- Bowley DM, Rein P, Cherry R, Vellema J, Snyman T, Boffard KD. S Afr J Surg 2004; 42(1): 7-10.
Correspondence: D. Bowley, Johannesburg Hospital Trauma Unit, Department of Surgery, University of the Witwatersrand, Johannesburg, SOUTH AFRICA; (email: unavailable).
OBJECTIVE: The abuse of alcohol and drugs is a major public health problem and intoxication is one of the most important risk factors for violence and other causes of injury. The aim of the current study was to evaluate the prevalence of drug and alcohol use associated with injury in adult trauma patients in an inner city trauma unit in Johannesburg.
METHODS: A cohort of 105 adult trauma patients admitted to our university trauma unit and its allied medicolegal laboratory were studied in order to provide prospective data and enable us to correlate the prevalence and type of substance abuse with the demographics and injury patterns after major trauma.
FINDINGS: Forty-five patients required resuscitation at the Johannesburg Hospital Trauma Unit (JHTU) and 60 patients were examined at the Johannesburg Medicolegal Laboratory (JMLL), giving a total of 105 patients. Blood alcohol concentration (BAC) was positive in 59% of the patients. The average BAC in the trauma unit patients was 37 mmol/l (0.17 g/dl), more than three times the legal limit for driving. Of the patients 43.7% were positive for urinary cannabis; women were statistically significantly more likely to have taken cannabis than men (p = 0.039). There was no difference in rates of exposure to cannabis or alcohol in patients who were the victims of interpersonal violence compared with the victims of accidents (p = 0.17). Only 3 patients had taken other drugs of abuse; 2 had taken Mandrax (methaqualone) and 1 amphetamine.
COMMENTS: Alcohol and cannabis are commonly misused by trauma patients in Johannesburg; the degree of misuse of other drugs appears to be low. Intoxication is a significant risk factor for violence and accidents and the resultant injuries are a massive burden on our society. Doctors have a responsibility to highlight the association between substance misuse and trauma and should also attempt to persuade individual trauma patients to reduce future alcohol consumption.
Routine assessment of family and community health risks: Parent views and what they receive.
- Kogan MD, Schuster MA, Yu SM, Park CH, Olson LM, Inkelas M, Bethell C, Chung PJ, Halfon N. Pediatrics 2004; 113(6 Part 2): 1934-1943.
Correspondence: Michael D. Kogan, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, USA; (email: mkogan@hrsa.gov).
OBJECTIVE: To examine the prevalence of parent-provider discussions of family and community health risks during well-child visits and the gaps between which issues are discussed and which issues parents would like to discuss.
METHODS: Data came from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 children aged 4 to 35 months. The outcome measures were 1) the reported discussions with pediatric clinicians about 7 family and community health risks and 2) whether the parent believes that pediatric clinicians should ask parents about each risk.
FINDINGS: Most parents believe that pediatric providers should discuss topics such as smoking in the household, financial difficulties, and emotional support available to the parent. However, with the exception of "household smoking," fewer than half of parents have been asked about these topics by their child's clinician. Parents of black and Hispanic children were more likely than parents of white children to be asked about several of these issues, as were parents of the youngest children and those with publicly financed health insurance. The greatest gap between parents' views and their reports of discussion with the clinician occur for parents of white children and older children. Among parents who hold the view that a topic should be discussed, parents of white and older children are less likely than others to report discussing some or all family and community health risks.
COMMENTS: The low frequency of discussions for many topics indicates potential unmet need. More universal surveillance of parents with young children might ensure that needs are not missed, particularly given that strong majorities of parents view family and community topics, with the exception of community violence, as appropriate for discussion in clinic visits.
OBJECTIVE: To find out whether victims of terrorism and their relatives have higher prevalence of affective, anxiety, and alcohol abuse disorders than the general population.
METHODS: Between January 1997 and January 2001, 544 families affected by terrorist violence in Spain were interviewed. Victims and their relatives (n = 1,021) were evaluated by means of the PRIME-MD. They were classified according to the degree of involvement in the attacks as: relatives of victims (RV), direct victims (DV) and direct victims who were also relatives of other victims (DVRV). Their scores were compared with those of a primary health-care sample.
FINDINGS: Depressive symptoms were more prevalent among victims (DVRV, 59.2%; DV, 57.6%; RV, 50.2%) than among controls (40.0%) (p = 0.036) and their prevalence was directly related to the degree of involvement in the attacks. Similar results were obtained for anxiety disorders (DVRV, 52.6%; DV, 56.5%; RV, 45.0%, and controls 26.4%) (p = 0.017). Alcohol abuse prevalence (DVRV, 6.6%; RV, 5.9%) was very close to that of the primary health-care sample (4.8%) with the exception of direct victims (DV, 15.9%) in whom it was higher (p = 0.016).
COMMENTS: The prevalence of psychopathology was higher among victims of terrorism than among primary health-care patients and it was directly related to the involvement in the attack. Low perceived social support, family and personal history of psychiatric disease, and type of attack (explosives) increased the risk of suffering mental disorders.
Antecedents of fatigue, close calls, and crashes among commercial motor-vehicle drivers.
- Morrow PC, Crum MR. J Safety Res 2004; 35(1): 59-69.
Correspondence: Paula C. Morrow, Department of Management, Iowa State University, 2350 Gerdin Business Building, Ames, IA 50011-1350, USA; (email: pmorrow@iastate.edu).
OBJECTIVE: Minimizing driver fatigue among commercial motor-vehicle (CMV) drivers is a major safety issue in the United States. This study examines the effects of potentially fatigue-inducing factors inherent in truck driving work and company safety management in explaining: (a) drivers driving while fatigued, (b) the frequency of close calls due to fatigue, and (c) actual crashes among CMV drivers.
METHODS: Data for this study are derived from a survey of CMV drivers in 116 trucking firms, with all data being driver-reported. The relative roles of fatigue-inducing factors and safety management practices in explaining variation in fatigue, close calls, and crashes are reported, along with the roles of fatigue in affecting close calls and crashes via hierarchical regression.
FINDINGS: Findings indicated that fatigue-inducing factors inherent in driving work and safety practices accounted for appreciable variation in driving fatigued (R(2) =.42) and close calls (R(2) =.35), but not crash involvement. Driving while fatigued also accounted for incremental increases in the amount of variation in close calls, after consideration of inherent factors and safety practices.
COMMENTS: Findings indicate that safety practices (e.g., establishment of a strong safety culture, dispatcher scheduling practices, company assistance with fatiguing behaviors such as loading and unloading) have considerable potential to offset fatigue-inducing factors associated with truck driving work.
Behavioural adaptation to adaptive cruise control (ACC): implications for preventive strategies.
Correspondence: Christina M. Rudin-Brown, Ergonomics Division, Standards Research and Development, Road Safety and Motor Vehicle Regulation, Transport Canada, 330 Sparks Street, 8th Floor, Ottawa, ON, K1A 0N5 CANADA; (email: brown@tc.gc.ca).
