The objective of this paper is to discuss the benefits and risks of providing drinkers with tools that allow them to estimate their blood alcohol concentration (BAC), and to examine the field usability of one commercially available tool. Drinking and driving laws are specified in terms of the driver's BAC, and there is concern that the absence of a method for drivers to accurately estimate their BAC level limits their ability to determine whether they can drive legally. A number of devices that provide a method for the individual to estimate or measure their BAC have been developed. Although some of these devices--such as the "know your limit" (KYL) cards--have been widely distributed, their effectiveness in encouraging good driving decisions have rarely been tested. This article describes a pilot study on the field usability of the Guardian Angel (GA) personal alcohol test in a field setting. The GA test analyzes saliva samples from drinking and indicates under which BAC category they fall (.00 -.04;.04 -.08;.08+). The research examined whether drinkers could, in natural drinking environments, correctly administer and interpret the test results. The methodology involves sampling drinkers on a weekend night on and around the grounds of a large West Coast university as they traveled between off-campus parties, bars, and their dorms. They were asked to assess their own intoxication and impairment, then self-administer and interpret the Guardian Angel test. After interpreting the test, participants were asked to reassess their intoxication and impairment levels, and were given a breath BAC test using a calibrated unit. The results revealed that although the majority of drinkers' were able to administer the GA test, their interpretations did not correspond with actual BACs. The interpretations of the GA test produced false-negatives, underestimating actual BACs. Drinkers perceived themselves to be less intoxicated, on average, after interpreting the GA test results. In conclusion, this research addresses potential pros and cons of providing BAC information to drinkers. It underscores the importance of testing BAC estimation tools under field conditions and the potential risks associated with tests that do not produce accurate results.
Child passenger deaths involving drinking drivers -- United States, 1997--2002.
This document including tables, figures, references, and an editorial note is available online: ( Download Document ).
The summary below includes the Erratum Update that was released by the Centers for Disease Control on 13 February 2004. However, the Acrobat version of the report (available from the link above) was not updated and includes the error. If you plan to use the Acrobat document you may wish to write in the correction.
Motor-vehicle crashes are the leading cause of death among children aged ≥1 year in the United States, and one in four crash-related deaths among child passengers aged ≤14 years involves alcohol use. To characterize the occurrence of child passenger deaths involving drinking drivers during 1997--2002, CDC analyzed data from the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration. This report summarizes the results of that analysis, which indicated that among the 2,335 (the original publication, in error, used the number 2,355) children who died in alcohol-related crashes, 1,588 (68%) were riding with drinking drivers; the majority of these children were not restrained. To reduce the number of child fatalities in alcohol-related motor-vehicle crashes, effective interventions are needed to prevent alcohol-impaired driving and to increase use of child passenger restraints.
FARS is a census of fatal motor-vehicle crashes that occur on public roadways in the United States and result in the death of an occupant or nonoccupant (e.g., pedestrian or bicyclist) within 30 days of the crash. A fatal motor-vehicle crash was classified as alcohol related if either a driver or nonoccupant had a blood alcohol concentration (BAC) of ≥0.01 g/dL. When BACs were not available, they were imputed from driver and crash characteristics by using a two-stage estimation procedure (3). A drinking driver was defined as a driver with a measured or imputed BAC of >0.01 g/dL. Child passengers were defined as passengers aged ≤14 years.
During 1997--2002, a total of 9,622 child passengers died in motor-vehicle crashes; 2,335 (24%) were killed in crashes involving drinking drivers. Of the 2,061 alcohol-related crashes involving drinking drivers in which children were killed, 1,624 (79%) involved at least one driver with a BAC of ≥0.08 g/dL (in 31 states as of December 31, 2002, the legal BAC level for drivers aged ≥;21 years is ≤0.08 g/dL). Of these crashes, 1,238 (60%) occurred during 6 a.m. -- 9 p.m.
Of the 2,335 children who died in alcohol-related crashes, 1,588 (68%) were riding with drinking drivers. The median BAC of the 1,409 drinking drivers who were transporting children was 0.13 g/dL (range: 0.01--0.65 g/dL). Of the 1,409 drinking drivers involved in these crashes, 956 (68%) survived.
For all child passenger deaths, including those not involving drinking drivers, child passenger restraint use decreased as both the child's age and BAC of the child's driver increased (Figure). Of 1,451 child passengers with known restraint information who died while riding with drinking drivers, 466 (32%) were restrained at the time of the crash.
Influence of an injury reduction program on injury and fitness outcomes among soldiers.
- Knapik JJ, Bullock SH, Canada S, Toney E, Wells JD, Hoedebecke E, Jones BH. Inj Prev 2004; 10(1): 37-42.
Correspondence: Joseph Knapik, Directorate of Epidemiology and Disease Surveillance, US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010, USA; (email: joseph.knapik@apg.amedd.army.mil).
OBJECTIVE: This study evaluated the influence of a multiple injury control intervention on injury and physical fitness outcomes among soldiers attending United States Army Ordnance School Advanced Individual Training.
METHODS: The study design was quasiexperimental involving a historical control group (n = 2559) that was compared to a multiple intervention group (n = 1283). Interventions in the multiple intervention group included modified physical training, injury education, and a unit based injury surveillance system (UBISS). The management responsible for training independently formed an Injury Control Advisory Committee that examined surveillance reports from the UBISS and recommended changes to training. On arrival at school, individual soldiers completed a demographics and lifestyle questionnaire and took an army physical fitness test (APFT: push-ups, sit-ups, and two mile run). Injuries among soldiers were tracked by a clinic based injury surveillance system that was separate from the UBISS. Soldiers completed a final APFT eight weeks after arrival at school.
FINDINGS: Cox regression (survival analysis) was used to examine differences in time to the first injury while controlling for group differences in demographics, lifestyle characteristics, and physical fitness. The adjusted relative risk of a time loss injury was 1.5 (95% confidence interval 1.2 to 1.8) times higher in the historical control men and 1.8 (95% confidence interval 1.1 to 2.8) times higher in the historical control women compared with the multiple intervention men and women, respectively. After correcting for the lower initial fitness of the multiple intervention group, there were no significant differences between the multiple intervention and historical control groups in terms of improvements in push-ups, sit-ups, or two mile run performance.
