (RR 8.1, 95% CI 1.2 to 53.5) were more likely to be preventable. Projecting the findings to the entire United States, an estimated 442 deaths might have been prevented in 2000 had all guns been equipped with these safety devices.
COMMENTS: Incorporating safety devices into firearms is an important injury intervention, with the potential to save hundreds of lives each year.
Effect of urban closed circuit television on assault injury and violence detection.
Correspondence: Vaseekaran Sivarajasingam, Department of Oral Surgery, Medicine and Pathology, Violence Research Group, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XY, UK; (email: vassiva@btinternet.com).
OBJECTIVE: To evaluate the effect of closed circuit television (CCTV) surveillance on levels of assault injury and violence detection.
DESIGN: Intervention versus control study design.
SETTING: Five town/cities with CCTV surveillance and five, matched control centers without CCTV surveillance in England.
INTERVENTION: CCTV installation and surveillance.
METHODS: Assault related emergency department attendances and violent offenses recorded by the police in CCTV and control centers in the four years, 1995-99, two years before and two years after CCTV installation, were compared.
FINDINGS: Assault related emergency department attendances decreased in intervention centers (3% decrease, ratio 0.96; 95% confidence interval (CI) 0.93 to 0.99) and increased in control centers (11% increase, ratio 1.11; 95% CI 1.08 to 1.14). Overall, changes in emergency department assault attendance in CCTV and control centers were significantly different (t test, p<0.05). Police recorded violence increased in CCTV (11% increase, ratio 1.16; 95% CI 1.08 to 1.24) and control centers (5% increase, ratio 1.06; 95% CI 0.99 to 1.13). Overall, changes in police recording in CCTV and control centers were not significantly different (t test, p>0.05). In CCTV centers, decreases in assault related emergency department attendances and increases in police violence detection were not uniform.
COMMENTS: CCTV surveillance was associated with increased police detection of violence and reductions in injury or severity of injury. CCTV center variation deserves further study.
Violence-related traumatic brain injury: a population-based study.
BACKGROUND: Most studies of traumatic brain injury (TBI) and violence are small, focus on one violent mechanism only, and are nonrepresentative. This large, population-based effort examines characteristics, circumstances of injury, treatment pathways, and outcomes of persons with TBI as a result of all types of violence, compares them with other TBI survivors, identifies a risk profile, and examines how a violent cause impacts later outcomes.
METHODS: This study involved medical record abstraction and telephone survey at 1 year postinjury of a weighted sample of 2,771 Coloradans hospitalized with TBI between January 1, 1996, and June 30, 1999.
FINDINGS: People with violently incurred TBI are more likely to be young, male, members of minority groups, single, and premorbid alcohol abusers than other TBI survivors. At 1 year postinjury, they report less community integration and more headaches, confusion, and sensory and attentional disturbances. Predictors of these outcomes included age, gender, injury severity, and employment status.
COMMENTS: It appears that essentially the same factors that increase risk of sustaining a violent TBI negatively impact later outcomes as well.
It has been argued that individuals who engage in spouse abuse increase their violence toward their partners, which can culminate in the death of either the assaulter or the victim. The aim of this review is to identify risk factors that determine whether an abusive relationship will end in eventual death. An extensive search revealed 22 empirical research studies on risk factors for spousal homicide. The circumstances of spousal homicide are described and salient risk factors are highlighted. In the United Kingdom, 37% of all women were murdered by their current or former intimate partner compared to 6% of men. The most common cause of an intimate partner's death in England and Wales was being attacked with a sharp implement or being strangled. By contrast, the most common cause in the United States for spousal homicide was being shot. Nine major risk factors are found that may help predict the probability of a partner homicide and prevent future victims.