This test-track study assessed whether adaptive cruise control (ACC) induces behavioural adaptation in drivers. Eighteen experienced drivers drove a test vehicle while following a lead vehicle in three counterbalanced conditions: No ACC (self-maintained average headway of 2 s), ACC-Short (headway of 1.4 s) and ACC-Long (headway of 2.4 s). Results demonstrate that ACC can induce behavioural adaptation in drivers in potentially safety-critical ways. Compared to driving unsupported, participants located significantly more items per minute on a secondary task when using ACC, while their response times to a hazard detection task increased. This effect was particularly pronounced in those scoring high on a sensation-seeking scale. Using ACC resulted in significantly more lane position variability, an effect that was also more pronounced in high sensation-seekers. Drivers' trust in ACC increased significantly after using the system, and these ratings did not change despite a simulated failure of the ACC system during the ACC-Long condition. Response time to the simulated ACC failure was related to a driver's locus of control: Externals intervened more slowly than Internals. All drivers reported relying on the ACC system to keep their vehicle at a safe distance from the lead vehicle. Results are consistent with similar research conducted on lane departure warning systems. Driver awareness training is a potential preventive strategy that could minimize the behavioural adaptation associated with novel in-vehicle systems such as ACC.
Correspondence: Mark J. M. Sullman, Department of Human Resource Management, Private Bag 11 222, Massey University, Palmerston North, NEW ZEALAND; (email: m.sullman@massey.ac.nz).
Research has shown that using a mobile phone whilst driving may increase the risk of being crash involved by as much as nine times. As around 65% of New Zealand's population own mobile phones, this represents a potentially very significant hazard. In order to effectively target interventions towards those drivers who use mobile phones while driving, information is needed about the characteristics of these drivers. The present study investigated the frequency of mobile phone use on New Zealand's roads and the characteristics of drivers who use mobile phones while driving. The research found that more than half (57.3%) of the participants used a mobile phone at least occasionally while driving. Those who reported using a mobile phone more often whilst driving tended to; be male, reside in a main urban area, report a higher annual mileage, drive a later model car with a larger engine, prefer a higher driving speed, have less driving experience (in years) and to be younger. In line with previous research, there was also a significant relationship between crash involvement and use of a mobile phone whilst driving. However, once the contributions of the demographic and descriptive variables had been partialled out, using hierarchical logistic regression, the relationship between crash involvement and mobile phone use was no longer significant.
Correspondence: Mark D. Grabiner, Department of Biomedical Engineering, The Cleveland Clinic Foundation, 9500 Euclud Avenue, Cleveland, OH 44195, USA; (email: grabiner@uic.edu).
Fall-related injuries are the most common and serious medical problems facing older adults. Recent studies of older adults have focused on the variability of step kinematics and the relationship to falling. The accuracy of step variability estimates is proportional to the number of steps that are collected. The use of an instrumented treadmill allows simultaneous collection of spatial and temporal step kinematics for a large number of continuous steps. The current study was conducted to determine the influence of age, walking velocity and handrail use on the variability of step kinematics using a treadmill protocol. Eighteen young adults (average age: [Formula: see text] years) and 12 healthy older adults (average age: [Formula: see text] years) were recruited from the community. Temporal and spatial gait parameters were quantified using custom designed software from measurements collected during treadmill walking. The primary independent variables were the variability of step length, step width, and step time. Step width variability of older adults was significantly larger than that of young adults. Walking velocity did not influence step kinematic variability. Handrail usage influenced the variability of step length and step width, but not of step time. The present results, and those of previous studies, point to a consistent relationship between age and step width variability. Since step width variability has been implicated in falls, further research is warranted.
Correspondence: Ajith H. Gunatilaka, Accident Research Centre, Monash University, Melbourne, AUSTRALIA; (email: ajith.gunatilaka@general.monash.edu.au).
OBJECTIVE: A recent case series study found that only 4.7% of 402 playgrounds in which arm fractures occurred in Victorian schools complied with the recommended 20 cm depth of tanbark. Tanbark depths at fall sites varied between 0-27 cm and the mean was 11.1 (5.0) cm. The purposes of the present study were to (1) measure impact attenuation properties of shallow and compacted depths of tanbark; (2) validate laboratory measurements with in situ data; (3) compare impact attenuation properties of compacted tanbark with an Australian manufactured rubber based surface material; and (4) study the impact performance of rubber and tanbark hybrid surfacing.
METHODS: A standard test headform was dropped on tanbark and rubber surfaces in a laboratory setting to measure peak impact deceleration and head injury criterion (HIC) values. Variations in surface depth ranged from 2 cm-20 cm (tanbark) and 2 cm-9 cm (rubber). Drop height ranged from 0.5 m-2.5 m.
FINDINGS: Peak deceleration and HIC increased with increasing drop height and decreasing surface depth. Laboratory measurements at depths less than 8 cm overestimated peak deceleration and HIC values compared with in situ playground measurements. Impact attenuation of a 9 cm thick bilaminate rubber material was comparable to that of an 18 cm depth of compacted tanbark. Rubber-tanbark hybrid surfaces showed improved impact attenuation over individual surfaces.
COMMENTS: Compacted tanbark of depth less than 8 cm is ineffective in attenuating playground falls, resulting in excessive impact deceleration and HIC values. Shallow and compacted tanbark found in many Victorian school playgrounds poses a high risk for severe head injury. This calls for stricter enforcement of playground surface depth compliance.
Creating safer workplaces: assessing the determinants and role of safety climate.
- DeJoy DM, Schaffer BS, Wilson MG, Vandenberg RJ, Butts MM. J Safety Res 2004; 35(1): 81-90.
Correspondence: David M. DeJoy, Workplace Health Group, Department of Health Promotion and Behavior, University of Georgia, 315 Ramsey Center, Athens, GA 30602-6522, USA; (email: ddejoy@coe.uga.edu).
BACKGROUND: Although there has been considerable interest in safety climate, relatively little attention has been given to the factors that determine safety climate or to testing the hypothesized mediating role of safety climate with respect to safety-related outcomes.
METHODS: Questionnaire responses were obtained from 2,208 employees of a large national retail chain in 21 different locations.
FINDINGS: After controlling for demographic variables, three factors: environmental conditions, safety-related policies and programs, and general organizational climate, accounted for 55% of the variance in perceived safety climate. Interestingly, organizational climate made a significant contribution to safety climate, even after controlling for the other more safety-relevant variables. Partial correlations showed that safety policies and programs had the largest observed correlation with safety climate, followed by two of the dimensions of organizational climate (communication and organizational support). Using Baron and Kenny's (J. Pers. Soc. Psychol. 51 (1986) 1173) procedures, the principal effects of the various work situation factors on perceived safety at work were found to be direct rather than mediated by safety climate. Safety climate influenced perceived safety at work, but its role as a mediator was limited.
COMMENTS: These results are discussed in terms of other recent findings on safety climate and the growing interest in understanding management and organizational factors in the context of workplace safety.
Blasting injuries in surface mining with emphasis on flyrock and blast area security.
Correspondence: T. S. Bajpayee, Disaster Prevention and Response Branch, Pittsburgh Research Laboratory, National Institute for Occupational Safety and Health, P.O. Box 18070, Pittsburgh, PA 15236-0070, USA; (email: TBajpayee@cdc.gov).
BACKGROUND: Blasting is a hazardous component of surface mining. Serious injuries and fatalities result from improper judgment or practice during rock blasting. This paper describes several fatal injury case studies, analyzes causative factors, and emphasizes preventive measures.
METHODS: This study examines publications by MSHA, USGS, and other authors. The primary source of information was MSHA's injury-related publications.