COMMENTS: This multiple intervention program contributed to a reduction in injuries while improvements in physical fitness were similar to a traditional physical training program previously used at the school.
Correspondence: D.W. Lovejoy, Hartford Hospital, Institute of Living, University of Connecticut School of Medicine, USA; (email: dlovejo@harthosp.org).
BACKGROUND: Early publicized predictions of an onslaught of psychiatric distress following the terrorist events of September 11, 2001, have not materialized, and it remains unlikely at present that the medical and insurance communities will experience a significant increase in psychiatric utilization rates secondary to September 11. A handful of research studies have begun to characterize the psychiatric impact of the events associated with the September 11 terrorist attacks. Information related to the manifestation of psychiatric distress following disasters is of particular interest to the scientific, clinical and disability insurance communities given the ongoing threat of further terrorist attacks.
METHODS: A comprehensive literature search was completed to identify articles that address our current understanding of posttraumatic stress disorder (PTSD) and patterns of psychiatric distress that typically follow manmade disasters. To help in conveying such a conceptual framework, we integrated basic research relating to PTSD with epidemiological data relating to past disasters (e.g., the Oklahoma City bombing) and the events of September 11.
FINDINGS AND COMMENTS: A critical analysis of the September 11 research literature is offered with suggestions for research that would strengthen our understanding of the manifestation of psychiatric distress associated with manmade disasters.
Recent research indicates that cell phone use can distract drivers from safe vehicle operation. However, estimates of the prevalence of cell phone use while driving have been limited to daytime hours and low-speed roadways. This paper describes the results of a study to estimate rates of cell phone use and other distractions by examining approximately 40,000 high-quality digital photographs of vehicles and drivers on the New Jersey Turnpike. The photographs, which originally were collected as part of a separate study, were taken both during the day and during the night and at different locations across the span of the Turnpike. A radar gun linked to the camera recorded the speeds of vehicles as they passed. This provided us with the speeds of every vehicle photographed, and allowed us to determine population counts of vehicles. A panel of three trained coders examined each photograph and recorded the presence of cell phone use by the drivers or any other distracting behavior. Demographic information on the driver was obtained during previous examinations of the photographs for an unrelated study. A rating was considered reliable when two out of the three coders agreed. Population estimates (and confidence intervals) of cell phone use and other distractions were estimated by weighting the cases by the inverse probability of vehicle selection. Logistic regression was used to predict cell phone use from demographic and situational factors. The results indicated that the most frequent distraction was cell phone use: 1.5% of the drivers on the Turnpike were using cell phones compared to the 3 to 4% use rates reported in the National Occupant Protection Use Survey (NOPUS) surveys conducted during the daytime on lower speed roadways. The Turnpike survey indicated that cell phones were used less on weekends and at night, and when the driver was exceeding the speed limit or had a passenger in the car.
Older women drivers: fatal crashes in good conditions.
- Baker TK, Falb T, Voas R, Lacey J. J Safety Res 2003; 34(4): 399-405.
Correspondence: Tara Kelley Baker, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; (email: kelley-b@pire.org).
BACKGROUND: By 2030, there will be approximately 70 million older people (65+) in the United States, more than twice their number in 2000. This increase also represents an increased percentage of older licensed drivers. Thus, it is important to understand the special circumstances of how they may be involved in traffic crashes.
METHOD: This study used the Fatality Analysis Reporting System (FARS), which is a census of all fatal crashes occurring in the United States over the last two decades maintained by the National Highway Traffic Safety Administration (NHTSA), to study the special characteristics of fatal crashes involving females older than 70 years.
FINDINGS: The results indicate that senior women are overrepresented in crashes that occur under the "safest" conditions, on roads with low speed limits, in daylight, when traffic is low (not at rush hour), when the weather is good, and when the roads are dry.
Serious eye injuries caused by bottles containing carbonated drinks.
- Kuhn F, Mester V, Morris R, Dalma J. Br J Ophthalmol 2004; 88(1): 69-71.
Correspondence: Ferenc Kuhn, American Society of Ocular Trauma, 1201 11th Avenue South, Suite 300, Birmingham, AL 35205, USA; (email: fkuhn@mindspring.com).
OBJECTIVE: To analyse serious eye injuries caused by bottles containing pressurized drinks.
METHODS: Retrospective review of the databases of US, Hungarian, and Mexican eye injury registries.
FINDINGS: In the combined database (12 889 injuries), 90 cases (0.7%) were caused by bottle tops or glass splinters. The incidence varied widely: 0.3% (United States), 3.1% (Hungary), and 0.9% (Mexico), as did the agent. Champagne bottle corks were responsible in 20% (United States), 71% (Hungary; p<0.0001), and 0% (Mexico). Most eyes improved, but 26% remained legally blind.
COMMENTS: The presence of warning labels on champagne bottles appears to reduce cork related eye injuries, as does using plastic bottles and caps.
Prevention of occupational injuries: moral hazard and complex agency relationships.
- Trontin C, Bejean S. Safety Science 2004; 42(2): 121-141.
Correspondence: Christian Trontin, Institut National de Recherche et de Securite pour les accidents du travail et les maladies professionnelles, Av. de Bourgogne, 54501, Vandoeuvre les Nancy, FRANCE; (email: christian.trontin@inrs.fr).
This paper exploits the results of agency theory with the aim of contributing a new viewpoint and a form for analysis of the current functioning of the occupational injury and disease section of the French Social Security system in its mission of providing incentives for prevention. After outlining the organization and specific features of insurance against occupational risks, an initial level of analysis highlights the presence of moral hazard in relations between insurer and company and between company and employee. A second level of analysis with the appeal to complex agency relationship models, multitask model and third-party model, is necessary to take into account the consequences for occupational injury prevention of wage indexing on productivity and the presence of supervisors between the legislator and the company.
The influence of safety at work on safety at home and during leisure time.
- Lund J, Hovden J. Safety Science 2004; 41(9): 739-757.
Correspondence: Johan Lund, Department of General Practice and Community Medicine, University of Oslo, PO Box 1130, Blindern, N-0317, Oslo, NORWAY; (email: johan.lund@samfunnsmed.uio.no).
It has been argued that the effects of safety programs extend to safety related behavior outside the work environment. Data from studies of the behavior of workers in three industries with a high focus on safety were examined in order to explore this argument. By means of data collected through a questionnaire, safe behavior and emergency preparedness behavior at home and during leisure time were measured in a case-control study. The findings indicate that workers in two of the three studies did not transfer safe behavior from workplaces with a high focus on safety to home and leisure arenas. The safety consciousness acquired by workers at their workplaces in the absence of specially designed home and leisure time intervention projects seems to be insufficiently comprehensive or deep enough to influence safe behavior in other arenas. While safe behavior was not transferred, the emergency preparedness behavior was. This indicates that the contextual and situational aspects of emergency preparedness are shared across risk arenas.
Features of electric arc accidents and use of protective clothing in Finland.
- Makinen H, Mustonen S. Safety Science 2004; 41(9): 791-801.
Correspondence: Helena Makinen, Finnish Institute of Occupational Health, FIN-, Topeliuksenkatu 41 a A, FINLAND; (email: helena.makinen@ttl.fi).
An electric arc produces a high level of thermal energy which ignites normal materials and causes burn injuries to the workers nearby. The amount of energy released in an electric arc depends on the type of electrical installation, and is determined by the following parameters: current, duration of the arc, length of arc, distance from the arc and source voltage. The effects on the human body thus depend on the energy, and the kind of clothing being worn. This study analyses 25 electric arc accidents that occurred in Finland in 1996-1999, and the role that protective clothing played in them. The study also investigates the current usage of protective clothing and other personal protective equipment, as well as the implementation of technical measures and training in decreasing the risk of electric arc accidents in power stations and transmission utilities. Most of the accidents studied took place in a low voltage installation with a nominal voltage of 400 V. However, the accidents that occurred in a medium voltage installation were more serious than those that occurred in low voltage installations. Workers who did not wear flame-retardant protective clothing encountered accidents that led to bodily injury more frequently. Workers who wore garments that are flame-retardant and do not break open in an accident, suffered less serious injuries. In order to adapt the protection level of the clothing to the true need for protection, different levels should be defined rather than setting only one, fixed level of protection. Companies should analyse their work sites to assess the occurrence of risk and the kind of protection that is needed. Technical measures should be implemented first. Training should aim to change attitudes so that intentional risks will not be taken, and that personal protective equipment will be used when required.
In accidents involving sports utility vehicles (SUVs), injuries to pedestrian leg, knee ligaments, and femur are likely to occur. Therefore, the European Enhanced Vehicle Safety Committee proposed two subsystem test methods for evaluation of SUV bumper aggressiveness. Such evaluation can be conducted by means of either a legform impactor (evaluation of risk of knee and tibia injury), or an upper legform impactor (evaluation of risk of thigh and pelvis injury) test. Each of these two test methods has its own injury criteria and injury acceptance levels. Therefore, the first objective of this research is to clarify any differences between the test results obtained when evaluating SUV bumper aggressiveness by means of these two impactors. The second objective is to determine whether or not a legform impactor can be applied to estimate the risk of femur fracture, and if an upper legform impactor can be used to estimate the risk of knee ligament injury. The present results indicate the test method using an upper legform impactor yields higher ratios of injury criteria to the relevant EEVC/WG17 injury acceptance levels than by using a legform impactor. Thus, the upper legform impactor test rates an SUV bumper as more aggressive than the legform impactor test. The present study suggests the lower leg acceleration obtained by the legform impactor can be used to adequately assess the risk of femur fracture, when evaluating the aggressiveness of an SUV bumper using proposed injury acceptance levels reported in the literature. Similarly, the impact force obtained by the upper legform impactor can be used to assess the risk of cruciate ligament injury.
Community based programs to prevent poisoning in children 0-15 years.
- Nixon J, Spinks A, Turner C, McClure R. Inj Prev 2004; 10(1): 43-46.
Correspondence: Cathy Turner,Injury Research Unit, School of Population Health, Mayne Medical School, University of Queensland, Herston Rd, Herston, QLD, AUSTRALIA; (email: C.Turner@sph.uq.edu.au).
OBJECTIVE: Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in preventing poisoning in children 0-15 years of age.
METHODS: A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; target population was children under 15 years; outcome measure was poisoning rates; and either a community control or an historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies.
FINDINGS: The review found only four studies, which met all the inclusion criteria. Only two studies used a trial design with a contemporary control and only one study provided convincing evidence of an effective community program for reducing poisoning in children.
COMMENTS: There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community based childhood poisoning prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.
OBJECTIVE: To investigate the possible development of long-term disabilities arising from pediatric equestrian injuries.
METHODS: All patients, aged 17 years or younger, treated in a hospital setting because of an equestrian injury during a five-year period received a questionnaire. A reference population and healthy friends served as controls.
FINDINGS: Four years post-injury, 41 of the 100 respondents still experienced disabilities following the injury. The median Injury Severity Score was 4. Absenteeism from school lasted 2 weeks, and from horse riding, 4 months. Compared to the reference population, the results of the Child Health Questionnaire were poorer considering most of its subscales. In comparison with the friends, the patients only scored lower on 'physical functioning'. The risk factors concerning poor long-term outcomes were being an advanced rider, sustaining injuries other than fractures of the extremities or sustaining subsequent injuries following the riding accident.
COMMENTS: Although equestrian injuries in children are minor to moderate in their severity, these injuries are significant considering that a large proportion of patients experience long-term disabilities.
Football (soccer) injuries during FIFA tournaments and the Olympic Games, 1998-2001: development and implementation of an injury-reporting system.
- Junge A, Dvorak J, Graf-Baumann T, Peterson L. Am J Sports Med 2004; 32(1 Suppl): 80S-89S.
Correspondence: Astrid Junge, Federation Internationale de Football Association Medical Assessment and Research Center, Schulthess Klinik, Lengghalde 2, Zurich 8008, SWITZERLAND; (email: unavailable).