FINDINGS: During the 21-year period from 1978 to 1998, the mean yearly explosive-related injuries (fatal and nonfatal) for surface coal mines was 8.86 (95% CI: 6.38-11.33), and for surface metal/nonmetal mines 10.76 (95% CI: 8.39-13.14). Flyrock and lack of blast area security accounted for 68.2% of these injuries. This paper reviews several case studies of fatal injuries. Case studies indicate that the causative factors for fatal injuries are primarily personal and task-related and to some extent environmental. A reduction in the annual injuries in surface coal mines was observed during the 10-year period of 1989-1998 [5.80 (95% CI: 2.71-8.89) compared to the previous 10-year period of 1979-1988 [10.90 (95% CI: 7.77-14.14)]. However, such reduction was not noticed in the metal/nonmetal sector (i.e., 9.30 [95% CI: 6.84-11.76] for the period 1989-1998 compared with 11.00 [95% CI: 7.11-14.89] for the period 1979-1988).
COMMENTS: A multifaceted injury prevention approach consisting of behavioral/educational, administrative/regulatory, and engineering interventions merits consideration.
IMPACT ON INDUSTRY: The mining community, especially the blasters, will find useful information on causative factors and preventive measures to mitigate injuries due to flyrock and lack of blast area security in surface blasting. Discussion of case studies during safety meetings will help to mitigate fatal injuries and derive important payoffs in terms of lower risks and costs of injuries.
Can social psychological models be used to promote bicycle helmet use among teenagers? A comparison of the Health Belief Model, Theory of Planned Behavior and the Locus of Control.
- Lajunen T, Rasanen M. J Safety Res 2004; 35(1): 115-123.
Correspondence: Timo Lajunen, Department of Psychology, Middle East Technical University, ODTU 06531, Ankara, TURKEY; (email: timo@metu.edu.tr).
OBJECTIVE: The bicycle helmet use rate is still low among teenagers despite the cumulating evidence that bicycle helmets can prevent cyclists from serious injuries and death. The objective of this study was to investigate the usefulness of the Health Belief Model (HBM; Health Education Monographs, 2 (1974) (1), Theory of Planned Behavior (TPB; Ajzen, I. (1988). Attitudes, personality and behavior. Open University Press, Milton Keynes) and Locus of Control model (LC; Psychological Monographs, (1966) (80) in understanding the intention to use bicycle helmet use among bicycle helmet owners.
METHODS: Data were collected at two schools in Helsinki, Finland. Students (N=965) completed a questionnaire including three social psychological models applied to helmet use. Models were compared by structural equation modeling techniques.
COMMENTS: Results showed that the TPB and LC model fitted the data well, whereas fit of the HBM model was lower than the fit of TPB and LC models. All components of TPB and external LC orientation were significantly related to the intention to use a helmet. TPB together with LC model provide a promising theoretical framework for helmet use promotion campaigns. Practical suggestions for future bicycle helmet campaigns were provided.
Active transportation and physical activity: opportunities for collaboration on transportation and public health research.
Physically inactive lifestyles are a major public health challenge, and research in the transportation field on influences on the choice to walk and bike may provide guidance toward solutions. In the interests of promoting effective collaboration among the transportation, planning, and health fields, the current paper was written to fulfill three purposes. The first purpose was to summarize the transportation and planning studies on the relation between community design and non-motorized ("active") transport and to interpret these studies from a health perspective. The second purpose was to summarize studies from the health literature that examine the relation between physical environmental variables and leisure-time physical activity that have relevance for transportation research. The third purpose was to promote more collaboration among transportation, planning, and health investigators by identifying opportunities for transdisciplinary research.
Epidemiological assessment of 160 cases of insulin overdose recorded in a regional poisons unit.
- von Mach MA, Meyer S, Omogbehin B, Kann PH, Weilemann LS. Int J Clin Pharmacol Ther 2004; 42(5): 277-280.
Correspondence: M. A. von Mach, II Medical Department, Division of Clinical Toxicology, University Hospitals, Mainz, GERMANY; (email: marcm@giftinfo.uni-mainz.de).
OBJECTIVE: Overdoses with insulin are common, and cases of hypoglycemic coma can be fatal and cause cerebral defects. However, data published on this topic are rare, consisting mostly of case reports or reports in a small number of patients. The present investigation analyzes inquiries made to a regional poisons unit involving overdoses with insulin.
METHODS: A total of 175,890 inquiries for the years 1995-2003 (until September) were evaluated. 160 inquiries were received by telephone concerning insulin overdoses, and a standardized questionnaire was sent to the physicians asking for follow-up information. The cases were analyzed in regard to etiology, type of insulin used, concomitant substances being taken by the patient, symptoms and clinical outcome.
FINDINGS: Of the 160 inquiries investigated, 53.1% of the patients were female, 43.1% male and in 3.8% the sex of the patient was unknown. The average age was 44.7 years. 89.4% involved suicidal or parasuicidal cases, 5.0% were accidental overdoses and 1.9% involved cases of criminal overdose (3.7% were for other reasons). Rapidly acting insulins (57.8%) were used more commonly than long-acting formulations (42.8%). Benzodiazepines were the most frequently ingested concomitant medication (37.5%) with ethanol 15.6%, antihypertensive drugs 12.5% and antidepressants 10.0%. Most patients presented with a delay of 2-3 hours after insulin administration (15.0%). Almost 50% of the patients presented within the first 6 hours. According to the Poisoning Severity Score, no symptoms were observed in 16.8% of the patients, minor symptoms in 36.8%, major symptoms in 25.2% and serious symptoms in 21.3%. Information concerning the clinical outcome (75 cases) showed that a full recovery occurred in most patients (94.7%), but in 2.7% there were cerebral defects and 2.7% of the patients died.
COMMENTS: The etiology of overdoses with insulin was mainly deliberate self-poisoning. Physicians should take into account that long-acting insulin formulations and concomitant substances were frequently used. For overdoses with insulin, relatively high rates of serious symptoms and deaths were observed.
Is mass-mailing an effective form of passive poison center awareness enhancement?
- Krenzelok EP, Mrvos R. Vet Hum Toxicol 2004; 46(3): 155-156.
Correspondence: Edward Krenzelok, Pittsburgh Poison Center, 3705 Fifth Avenue, Children's Hospital of Pittsburgh, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA; (email: unavailable).
This project determined whether the massive distribution of poison center telephone number (Poison Help 800-222-1222) awareness stickers via a direct mail campaign, as a passive education technique, enhanced poison center awareness and was cost-effective. A regional ambulance service conducts an annual membership renewal/solicitation drive via mail to all residents within its service area. A sheet of Poison Help stickers was inserted in each ambulance service recruitment envelope and mass-mailed in 3 separate mailings over 4 w to 51% of households in a single county (population 368,983) at a direct expense of 4,477 dollars. Call volumes from zip codes that received the mailing were compared to an identical benchmark time period from the previous year. Analysis of call volume data over the study period revealed that call volume decreased by 1.3% during the study period. A mass-mail campaign to enhance poison center awareness failed to increase poison center call volume from the targeted county and, cannot be construed as cost-effective.
Correspondence: Joseph L Annest, Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE (MS-K59), Atlanta, GA 30341-3724, USA; (email: lannest@cdc.gov).
OBJECTIVE: To quantify and characterize injuries resulting from paintball game related activities among persons >/=7 years in the United States.
SETTING: Hospitals included in the National Electronic Injury Surveillance System (NEISS); these are composed of a stratified probability sample of all hospitals in the United States with emergency departments.
METHODS: Using NEISS, non-fatal injury data for paintball game related injury cases from 1997-2001 were obtained from emergency department records. Participation estimates used to calculate injury rates were obtained from a yearly survey funded by the National Sporting Goods Association.
FINDINGS: An estimated 11 998 persons >/=7 years with paintball game related injuries were treated in emergency departments from 1997-2001, with an annual average rate of 4.5 per 10 000 participants (95% confidence interval 3.3 to 5.7). The paintball game related injury rate was highest for 18-24 year olds (4.9 per 10 000 participants) and most injuries (94.0%) occurred among males. Almost 60% of all injured persons >/=7 years were treated for paintball pellet wounds of which most were to the eye. While 76.9% of injured persons ages 7-17 years were treated for paintball pellet wounds, almost 40% of those >/=18 years were treated for injuries resulting from overexertion or a fall. Lower extremity injuries were also common (23.0%), mostly from overexertion. Most injured persons (95.5%) were treated and released.
COMMENTS: As paintball games become more popular, efforts are needed to increase training, enforce rules, and educate participants about how to stay safe, such as wearing protective eye gear, when engaged in paintball games at home, in a public area, or in a sports field.
Recreational injuries among older Americans, 2001.
Correspondence: L W Gerson, Division of Community Health Sciences, Northeastern Ohio Universities College of Medicine,PO Box 95, Rootstown, OH 44272-0095, USA; (email: lgerson@neoucom.edu).
OBJECTIVE: To describe the epidemiology of non-fatal recreational injuries among older adults treated in United States emergency departments including national estimates of the number of injuries, types of recreational activities, and diagnoses.
METHODS: Injury data were provided by the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a nationally representative subsample of 66 out of 100 NEISS hospitals. Potential cases were identified using the NEISS-AIP definition of a sport and recreation injury. The authors then reviewed the two line narrative to identify injuries related to participation in a sport or recreational activity among men and women more than 64 years old.
FINDINGS: In 2001, an estimated 62 164 (95% confidence interval 35,570 to 88,758) persons >/==" BORDER="0">65 years old were treated in emergency departments for injuries sustained while participating in sport or recreational activities. The overall injury rate was 177.3/100,000 population with higher rates for men (242.5/100 000) than for women (151.3/100 000). Exercising caused 30% of injuries among women and bicycling caused 17% of injuries among men. Twenty seven percent of all treated injuries were fractures and women (34%) were more likely than men (21%) to suffer fractures.
COMMENTS: Recreational activities were a frequent cause of injuries among older adults. Fractures were common. Many of these injuries are potentially preventable. As more persons engage in recreational activities, applying known injury prevention strategies will help to reduce the incidence of these injuries.
Parental perceptions regarding mandatory mouthguard use in competitive youth soccer.
Correspondence: J M Pribble, Department of Emergency Medicine, University of Michigan, 300 NIB, 2D06, Box 0437, Ann Arbor, MI 48109-0437, USA; (email: jpribb@umich.edu).
OBJECTIVE: To understand factors that influence parental perceptions regarding mandatory mouthguard use in competitive youth soccer.
METHODS: A web based survey of parents whose 8-14 year old children participated in outdoor competitive youth soccer during the fall of 2002. Questions focused on: previous injury, education provided, dentist/physician recommendations, and parental perceptions of mouthguard use.
MAIN OUTCOME MEASURE: The outcome variable was parental agreement with the statement "mouthguards should be mandatory for competitive youth soccer." Logistic regression and chi(2) were performed using STATA 8.0.
FINDINGS: Altogether 120 parents participated. The children had a mean (SD) age of 11.8 (1.5) years and 48% were female; 14% wore mouthguards and 11% suffered orofacial injuries. Nineteen percent of parents reported receiving educational material from the youth soccer organization. Although 92% of parents believed that mouthguards were effective in reducing orofacial injuries, only one half agreed that mouthguards should be mandatory. Thirty percent of respondents reported that their dentist/physician recommended mouthguards for competitive youth soccer. Logistic regression showed that dentist/physician recommendation and parental female gender were independently associated with parental agreement for mandatory mouthguard use (odds ratio 2.9, 95% confidence interval (CI) 1.2 to 7.3; odds ratio 3.0, 95% CI 1.1 to 6.5).
COMMENTS: Few athletes wear mouthguards during competitive youth soccer. Health care professionals in this study did not capitalize on the apparent influence they have on parental beliefs regarding mouthguard use. Efforts are needed by both health professionals and soccer organizations to educate parents about orofacial injuries and mouthguard use in competitive youth soccer.
Frequency of maxillofacial injuries in all-terrain vehicle collisions.
- Holmes PJ, Koehler J, McGwin G Jr, Rue LW 3rd. J Oral Maxillofac Surg 2004; 62(6): 697-701.
Correspondence: P. Holmes, Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Ave S, Birmingham, AL 35294, USA; (email: pholmes@mail.dental.uab.edu).
PURPOSE: We sought to evaluate the frequency and distribution of maxillofacial injuries associated with all-terrain vehicle (ATV) collisions and to compare this with patients involved in motorcycle accidents over the same 5-year period at the University of Alabama at Birmingham.
METHODS: The records of all patients involved in ATV collisions who were admitted to the University of Alabama at Birmingham Trauma Center from January 1998 to January 2003 were reviewed. Age, gender, mechanism of injury, length of stay, Glasgow Coma Scale (GCS) score, maxillofacial injuries, Injury Severity Score (ISS), and maxillofacial Abbreviated Injury Scale (AIS) score were the factors considered for the study. These variables were also analyzed for patients involved in motorcycle collisions who sustained maxillofacial trauma.
FINDINGS: There were a total of 72 ATV collisions; 23 patients (32%) sustained maxillofacial injuries. The mean age was 31, and there were 59 males (82%) and 13 females (18%). The most common mechanism of injury was an ATV rollover. The warmer seasons and weekend days had the highest frequency of ATV trauma. Of the 23 patients who sustained maxillofacial injuries, the average maxillofacial AIS score was 2. The length of stay and GCS score were 8 days and 12, respectively, compared to 5 days and 15 in the nonmaxillofacial injury group. The most common maxillofacial fracture seen was a zygomaticomaxillary complex fracture (n = 8), followed by mandibular fractures (n = 6), and orbital floor blowout fractures (n = 5). Eighty-three percent of patients with maxillofacial injuries required an operative intervention during their hospitalization. The distribution of maxillofacial fractures in the ATV group was similar to that of an equivalent motorcycle group, but the frequency for the ATV group was higher (32% versus 8%). The length of stay for the motorcycle group was 11 days versus 8 days for the ATV group. The GCS scores, maxillofacial AIS scores, and ISS were similar between the 2 groups (12, 2, and 18, respectively). In patients who sustained maxillofacial fractures, neurologic injuries were the most frequent concomitant injury in the ATV group, whereas orthopedic injuries occurred more often in the motorcycle group.
COMMENTS: Maxillofacial injuries are common findings in ATV collisions. ATV patients with maxillofacial fractures have more neurologic impairment at admission and longer hospitalizations than patients sustaining motorcycle injuries. There needs to be an increase in the public health effort to educate individuals about the dangers of ATVs and to provide proper safety guidelines before the purchase of a vehicle.