BACKGROUND: Standardized assessment of sports injuries provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and characteristics of injury.
OBJECTIVE: Development and implementation of an easy to use injury-reporting system to analyze the incidence, circumstances and characteristics of injury during major international football tournaments.
STUDY DESIGN: Prospective survey.
METHODS: A comprehensive injury report form was developed, and implemented during 12 international football tournaments. The physicians of all participating teams were asked to report all injuries after each match. The response rate was 84% on average.
FINDINGS: A total of 901 injuries were reported from 334 matches, which is equivalent to an incidence of 2.7 injuries per match. Approximately one injury per match resulted in a player's absence from training or matches. On average 86% of the injuries arose as a result of contact with another player, and approximately half of all injuries were caused by foul play. The number of injuries per match differed substantially between the tournaments for players of different age, sex and skill-level.
COMMENTS: An injury-reporting system has been implemented as matter of routine in FIFA tournaments. The consistent findings in the present study demonstrate the high quality of the data obtained.
Rule violations as a cause of injuries in male Norwegian professional football (soccer): are the referees doing their job?
- Andersen TE, Engebretsen L, Bahr R. Am J Sports Med 2004; 32(1 Suppl): 62S-68S.
Correspondence: Thor Einar Andersen, Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, Olso, NORWAY; (email: thor.einar.andersen@nih.no).
BACKGROUND: Foul play is an important cause of injury in football. Reduction of foul play and adherence to the laws of the game may be possible interventions to reduce the rate of injuries.
OBJECTIVE: To evaluate how violations of the laws of the game contribute to injury and to investigate whether the decisions made by the referees are correct in high-risk situations.
STUDY DESIGN: Prospective cohort study.
METHODS: Videotapes and injury information were collected for 174 of 182 matches from the male Norwegian professional league during the 2000 season. Three Norwegian FIFA referees performed retrospective blinded evaluation of the 406 incidents.
FINDINGS: Less than one-third of the injuries identified on video and about 40% of the incidents with a high risk of injury resulted in a free kick being awarded. About 1 in 10 of these situations led to either a yellow or red card. The agreement between decisions made by the match referee and the expert referee panel was good, that is, their decisions agreed in 85% of the situations in which injury occurred.
COMMENTS: There may be a need for an improvement of the laws of the game of football to protect players from dangerous play.
The influence of tackle parameters on the propensity for injury in international football (soccer).
- Fuller CW, Smith GL, Junge A, Dvorak J. Am J Sports Med 2004; 32(1 Suppl): 43S-53S.
Correspondence: Colin W. Fuller, University of Leicester, 154 Upper New Walk, Leicester, Leicestershire LE1 7QA, UK; (email: cwf2@le.ac.uk).
PURPOSE: To understand how tackling leads to injury in football, to develop a framework for classifying tackles, and to identify tackles with the greatest propensity to cause injury. METHOD: Video recordings of 123 matches in three FIFA tournaments were used to identify tackling parameters. Team physicians prepared reports of postmatch medical attention to players. RESULTS: Tackles from the side were twice as likely to require postmatch medical attention as tackles from behind. Injuries to the head/neck of tackled and tackling players and the torso of tackling players were more likely to receive on-pitch medical attention than other injuries. Injuries to the foot for tackled and tackling players and the lower leg and thigh for tackling players were less likely to receive on-pitch medical attention than other injuries. Tackles with the greatest propensity for causing injury involved clash of heads and two-footed tackles for tackled players and clash of heads, two-footed tackles, jumping vertically, and tackles from the side for tackling players. CONCLUSION: The laws of football relating to tackling should be reviewed to provide greater protection from injury by reducing the overall level of risk and, in particular, by protecting players from tackles with the highest propensity for causing injury.
Football (soccer) injuries at Asian tournaments.
- Yoon YS, Chai M, Shin DW. Am J Sports Med 2004; 32(1 Suppl): 36S-42S.
Correspondence: Young Sul Yoon, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, KOREA; (email: ysyoon@yumc.yonsei.ac.kr).
OBJECTIVE: To examine the incidence and patterns of injuries that required medical attention among Asian football players.
METHODS: A total of 411 Asian football players at both senior and youth (U-20) elite levels were observed during 50 international matches. Independent injury observers and team doctors determined the occurrence of injuries and recorded the location, type, time, and circumstances of the injuries using a protocol sheet.
FINDINGS: The overall injury frequency rate was 45.8 out of 1000 hours. As the tournaments progressed into the knockout stages, the incidence and severity of the injuries increased. The most common sites of injuries were the knees (18.5%), lower legs (17.3%), and ankles (14.2%). Although most injuries were diagnosed as contusions, the more serious injuries were those diagnosed as sprains (especially concerning the knee and ankle) or strains (thigh and back).
COMMENTS: The incidence of injuries to Asian football players were higher than those to European players, but the patterns of the injuries showed no major differences. Clinical Relevance: To develop an injury-prevention program, more solid and comprehensive data need to be collected to identify the risk factors and variables associated with higher incidence of injuries to Asian football players.
An assessment of player error as an injury causation factor in international football (soccer).
- Fuller CW, Smith GL, Junge A, Dvorak J. Am J Sports Med 2004; 32(1 Suppl): 28S-35S.
Correspondence: Colin W. Fuller, University of Leicester, 154 Upper New Walk, Leicester, Leicestershire LE1 7QA, UK; (email: cwf2@le.ac.uk).
OBJECTIVE: To quantify the frequency of injury in football as a function of tackle parameters.
METHODS: Video recordings of 123 international matches in three Federation Internationale de Football Association tournaments were used to analyze tackle parameters, and team physicians provided reports of postmatch medical attention to players.
FINDINGS: A total of 8572 tackles were assessed, of which 3464 (40.4%) were fouls. There were 299 incidents of on-pitch medical attention, of which 131 (44%) resulted from foul tackles, and 200 postmatch team physicians' reports, of which 96 (48%) resulted from foul tackles. The cases of on-pitch medical attention resulted in 76 (25%) postmatch physicians' reports, but 124 (62%) of the postmatch physicians' reports were not associated with on-pitch medical attention. Tackled players received 74% of the postmatch medical reports. Tackle types with the greatest probability of requiring medical attention were from the side in terms of tackle direction, jumping vertically in terms of tackle mode, and a clash of heads in terms of tackle action.