The frequency of early fatality and the transient nature of emergency medical care mean that a single database will rarely suffice for population based injury research. Linking records from multiple data sources is therefore a promising method for injury surveillance or trauma system evaluation. The purpose of this article is to review the historical development of record linkage, provide a basic mathematical foundation, discuss some practical issues, and consider some ethical concerns. Clerical or computer assisted deterministic record linkage methods may suffice for some applications, but probabilistic methods are particularly useful for larger studies. The probabilistic method attempts to simulate human reasoning by comparing each of several elements from the two records. The basic mathematical specifications are derived algebraically from fundamental concepts of probability, although the theory can be extended to include more advanced mathematics. Probabilistic, deterministic, and clerical techniques may be combined in different ways depending upon the goal of the record linkage project. If a population parameter is being estimated for a purely statistical study, a completely probabilistic approach may be most efficient; for other applications, where the purpose is to make inferences about specific individuals based upon their data contained in two or more files, the need for a high positive predictive value would favor a deterministic method or a probabilistic method with careful clerical review. Whatever techniques are used, researchers must realize that the combination of data sources entails additional ethical obligations beyond the use of each source alone.
Little is known about the magnitude of hand injuries at national levels. This paper quantifies and characterises the incidence of hand injuries that require acute medical attention at Emergency Departments in The Netherlands and Denmark. Except for the incidence rate and the referral after treatment, the overall picture of hand injuries is similar for both countries: hand injuries show a peak for teenagers, result mainly from home and leisure accidents, are mainly caused by objects and falls, the majority affect fingers and result mainly in superficial injuries, open wounds and fractures, a small proportion of the victims is admitted into hospital. We conclude that hand injuries are a real burden to society and are worthwhile to be prevented with special attention for home and leisure accidents and occupational accidents. Data recording on the backgrounds of accidents and their long term consequences should be improved.
The comparison on cause and treatment of injuries between two types of Emergency Department among 25 hospitals.
- Li ZJ, Chen SY, Zhou J, Wu YQ. Zhonghua Liu Xing Bing Xue Za Zhi 2004; 25(3): 214-217.
Correspondence: Z. Li, Chinese Center for Disease Control and Prevention, Beijing 100050, CHINA; (email: unavailable).
OBJECTIVE: To analyze the characteristics of injuries between two types of Emergency Department (ED) in China.
METHODS: We selected 25 hospital EDs in the whole country as spots for investigation, and designed one special questionnaire to collect information, from 1st July, 2001 to 30th June, 2002.
FINDINGS: In city hospitals (CIH), the proportion of injury to all diseases were 19.65%, and in country hospital (COH) it was 29.88%. The fatality rate of injuryies was 1.29% in COH, which was higher than that of CIH's (P < 0.001). In COH, ambulance was more frequently used to treat injury patients than in CIH, but the average rescue time was not different. In cities, machinery was the leading cause (about 32.88%), but in country it was due to transpert (35.34%). Traffic accidents, suicide/homicide and unintentional drowning were the main causes of death. In CIH, the number of unintentional poisoning was almost twice as intentional, but in COH the patients due to poisoning suicide act were more than unintentional poisoning, with 2/3 of the poisoning causes were women. Patients due to chemical, drug and food poisoning accounted for 86.13% in CIH, while in COH the main causes were pesticidal, chemical and druggery (89.80%). In all poisons, pesticide was the leading cause for death.
COMMENTS: It's suggested that patients with injury be treated timely since the acute injury patients accounted for important part of ED's patients. The differences between CIH and COH were obvious, with better ability of treatment in CIH than in COH. More relevant measures were needed to improve the ability of acute treatment for injuries.
BACKGROUND: This study investigated the impact of safety beliefs on safe behavior and the effect of age, gender, class standing, and geographic region on these beliefs and behaviors. It also compares the level of safety beliefs and safe behavior of Midwestern college students in 1993 to those in 2002.
METHODS: A total of 1,059 undergraduate students at four Midwestern universities completed the 33-item questionnaire developed by Crowe (J. Saf. Res. 26 (1995) 187) during the spring semester of 2002.
FINDINGS: Significant main effects for gender and age on safety beliefs and safe behavior were found as well as a significant interaction between gender and age for both outcome variables. The regression model with the independent variables of personal responsibility and gender yielded a multiple R of.58, which explained 34% of the variance of the self-reported safe behavior. Midwestern college students in 2002 were found less safety-conscious in terms of self-reported safety beliefs and safe behavior than those in 1993.
COMMENTS: The findings indicate that safety education of adolescents and young adults in the United States has not been effective, at least for the last decade, or today's social and school environment is less conducive to the students' safe behavior and beliefs than a decade ago. Impact on industry: Proactive multidisciplinary approaches to enhance safe behavior and beliefs of young adults should be made based on critical evaluation of current approaches.
Correspondence: G. Smith, Center for Injury Research and Policy, Columbus Children's Research Institute, Children's Hospital, Columbus, Ohio and Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Columbus, Ohio, USA; (email: unavailable).
Ninety-six children were admitted during a 9-year period to a pediatric level 1 trauma center for treatment of farm-related injuries. The age range was from 6 weeks to 17 years (median, 7.5 years; mean, 7.6 years; standard deviation, 4.4). Thirty-nine patients (40.6%) had an animal-related injury, including 36 children (37.5%) who had an injury associated with a horse. Amish children had an increased risk of horse-related injury when compared with non-Amish children (p=0.04; RR=2.09, 95% CI: 1.18<RR<3.70). Thirty-seven patients (38.5%) had farm machinery-related injuries, including 14 children (14.6%) with an injury associated with a tractor. Falls from buildings or haylofts accounted for injuries to 12 patients (12.5%). Head trauma accounted for 35 cases (36.4%), with skull fractures in 23 cases (24.0%). Animal-related injuries were significantly associated with head/maxillofacial trauma (p = 0.001; RR = 2.15, 95% CI: 1.35 <RR<3.41). Five children (5.2%) died, and one child with a severe brain injury was discharged to a long-term rehabilitation facility. Animals, especially horses, accounted for a large percentage of farm-related injuries in this population.
Correspondence: Laura L. Finley, University of Northern Colorado and Metropolitan State College of Denver; and Adjunct Professor, Center for Applied Studies in American Ethnicity, Colorado State University; Greeley, CO 80634, USA; (email: unavailable).
While politicians and the media have devoted a great deal of attention to the "problem" of school violence, classrooms teachers remain an underutilized source of information and inspiration about the frequency of school violence, its causes, its consequences, and appropriate interventions. In essence, teachers have been given little, if any, voice. This article is a reflective piece that integrates the author's own experiences as a teacher, focus group data with high school teachers, and the extant literature regarding the importance of teacher voice. Research and theory regarding the relationship between the colonizer and the colonized serve as background. Also explored are the ways that teachers' voices are stifled, as well as suggestions for empowering teachers.
OBJECTIVE: Older fallers aged over 70 years have shown impaired balance abilities, but it is unclear if impairment in balance control can be detected among fallers who are in their 50's and 60's. The aim of this study was to analyze possible differences in balance control and other health-related factors between female fallers and non-fallers aged 50-68 years.
METHODS: Women 50-68 years of age (N=40) who had fallen outside and needed medical attention were recruited through a larger fall accident study. Non-fallers (N=97) were women representing the same age group who had not fallen during the preceding 12 months. A battery of standing force platform balance tests were administered together with an interview on health status, use of medication, dizziness, vision, hearing, and physical activity.
FINDINGS: Significant differences were not found between women with injurious falls and non-fallers in the various balance tests. In the younger age group (50-58 years), chronic illnesses, use of medication, dizziness, and self-reported problems with vision and hearing were more common in fallers than in non-fallers.
COMMENTS: Our results suggest that, in active and independent women aged 50-68 years, it is not possible to use standing force platform balance tests to detect differences between fallers and non-fallers. However, younger women (50-58 years) with injurious falls reported more health-related problems than other groups, a fact which should be taken into consideration to prevent further development of fall-related problems.
Personality trait risk factors for attempted suicide among young women with eating disorders.
- Youssef G, Plancherel B, Laget J, Corcos M, Flament MF, Halfon O. Eur Psychiatry 2004; 19(3): 131-139.
Correspondence: G. Youssef, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (Pr. O. Halfon), Lausanne, SWITZERLAND; (email: unavailable).
OBJECTIVE: Clinical observations and a review of the literature led us to hypothesize that certain personality and character traits could provide improved understanding, and thus improved prevention, of suicidal behaviour among young women with eating disorders.
METHODS: The clinical group consisted of 152 women aged between 18 and 24 years, with DSM-IV anorexia nervosa/restrictive type (AN-R = 66), anorexia nervosa/purging type (AN-P = 37), bulimia nervosa/non-purging type (BN-NP = 9), or bulimia nervosa/purging type (BN-P = 40). The control group consisted of 140 subjects. The assessment measures were the Minnesota Multiphasic Personality Inventory-second version (MMPI-2) scales and subscales, the Beck Depression Inventory (BDI) used to control for current depressive symptoms, plus a specific questionnaire concerning suicide attempts.
FINDINGS: Suicide attempts were most frequent in subjects with purging behaviour (30.0% for BN-P and 29.7% for AN-P). Those attempting suicide among subjects with eating disorders were mostly students (67.8%). For women with AN-R the scales for 'Depression' and 'Antisocial practices' represented significant suicidal risk, for women with AN-P the scales for 'Hysteria', 'Psychopathic deviate', 'Shyness/Self-consciousness', 'Antisocial Practices', 'Obsessiveness' and 'Low self-esteem' were risk indicators and for women with BN-P the 'Psychasthenia', 'Anger' and 'Fears' scales were risk indicators.
COMMENTS: This study provides interesting results concerning the personality traits of young women with both eating disorders and suicidal behaviour. Students and those with purging behaviour are most at risk. Young women should be given more attention with regard to the risk of suicide attempts if they: (a) have AN-R with a tendency to self-punishment and antisocial conduct, (b) have AN-P with multiple physical complaints, are not at ease in social situations and have antisocial behaviour, or (c) if they have BN-P and tend to be easily angered with obsessive behaviour and phobic worries. The MMPI-2 is an interesting assessment method for the study of traits indicating a risk of suicidal behaviour in young subjects, after controlling for current depressive pathology.
Marital status and the risk of suicide: experience from England and Wales, 1982-1996.
- Yip PS, Thorburn J. Psychol Rep 2004; 94(2): 401-407.
Correspondence: S. Yip, Hong Kong Jockey Club, Centre for Suicide Research and Prevention, University of Hong Kong, Pokfulam Road, HONG KONG; (email: sfpyip@hku.hk).
This analysis examined suicide rates by age, sex, and marital status in England and Wales for the period 1982-1996. Never married, widowed, and divorced people had higher rates of suicide than those who were married, for both sexes. Among the widowed ages 20-39 years, both sexes had the highest rate, and the rate decreased with age. The suicide rate for divorced people was similar to those who had never married, except for the younger group ages 20-29 years. The male:female ratios for the relative suicide risk for never married, widowed, and divorced to married for both sexes were statistically significantly different for older adults. The decrease in suicide rates observed for the period 1982-1996 in England and Wales was mainly attributable to the reduction of suicide rates among the widowed and divorced.
Medical illness and the risk of suicide in the elderly.
- Juurlink DN, Herrmann N, Szalai JP, Kopp A, Redelmeier DA. Arch Intern Med 2004; 164(11): 1179-1184.
Correspondence: David Juurlink, Clinical Epidemiology and Healthcare Research Program, Psychiatry, and Population Heath Sciences, University of Toronto, and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, CANADA; (email: dnj@ices.on.ca).
BACKGROUND: Suicide is a leading cause of death, and rates are especially high among the elderly. Medical illnesses may predispose to suicide, but few controlled studies have examined the association between specific diseases and suicide. We explored the relationship between treatment for several illnesses and the risk of suicide in elderly patients using a population-based approach.
METHODS: All Ontario residents 66 years or older who committed suicide between January 1, 1992, and December 31, 2000, were identified from provincial coroners' records. Their prescription records during the preceding 6 months were compared with those of living matched controls (1:4) to determine the presence or absence of 17 illnesses potentially associated with suicide.
FINDINGS: During the 9-year study period, we identified 1354 elderly patients who died of suicide. The most common mechanisms involved firearms (28%), hanging (24%), and self-poisoning (21%). Specific illnesses associated with suicide included congestive heart failure (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.33-2.24), chronic obstructive lung disease (OR, 1.62; 95% CI, 1.37-1.92), seizure disorder (OR, 2.95; 95% CI, 1.89-4.61), urinary incontinence (OR, 2.02; 95% CI, 1.29-3.17), anxiety disorders (OR, 4.65; 95% CI, 4.07-5.32), depression (OR, 6.44; 95% CI, 5.45-7.61), psychotic disorders (OR, 5.09; 95% CI, 3.94-6.59), bipolar disorder (OR, 9.20, 95% CI, 4.38-19.33), moderate pain (OR, 1.91; 95% CI, 1.66-2.20), and severe pain (OR, 7.52; 95% CI, 4.93-11.46). Treatment for multiple illnesses was strongly related to a higher risk of suicide. Almost half the patients who committed suicide had visited a physician in the preceding week.
COMMENTS: Many common illnesses are independently associated with an increased risk of suicide in the elderly. The risk is greatly increased among patients with multiple illnesses. These data may help clinicians to identify elderly patients at risk of suicide and open avenues for prevention.
Newspaper framing of fatal motor vehicle crashes in four Midwestern cities in the United States, 1999-2000.
- Connor SM, Wesolowski K. Inj Prev 2004; 10(3): 149-153.
Correspondence: Susan M Connor, Rainbow Community Safety and Resource Center, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, WRN B47, Cleveland, OH 44106-6039, USA; (email: smc3@cwru.edu).
OBJECTIVE: To examine the public health messages conveyed by newspaper coverage of fatal motor vehicle crashes and determine the extent to which press coverage accurately reflects real risks and crash trends.
METHODS: Crash details were extracted from two years of newspaper coverage of fatal crashes in four Midwestern cities in the United States. Details and causal factors identified by reporters were compared to data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) using odds ratios and two tailed z tests.
FINDINGS: Papers covered 278 fatal crashes over the two year period, in contrast to 846 fatal crashes documented in FARS. Papers assigned blame in 90% of crashes covered, under-reported restraint use and driver's risk of death, failed to reflect the protective value of restraints, and misrepresented the roles played by alcohol and teen drivers.