COMMENTS: Human error on the part of players during the process of tackling and inadequacies in the laws of football and/or their application by match referees were equally responsible for the high levels of injury observed.
Football (soccer) injuries during the World Cup 2002.
- Junge A, Dvorak J, Graf-Baumann T. Am J Sports Med 2004; 32(1 Suppl): 23S-27S.
Correspondence: Astrid Junge, FIFA Medical Assessment and Research Centre, Schulthess Klinik, Lengghalde 2, Zurich 8008, SWITZERLAND; (email: unavailable).
BACKGROUND: The Federation Internationale de Football Association (FIFA) World Cup is one of the largest, most popular sporting events but is associated with a certain risk of injury for the players.
OBJECTIVE: Analysis of the incidence, circumstances, and characteristics of soccer injury during the World Cup 2002.
STUDY DESIGN: Prospective survey.
METHODS: The physicians of all participating teams reported all injuries after each match on a standardized injury report form. The response rate was 100%.
FINDINGS: A total of 171 injuries were reported from the 64 matches, which is equivalent to an incidence of 2.7 injuries per match; approximately 1 to 2 injuries per match resulted in absence from training or match. More than a quarter of all injuries were incurred without contact with another player, and 73% were contact injuries. Half of the contact injuries, or 37% of all injuries, were caused by foul play as rated by the team physician and the injured player.
COMMENTS: The incidence of injuries during the World Cup 2002 was similar to those reported for the World Cup in 1994 and in 1998. Increased awareness of the importance of fair play may assist in the prevention of injury.
An assessment of football referees' decisions in incidents leading to player injuries.
- Fuller CW, Junge A, Dvorak J. Am J Sports Med 2004; 32(1 Suppl): 17S-22S.
Correspondence: Colin W. Fuller, University of Leicester, 154 Upper New Walk, Leicester, Leicestershire LE1 7QA, UK; (email: cwf2@le.ac.uk).
OBJECTIVE: To assess whether match injuries to footballers occurred as a result of players' noncompliance with the rules of the game, match referees could reliably identify the legality of incidents leading to injury, and the rules of football were adequate to protect players from injury.
METHODS: Video recordings of incidents leading to injury in 12 FIFA tournaments were used to identify parameters. Team physicians reported the details of match injuries. Two panels of FIFA referees reassessed the legality of incidents from these tournaments that resulted in injuries.
FINDINGS: In total, 148 general injuries and 84 head/neck injuries were assessed. For the general injuries, the match referees identified 47% and the referees' panel identified 69% as fouls. For head injuries, the match referees identified 40% and the referees' panel identified 49% as fouls.
COMMENTS: Decisions made on the legality of tackles leading to injury indicated that the current rules of football were adequate for the majority of tackle situations, although the reliability with which referees could identify fouls during some match conditions was low. For incidents leading to head/neck injuries, the match referees and the referees' panel both identified a smaller proportion of injury situations as fouls.
Risk factors for injuries in football (soccer).
- Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Am J Sports Med 2004; 32(1 Suppl): 5S-16S.
Correspondence: Roald Bahr, Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, P.O. Box 4014, Ulleval Stadion, 0806 Oslo, NORWAY; (email: roald.bahr@nih.no).
BACKGROUND: The injury risk in football is high, but little is known about causes of injury.
OBJECTIVE: To identify risk factors for football injuries using a multivariate model.
STUDY DESIGN: Prospective cohort study.
METHODS: Participants were 306 male football players from the two highest divisions in Iceland. Before the 1999 football season started, the following factors were examined: height, weight, body composition, flexibility, leg extension power, jump height, peak O(2) uptake, joint stability, and history of previous injury. Injuries and player exposure were recorded throughout the competitive season.
FINDINGS: Older players were at higher risk of injury in general (odds ratio [OR] = 1.1 per year, P = 0.05). For hamstring strains, the significant risk factors were age (OR = 1.4 [1 year], P < 0.001) and previous hamstring strains (OR = 11.6, P <0.001). For groin strains, the predictor risk factors were previous groin strains (OR = 7.3, P = 0.001) and decreased range of motion in hip abduction (OR = 0.9 [1 degrees ], P = 0.05). Previous injury was also identified as a risk factor for knee (OR = 4.6) and ankle sprains (OR = 5.3).
COMMENTS: Age and previous injury were identified as the main risk factors for injury among elite football players from Iceland.
Correspondence: Leonard Paulozzi, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop K60, Atlanta, GA 30341, USA; (email: lbp4@cdc.gov).
OBJECTIVES: This paper describes a new surveillance system called the National Violent Death Reporting System (NVDRS), initiated by the United States Centers for Disease Control and Prevention. NVDRS's mission is the collection of detailed, timely information on all violent deaths.
DESIGN: NVDRS is a population based, active surveillance system designed to obtain a complete census of all resident and occurrent violent deaths. Each state collects information on its own deaths from death certificates, medical examiner/coroner files, law enforcement records, and crime laboratories. Deaths occurring in the same incident are linked. Over 270 data elements can be collected on each incident.
SETTING: The 13 state health departments of Alaska, Colorado, Georgia, Maryland, Massachusetts, New Jersey, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin.
SUBJECTS: Cases consist of violent deaths from suicide, homicide, undetermined intent, legal intervention, and unintentional firearm injury. Information is collected on suspects as well as victims.
INTERVENTIONS: None.
OUTCOME MEASURES: The quality of surveillance will be measured in terms of its acceptability, accuracy, sensitivity, timeliness, utility, and cost. RESULTS: The system has just been started. There are no results as yet.
COMMENTS: NVDRS has achieved enough support to begin data collection efforts in selected states. This system will need to overcome the significant barriers to such a large data collection effort. Its success depends on the use of its data to inform and assess violence prevention efforts. If successful, it will open a new chapter in the use of empirical information to guide public policy around violence in the United States.