COMMENTS: Newspaper coverage did not accurately reflect real risk. Papers presented fatal crashes as dramas with a victim/villain storyline; in keeping with this narrative strategy, papers were most likely to cover stories where a driver survived to take the blame. By highlighting crashes that diverge from the norm, focusing on the assignment of blame to a single party, and failing to convey the message that preventive practices like seatbelt use increase odds for survival, newspapers removed crashes from a public health context and positioned them as individual issues. Public health practitioners can work with media outlets in their areas to draw attention to misrepresentations and change the way these stories are framed.
The influence of side airbags on the risk of head and thoracic injury after motor vehicle collisions.
- McGwin G Jr, Metzger J, Rue LW 3rd. J Trauma 2004; 56(3): 512-516.
Correspondence: Gerald McGwin, Section of Trauma, Burns, and Surgical Critical Care, Division of General Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, 35294-0016, USA; (email: gerald.mcgwin@ccc.uab.edu).
BACKGROUND: Side airbags (SABs) were developed as an energy-absorbing barrier to protect specific occupant body regions in near side impact motor vehicle collisions.
METHODS: The National Automotive Sampling System Crashworthiness Data System was used to evaluate drivers and front-seated passengers in 1998 or newer vehicles involved in near side impact collisions. Risk ratios were calculated comparing the risk of head and thoracic injury among occupants in vehicles with and without SABs adjusting for occupant, vehicle, and collision characteristics.
FINDINGS: Occupants in vehicles equipped with head protection SABs had a 75% lower risk of head injury (p = 0.008) after near side collisions. With respect to thoracic injury, SABs that provide thoracic protection are associated with a 68% reduction (p = 0.01) in thoracic injury risk.
COMMENTS: As SAB-equipped vehicles become an increasingly larger segment of the on-road vehicle fleet, the impact of head and thoracic injury after near side impact collision is likely to be reduced.
Road traffic accidents--severe injuries. Decision-making on the basis of partial data.
Correspondence: Kobi Peleg, Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, ISRAEL; (email: unavailable).
BACKGROUND: Road traffic accidents are the cause of approximately one quarter of trauma hospitalizations in Israel. A comparison of figures on severe traffic injuries, as published by the Israeli Central Bureau of Statistics (CBS) and the Israeli Police with data from registries in medical systems, revealed significant disparities. OBJECTIVE: To present gaps between registries and the possible consequences that presenting incomplete data to decision makers may have on their ability to set policy for reducing road traffic accidents. FINDINGS: The number of severe injuries according to the CBS, the National Council for Road Safety and the Israeli Police ranges from 3,378 to 2,573 per year, for the period 1998-2000. During the same time period, the national trauma registry that recorded data at only eight hospitals (of the 24 hospitals in the country), noted a total of 4,442 to 4,800 patients per year. The Ministry of Health's data, that includes figures from most of the hospitals in the country, reports between 10,290 to 11,009 road traffic accident hospitalizations per year for this same period of time. The CBS data is the formal national data, hence the database which decision makers use when considering the number of casualties due to road accidents consists of less than half of the actual number of cases. Furthermore, it is not a representative sample. When decisions are made without data, one uses common sense and reason. However, when the decision maker is presented with information, he assumes that these are valid, reliable, representative, well established data and relates to the information as such in the decision making process. If data is misleading, decisions may be ill-advised. COMMENTS: Gaps in information are presented, posing a question on the possible effect that the interpretation of partial data by decision makers may have on the decisions they make. It is strongly advocated that collaboration is needed between police and health agencies and that a system for collecting and analyzing data on road traffic casualties be established to combine health and police data. The existence of a reliable, complete and valid database is essential in order to succeed in the important battle to reduce morbidity and mortality from road traffic accidents.
Occupant restraint use in Canada.
- Boase P, Jonah BA, Dawson N. J Safety Res 2004; 35(2): 223-229.
Correspondence: Paul Boase, Transport Canada, 330 Sparks Street, Place de Ville, Tower C, Ottawa, Ontario, CANADA; (email: Boasep@tc.gc.ca).
Legislation regarding seat belt use in Canada is a provincial/territorial responsibility. Each of the 13 jurisdictions has enacted legislation and set the penalties regarding non-use of seat belts and appropriate child restraint systems. The federal government regulates occupant restraint systems and child restraints. In addition, Transport Canada (TC) gathers annual survey data on the use of seat belts and child restraints on Canadian roads and provides research support. National coordination toward the Canadian Road Safety Vision 2010 goal of a 40% reduction in fatalities and serious injuries related to non-belt/child restraint use and a 95% restraint usage rate is provided by the Canadian Council of Motor Transport Administrators' (CCMTA) National Occupant Restraint Program (NORP). The paper examines the history of legislation, provincial/territorial penalties, NORP, and TC involvement in promoting the use of occupant restraints.
Effects of safety belt laws on safety belt use by American high school seniors, 1986-2000.
Correspondence: Patrick M. O'Malley, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor MI, USA; (email: pomalley@umich.edu).
BACKGROUND: This manuscript evaluates the effects of enactment of state laws that required safety belt use in various U.S. states between 1986 and 2000.
METHODS: Safety belt use was assessed using nationally representative cross-sectional samples of high school seniors; evaluation of the effects of laws used data from over 2,000 high school seniors before and about 3,300 after the laws took effect in 20 states.
FINDINGS: Belt use was found to increase significantly between 1986 and 2000, and the laws contributed significantly to that increase. Increases were similar for students differing by gender, race/ethnicity, parent education, grades, truancy, evenings out per week, miles driven per week, and an index of illicit drug use.
COMMENTS: The data show that although the laws have increased belt use, use is not universal and continued efforts are needed. This study shows that many teenagers fail to use belts when there is a secondary use law; an implication is that primary laws would be more efficacious in increasing use among this vulnerable population.
Speed regulation by in-car active accelerator pedal.
Correspondence: Magnus Hjälmdahl, Department of Technology and Society, Lund University, John Ericssons vag 1, 221 00, Lund, SWEDEN; (email: magnus.hjalmdahl@tft.lth.se).
The long-term effects of driving with an active accelerator pedal on driver behaviour were studied by using an in-car observation method over the period beginning 2000 until 2001. The system produced a counterforce in the accelerator pedal when the speed limit was reached, but could be overridden by pressing the accelerator pedal harder. Twenty-eight drivers were studied when driving without the system and then when driving with the system after they had used it in their own cars for at least six months. The results showed that their behaviour towards other road users improved, they had a yielding behaviour correct to a higher degree and were more likely to give pedestrians the right of way at zebra crossings when driving with the active accelerator pedal. It was also found that the time gap to the vehicle in front increased slightly with the system. There were also signs of negative behavioural modifications in the form of drivers forgetting to adapt their speed to the speed limit or the prevailing traffic situation when they were not supported by the system and in low speed areas; these effects, however, were not statistically significant. Together with studies showing improved speed behaviour, the results of this study augur well for great safety effects of the system.
Private car as the grand equaliser? Demographic factors and mobility in Finnish men and women aged 65+.
The present study examined the association between selected demographic variables and community-related mobility of Finnish elderly citizens. A mail survey was sent to 2500 Finnish citizens aged 65 and over. The overall response rate was 62%. Mobility was measured in two dimensions: overt travel behaviour and unfulfilled travel needs. Several demographic variables had a clear association with both dimensions of mobility. Sub-groups with reduced mobility included women, rural residents, the oldest old, and those without a driver license. When the interactions of single demographic variables were controlled for, significant predictors for hindered mobility were absence of driver license and rural-type residing. The results indicate that the level of mobility varies among the elderly, and there are certain sub-groups with limited mobility, often those with less overall resources. The possibility to drive a private car is, at present, crucial for older persons' mobility, which has important implications both for further research and policy discussion.
Using traffic light information as navigational cues: implications for navigation system design.
There are compelling research findings that using landmarks such as traffic lights as navigation cues can enhance the acceptability, usability and safety of vehicle navigation systems. In this study, 30 participants undertook an on-road trial using simulated navigation instructions that omitted any reference to distance-to-turn, and instead incorporated information requiring drivers to count traffic lights and pedestrian lights. The study results confirmed that traffic lights can be used as navigation cues even when the density of traffic lights along a stretch of road is high and that the term "set of traffic lights" results in slightly better performance than "traffic lights" alone. Factors other than density were found to have an effect on navigation performance. More errors were made if the target turn was at a pedestrian light and if the turn was visually complex or concealed. In the absence of a navigation task, most drivers did not differentiate between traffic and pedestrian lights when counting the occurrences and only experienced difficulty in counting when the number exceeded 4. Implications for the design of future navigation systems are highlighted.
Impact of traveler advisory systems on driving speed: some new evidence.
Correspondence: Linda Ng Boyle, Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, IA 52242, USA; (email: linda-boyle@uiowa.edu).
This paper explores the effects of driving behavior using in-vehicle and out-of-vehicle traffic advisory information relating to adverse weather and incident conditions. A full-size, fixed-based driving simulator is used to collect data on drivers' speed behavior under four different advisory-information conditions: in-vehicle messages, out-of-vehicle messages, both types of messages, and no messages. The findings of this study suggest an interesting phenomenon in that, while messages are significant in reducing speeds in the area of adverse conditions, drivers tend to compensate for this speed reduction by increasing speeds downstream when such adverse conditions do not exist. As a result, the net safety effects of such message systems are ambiguous.
See items under Distraction and Attentional Issues
Homicide patterns vary from country to country, influenced by many factors. In the two-year period from January 1998 to December 1999, 82 homicide victims were autopsied. The sex ratio was about three males for one female.The largest number of victims was found in the age group 21-30 years. Assaults with blunt weapons were the most common means. Acquaintances committed 34% of homicides. In contrast to males, the killing of a female by a stranger was rare. Revenge was the most common reason followed by arguments. In 40.2% of cases, the location of crime was outdoors, 37.8% were at the victim's house and in 9.7% of cases, the crime was committed at another domicile such as the offender's house, lodgings or a relative's house. In 14.7% of cases, the dead bodies were located away from the scene of crime.
Rates of homicide and suicide on major national holidays.
- Bridges FS. Psychol Rep 2004; 94(2): 723-724.
Correspondence: F. Bridges, Division of Health, Leisure and Exercise Science, University of West Florida, 11000 University Parkway, Pensacola, FL 32514-5750, USA; (email: fbridges@uwf.edu).
Rates of U.S. homicides and suicides during 1972-1979 were higher on 7 major national holidays except one for homicides and were lower for suicides, except New Year's Day as Lester noted for 1972-1979.
Frequency of serial sexual homicide victimization in Virginia for a ten-year period.
The frequency of serial sexual murder has been widely discussed, and estimates of the number of victims in the United States range from 500 to 6000 per year. This study attempted to quantify the number of serial sexual murder victims in Virginia for a ten-year period. Multiple sources of data were utilized, including Federal Bureau of Investigation (FBI) case files, FBI's Violent Criminal Apprehension Program (ViCAP) reports, Virginia State Police ViCAP reports, Virginia Homicide Investigators Association, and the Virginia Division of Forensic Science DNA database, to effectively cull out all the known serial sexual murder victims for the given time period. Review of these records revealed a total of 28 victims of serial sexual murder, compared with a total of 5183 murder victims for the same ten-year period. The frequency of serial sexual victimization was 0.5% of all homicides for the given period. These results highlight the unusual frequency of serial sexual murder.
Are medical societies developing a standard for gun injury prevention?
- Longjohn MM, Christoffel KK. Inj Prev 2004; 10(3): 169-173.
CONTEXT: Following heightened gun violence in the 1990s, many medical societies in the United States adopted policies on the topic.
OBJECTIVE: Identify points of firearm violence policy agreement among large medical organizations.
DESIGN: Fourteen national medical societies-clinical focus, demonstrated interest in gun injury prevention, >2000 members-were selected for policy review in 2002. Policies were categorized on areas covered and items within these. Consensus areas were addressed by >/=7/14 societies.Consensus items were included by >/=7/14 societies, shared items by 5-6.
FINDINGS: There were five consensus areas: access prevention, gun commerce, research, public education, and clinical counseling. There were four consensus items: restricting gun access by enforcing existing laws, restricting access to all guns at the point of sale, restricting access to handguns at the point of sale, and creating a national database on gun injury and death. Shared items promote violence prevention, clinical education on risks of guns in the home, treating guns as consumer products, restricting gun access to children, bans on automatic weapons, and promoting trigger locks.
COMMENTS: Large medical societies in the United States agree on key approaches for reducing gun injury mortality and morbidity. Future research will be needed to track the evolution of this emerging standard for physician action, which now includes the consensus areas and items. It promises to be, in effect, a medical standard of care for gun injury prevention. The United States experience may be useful to others working on gun injury prevention.
Characteristics of household addresses that repeatedly contact 911 to report intimate partner violence.
- Houry D, Parramore C, Fayard G, Thorn J, Heron S, Kellermann A. Acad Emerg Med 2004; 11(6): 662-667.
Correspondence: Debra Houry, Department of Emergency Medicine and Center for Injury Control, Emory University, 1518 Clifton Road, Suite 230, Atlanta, GA 30322, USA; (email: dhoury@emory.edu)
OBJECTIVES: To determine whether households that generate several 911 calls differ in important ways from those that make a single call and to determine whether households that generate repeat 911 calls for intimate partner violence (IPV) experience more severe violence than those that do not.
METHODS: All cases of police-documented IPV were reviewed and linked with their respective 911 calls. Each incident report was reviewed to determine the relationship between the offender and victim, demographic characteristics of the offender and victim, weapon and substance involvement, prior incidents of IPV, and violence severity.
FINDINGS: Of the 1,505 IPV addresses identified during the 12-month study interval, 1,010 (67.1%) placed more than one phone call to report IPV. Sixty-nine percent of African American victims, 50.6% of white victims, and 36.8% of Hispanic victims were repeat callers (p < 0.001). There were no differences between addresses that generated repeat calls versus single calls with respect to offender alcohol or drug involvement, presence of children, victim age, or offender age. Sixty-seven percent of households with severe violence and 66.9% of households with minor violence generated repeat 911 calls (p = 0.98).
COMMENTS: Ethnic differences in 911 use for IPV exist between African Americans, whites, and Hispanics. However, unknown societal, economic, or cultural issues could have influenced this finding. Households that repeatedly contacted 911 during the study interval to report IPV were not more likely to experience severe violence than those that placed a single 911 call.