The objective of this study was to determine the annual incidence of fatal motor vehicle crashes involving street racing and to describe the characteristics of these crashes compared to other fatal crashes in the United States. The National Highway Traffic Safety Administration Fatality Analysis Reporting System data for 1998-2001 were used for the analyses. There were 149 568 fatal crashes and 315 (0.21%) involved street racing and 399 fatalities occurred in these crashes. In contrast to other fatal crashes, street racing fatal crashes were more likely to occur on urban roadways and were nearly six times more likely to occur at travel speeds >/==" BORDER="0">65 mph. Compared with other drivers involved in fatal crashes, street racers were more likely to be teenagers, male, and have previous crashes and driving violations. Street racing involves risky driving behaviors and warrants further attention.
Historical analysis of accidents in seaports.
- Darbra RM, Casal J. Safety Science 2004; 42(2): 85-89.
Correspondence: Rosa-Mari Darbra, Department of Chemical Engineering, Centre d'Estudis del Risc Tecnologic (CERTEC), Universitat Politecnica de Catalunya, Diagonal 647, 08028-Barcelona, Catalonia, SPAIN; (email: rm.darbra@upc.es).
A study has been carried out of accidents occurring in seaports. A total of 471 accidents occurring between the beginning of the twentieth century and October 2002 have been analyzed. The results obtained show a significant increase in the frequency of accidents over time: 83% of the accidents occurred in the last 20 years and 59% in the past decade. The most frequent accidents were releases (51%), followed by fires (29%), explosions (17%) and gas clouds (3%). More than half the accidents occurred during transport: loading/unloading operations, storage and process plants also make a large contribution to the total. The various causes of the accidents have also been analyzed, as have the type of substance involved and the consequences for the population (number of people killed, injured and evacuated). Finally, some conclusions are drawn concerning the need to improve certain safety measures in ports.
Risk perception and driving behavior among adolescents in two Norwegian counties before and after a traffic safety campaign.
- Rundmo T, Iversen H. Safety Science 2004; 42(1): 1-21.
Correspondence: Torbjorn Rundmo, Norwegian University of Science and Technology, Department of Psychology, 7491, Trondheim, NORWAY; (email: torbjorn.rundmo@sv.ntnu.no).
A campaign to promote safe driving behavior has been carried out among adolescents in two Norwegian counties since 1998. It focused on traffic accident risk perception. The aims of the present paper are to present the results of the evaluation of the effect of the campaign and to examine the association between risk perception and traffic behavior. A representative sample of adolescents aged 18-24 years old in the two Norwegian counties participating in the campaign (experimental group), as well as a control group of adolescents in two other counties not participating in the campaign were used. Data were collected before it started in October 1998 and also after the campaign (n=4376). The pre-and post-samples consisted of independent groups of respondents. The response rate was 93%. The respondents perceived the risk to be higher after the campaign than before. The respondents of the post-sample of the experimental group also reported less risk behavior in traffic. The number of speeding accidents was also reduced. Perceived risk was not changed among adolescents in the control group. Neither were there any changes in self-report risk behavior. The questionnaire measured cognition-based as well as emotion-based risk perception. Model tests showed that assessments of the probability of traffic accidents and concern were non-significant predictors for self-report risk behavior. Worry and other emotional reactions related to traffic hazards significantly predicted behavior. Sensation seeking, normlessness (i.e. a state where social norms no longer regulate behavior), and indifference with regard to traffic safety affected emotion-based risk perception.
Do children's intentions to risk take relate to actual risk taking?
OBJECTIVES: Concerns about safety and rigorous ethic standards can make it very difficult to study children's risk taking. The goal of this study was to determine how closely intentions to risk take relate to actual risk taking among boys and girls 6-11 years of age.
METHODS: Children initially completed an "intentions to risk take" task. Following administration of several questionnaires they later participated in an actual risk taking task.
FINDINGS: At all ages, for both boys and girls, intentions to risk take was highly positively correlated with actual risk taking. When discrepancies occurred these were usually of minimal magnitude.
COMMENTS: Tasks that tap children's intentions to risk take can serve as proxy indicators of children's actual risk taking.
Development of safer fodder-cutter machines: a case study from north India.
- Mohan D, Kumar A, Patel R, Varghese M. Safety Science 2004; 42(1): 43-55.
Correspondence: Dinesh Mohan, Transportation Research & Injury Prevention Programme, Indian Institute of Technology, Delhi, Hauz Khas, New Delhi, 110016, INDIA; (email: dmohan@cbme.iitd.ernet.in).
Fodder-cutter machines are used everyday by farmers and their families in India for preparation of fodder for the livestock they own. An epidemiological study done in north India showed that all age groups sustain fodder-cutter injuries while operating the machine. More than 45 and 64% of the victims were children below 15 years of age in Phase I and II. The injuries led to a large number of limb amputations [43 cases (80%)] among the persons operating the machine or playing with the machine taking treatments in the study area hospitals. A detailed study of injuries and machine characteristics resulted in a safer fodder-cutter design. The design changes are cost effective and can be incorporated,in both existing and new fodder-cutter machines. This paper reports the process of the community-based study and the safer design features of fodder-cutter machine.
Correspondence: Marizen Ramirez, Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#30, Los Angeles, CA 90027, USA; MarizenRamirez@chla.usc.edu).
OBJECTIVE: Approximately six million children with disabilities attend school in the United States. Cognitive and physical limitations may compromise their ability to handle environmental hazards and hence increase their risk for injury. The objective of this study was to describe the epidemiology of school related injury among children enrolled in 17 special education schools in one large, urban school district.
DESIGN: Altogether 6769 school children with disabilities were followed up from 1994-98. Injury and population data were collected from pupil accident reports and existing school records. Associations were estimated through generalized estimating equations.
FINDINGS: A total of 697 injuries were reported for a rate of 4.7/100 students per year. Children with multiple disabilities had a 70% increased odds of injury compared with the developmentally disabled (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3 to 2.3). The physically disabled (OR 1.4, 95% CI 1.0 to 1.9) had a modest increased odds of injury. Cuts, bruises, and abrasions composed almost three fourths of all injuries; almost half of these injuries were to the face. Falls (34%) and insults by other students (31%) were the most common external causes. More than a fourth of injuries were sports related, and 21% occurred on the playground/athletic field. Injury patterns differed across disabilities.
COMMENTS: Although limited to one school district, the population studied is the largest cohort thus far of school children with disabilities. With this large study base, potentially high risk groups were identified and circumstances of injury described. This information is imperative for developing and improving school based injury prevention measures.
Correspondence: Henry Aghanwa, Department of Psychiatry, School of Medical Sciences, Fiji School of Medicine, Islands, Suva, FIJI; (email: haghanwa@yahoo.com).
The objective of the study was to examine the sociodemographic and clinical factors influencing gender-specific attempted suicide. Suicide attempters, 40 males and 88 females, seen on a consultation-liaison psychiatric service over a period of 42 months (from January 1, 1999 to June 30, 2002) were compared on sociodemographic and clinical variables. The female attempters [22.99 years (SD 8.1)] were younger than their male counterparts [25.15 years (SD 9.5)] [P = 0.0002]. A higher proportion of the male attempters were engaged in outside occupations, compared with their female counterparts who were mainly full-time housewives or engaged in domestic duties [P = 0.003]. Alcohol misuse was more associated with male suicide attempts [P = 0.001]. Ninety percent of male attempters and 54.6% of the female attempters had the intention to die [P = 0.001]. Although depressive episode was the most common psychiatric disorder in male attempters, followed by neurotic and stress-related disorders, while neurotic and stress-related disorders ranked first in female attempters followed closely by depressive episode, the difference was not significant. However, significantly more male attempters required pharmacotherapy and psychological intervention than their female counterparts [P = 0.002]. More females had marital difficulties, although comparing the two groups on social difficulties did not yield a significant difference. Method used, personality disorders, previous attempt, repeat attempt, race, religion, and marital status were not significant distinguishing factors. Younger age, lack of employment outside home, marital problems, and nondeath motives were more influential in female attempted suicide, while alcohol misuse and severe psychiatric morbidity were more frequently associated with male attempted suicide. The findings support gender-specific preventive and interventional strategies.
Severity of depressive episodes according to ICD-10: prediction of risk of relapse and suicide.
Correspondence: Lars Vedel Kessing, Department of Psychiatry, University of Copenhagen (Department of Psychiatry, Rigshospitalet, Blegdamsvej 9, DK 2100 Copenhagen O, DENMARK; (email: lars.kessing@rh.dk).
BACKGROUND: The ICD-10 categorization of severity of depression into mild, moderate and severe depressive episodes has not been validated.
OBJECTIVE: To validate the ICD-10 categorization of severity of depression by estimating its predictive ability on the course of illness and suicidal outcome.
METHOD: All psychiatric in-patients in Denmark who had received a diagnosis of a single depressive episode at their first discharge between 1994 and 1999 were identified. The risk of relapse and the risk of suicide were compared for patients discharged with an ICD-10 diagnosis of a single mild, moderate or severe depressive episode.
FINDINGS: At their first discharge, 1103 patients had an ICD-10 diagnosis of mild depressive episode, 3182 had a diagnosis of moderate depressive episode and 2914 had a diagnosis of severe depressive episode. The risk of relapse and the risk of suicide were significantly different for the three types of depression - increasing from mild to moderate to severe depressive episode.
COMMENTS: The ICD-10 way of grading severity is clinically useful and should be preserved in future versions.
Driving and alternatives: older drivers in Michigan.
- Kostyniuk LP, Shope JT. J Safety Res 2003; 34(4): 407-414.
Correspondence: Lidia P. Kostyniuk, Transportation Research Institute, University of Michigan, 2901 Baxter Road, Ann Arbor, MI 48109-2150, USA; (email: lidakos@umich.edu).
METHOD: A statewide telephone survey of Michigan drivers and former drivers aged 65 and older collected information on transportation mode choices, experience with alternatives to driving, and whether drivers planned for when they could no longer drive.
FINDINGS: Results showed that most older adult households owned at least one automobile, and that the automobile was the primary mode of transportation. Most former drivers obtained rides from relatives and friends. Use of public transportation was low, and some seniors were not aware of available public transportation services. Older drivers did not plan for driving cessation. Over half the drivers who perceived a likelihood of driving problems within 5 years expected to keep driving beyond 5 years.
COMMENTS: Because of their lifelong reliance on the automobile, their desire to drive themselves, and their lack of experience with public transportation, efforts to enhance the mobility of older people should consider this background while alternatives to the personal automobile are developed.
Current helmet and protective equipment usage among previously injured ATV and motorcycle riders.
Injury recidivism among trauma patients may be related to an individual pattern of high risk behaviors. The extent to which an injury episode modifies this behavior pattern is unknown. A self report, voluntary, anonymous, cross sectional survey was administered to motorcycle and all-terrain vehicle (ATV) riders at a popular recreation site. Data included demographics, injury history, and current usage of helmet and protective gear. Two hundred eighty surveys were completed. History of ATV/motorcycle related minor and major injury were reported by 21% and 9%, respectively. Persons with a history of minor ATV/motorcycle injury only were less likely to use a helmet or protective equipment (78% v 74%, p = 0.58 and 49% v 41%, p = 0.29). Persons with a history of any major ATV/motorcycle injury were also less likely to use a helmet or protective equipment (77% v 56%, p = 0.03 and 48% v 40%, p = 0.53). These findings suggest a pattern of persistent high risk behavior among previously injured persons.
Evaluating the impact of passengers on the safety of older drivers.
- Hing JY, Stamatiadis N, Aultman-Hall L. J Safety Res 2003; 34(4): 343-351.
Correspondence: Nikiforos Stamatiadis, University of Kentucky, 265 Raymond Building, Lexington, KY 40506-0281, USA; (email: nstamat@engr.uky.edu).
BACKGROUND: This study involved a quasi-induced exposure analysis of 4 years of crashes involving older drivers in the state of Kentucky.
METHOD: Single- and multivehicle crashes were disaggregated according to the number of passengers: (a) no passenger, (b) one passenger, and (c) two or more passengers.
FINDINGS: Overall, the presence of two or more passengers was found to negatively impact the probability that drivers 75 years of age or older were at fault in crashes. Several potential factors were studied for interactive effects with passengers: vehicle occupant gender mix, time of the day, road curvature, grade, and number of lanes. The negative impact of passengers increased for some geometric road conditions. However, older drivers were found to be safer at night when carrying two or more passengers. The presence or absence of passengers was not found to affect the 65- to 74-year-old driver group. Groups of male vehicle occupants with a 75+ male driver were found to have high single-vehicle crash rates.
COMMENTS: These results are among the first to directly consider the effect of passengers on the crash-causing propensity of older drivers and the findings suggest more work is warranted to consider causes for the crash rate differences.
The Design of Child Restraint System (CRS) Labels and Warnings Affects Overall CRS Usability.
- Rudin-Brown CM, Greenley MP, Barone A, Armstrong J, Salway AF, Norris BJ. Traffic Inj Prev 2004; 5(1): 8-17.
Correspondence: Christina M. Rudin-Brown, Ergonomics Division, Road Safety and Motor Vehicle Directorate, Transport Canada, Ottawa, Ontario, CANADA; (email: unavailable).
A study was conducted that assessed the effectiveness of different child restraint system (CRS) label/warning designs on users' installation performance. Forty-eight paid participants installed a convertible CRS in a vehicle, and two child test dummies in a CRS, using one of four label conditions. The label conditions were: (1) no labels, (2) the manufacturer's labels that were already affixed to the CRS ("Current"), (3) labels that were designed according to a combination of the current U.S. regulations concerning CRS labels and recently proposed changes to these regulations ("Proposed"), and (4) labels that were designed according to human factors principles and guidelines, and that were based on a hierarchical behavioral task analysis ("Optimal"). Results demonstrated that, overall, the Optimal labels resulted in higher usability ratings and better task performance. This indicates that labels designed using human factors and task analyses that identify critical task information requirements for label features will result in increased user compliance with instructions, higher usability, and improved task performance. Surprisingly, having no labels on the CRS resulted in better installation performance than when either the Current or the Proposed label conditions were used. This indicates that label design can decrease task performance; the actual physical design of a CRS may be just as critical as label content in the installation choices provided to the user. Collectively, results suggest that implementation of the proposed changes to the U.S. regulations concerning CRS labeling would likely not result in increased performance or usability compared to existing manufacturer labels that follow the current guidelines. In order to achieve significantly better ease-of-use and task performance, it would be necessary to implement features of the Optimal label condition.
See items 1 & 2 under Alcohol and Other Drugs
See item 1 under Risk Factor Prevalence
See item 1 under Risk Perception and Communication
Correspondence: Margaret M. Feerick, Child Development and Behavior Branch, National Institute of Child Health and Human Development, Room 4B05, 6100 Executive Boulevard, MSC 7510, Bethesda, Maryland 20892-7510, USA; (email: feerickm@mail.nih.gov).
The articles in this special issue of Clinical Child and Family Psychology Review provide an overview of what is known about children's exposure to community violence and war/ terrorism, and indicate significant gaps in extant research. These gaps and research needs are summarized in this conclusion.
Pediatric residency training on domestic violence: a national survey.
- Bair-Merritt MH, Giardino AP, Turner M, Ganetsky M, Christian CW. Ambul Pediatr 2004; 4(1): 24-27.
Correspondence: Megan H. Bair-Merritt, Children's Hospital of Philadelphia, PA, USA; (email: unavailable).
BACKGROUND: Between 3.3 and 10 million children witness domestic violence (DV) each year. These children are at risk for both emotional and behavioral problems. In 1998, the American Academy of Pediatrics issued guidelines for pediatricians to screen for DV and for residency programs to include DV education. Prior studies have assessed practicing pediatricians' DV screening habits. This study was designed to assess chief residents' attitudes and training regarding DV screening.
METHODS: A 53-question survey regarding residents' attitudes and training surrounding DV was mailed to the chief residents of all 194 nonmilitary US pediatric residency programs. Descriptive and inferential analyses were performed.
FINDINGS: Sixty-eight percent of surveys were returned. Sixty-eight percent of respondents were female. Although 93% of chief residents felt that pediatricians should screen for DV, only 21% screen every patient. Only 24% agreed or strongly agreed that they felt experienced in handling DV cases. Although 60% of respondents say that they received 11 or more hours of residency training in how to handle child abuse, the majority (80%) received 4 hours or less of DV training. Seventy-one percent agreed or strongly agreed that pediatricians do not screen secondary to lack of training.
COMMENTS: Pediatric chief residents believe that DV is a significant pediatric health problem. However, screening practices are variable. Most chief residents feel that their training was not sufficient to make them comfortable screening for DV. Chief residents demonstrated openness to incorporating DV training into their programs, indicating a positive environment for DV curricula.
Trauma exposure and post-traumatic stress symptoms in urban African schools: Survey in Cape Town and Nairobi.
BACKGROUND: There is a lack of comparative data on the prevalence and effects of exposure to violence in African youth.
OBJECTIVE: We assessed trauma exposure, post-traumatic stress symptoms and gender differences in adolescents from two African countries.
METHOD: A sample of 2041 boys and girls from 18 schools in Cape Town and Nairobi completed anonymous self-report questionnaires.
FINDINGS: More than 80% reported exposure to severe trauma, either as victims or witnesses. Kenyan adolescents, compared with South African, had significantly higher rates of exposure to witnessing violence (69% v. 58%), physical assault by a family member (27% v. 14%) and sexual assault (18% v. 14%). But rates of current full-symptom post-traumatic stress disorder (PTSD) (22.2% v. 5%) and current partial-symptom PTSD (12% v. 8%) were significantly higher in the South African sample. Boys were as likely as girls to meet PTSD symptom criteria.
COMMENTS: Although the lifetime exposure to trauma was comparable across both settings, Kenyan adolescents had much lower rates of PTSD. This difference may be attributable to cultural and other trauma-related variables. High rates of sexual assault and PTSD, traditionally documented in girls, may also occur in boys and warrant further study.
