Correspondence: William Alex Pridemore, Indiana University, Department of Criminal Justice, IN and Harvard University, Davis Center for Russian Studies, Cambridge, MA, USA; (email: wpridemo@indiana.edu).
OBJECTIVE: This study employs unique newly available Russian mortality data to examine the social connection between binge drinking and homicide in the country. Setting, participants and measurements All death certificates of those aged 20-64 years in the Udmurt Republic, Russia, were analyzed according to day and cause of death for the years 1994-98. Deaths due to alcohol poisoning were used as a proxy for binge drinking.
FINDINGS: There was a high bivariate correlation (r = 0.75) between the daily distribution of deaths due to alcohol and homicide. The number of alcohol deaths was significantly higher on Saturdays and Sundays (presumably as a result of drinking on Friday and Saturday nights) and the number of homicide deaths was significantly higher on Fridays and Saturdays. Conclusions The levels of alcohol consumption and homicide in Russia are among the highest in the world, and there is mounting evidence that the two are related. Binge drinking, preference for distilled spirits and a high social tolerance for heavy drinking may act as social and cultural contextual factors that might increase the risk of violent outcomes. The high correspondence between the daily distribution of alcohol and homicide deaths provides indirect evidence for the social connection between them. While these findings do not represent a causal connection, when placed in the context of the growing literature on this topic they provide further support of an association between alcohol consumption and homicide rates in Russia and preliminary evidence for the intermediate role in this relationship played by social context.
Raising the bar: can increased statutory penalties deter drink-drivers?
The rate of road accidents per 100,000 vehicles registered was examined before and after the statutory penalties for drink-driving offences were doubled in New South Wales (NSW), Australia. Interrupted time-series analyses found significant increases in three non-fatal accident series after the implementation of the new penalties. The observed increase in the rate of single-vehicle night-time accidents, the accident category most likely to be alcohol-related, was not expected and runs contrary to the anticipated deterrent effect of the new laws. The failure of this policy to have an impact on aggregate-level road accident rates is discussed.
Preventing Alcohol-Related Traffic Injury: A Health Promotion Approach.
Correspondence: Peter Howat, Western Australian Centre for Health Promotion Research School of Public Health, Curtin University Perth Western Australia, AUSTRALIA; (email: p.howat@curtin.edu.au).
The conditions that give rise to drinking and driving are complex, with multiple and interrelated causes. Prevention efforts benefit from an approach that relies on the combination of multiple interventions. Health promotion provides a useful framework for conceptualizing and implementing actions to reduce drinking and driving since it involves a combination of educational, behavioral, environmental, and policy approaches. This review draws on data from a range of settings to characterize the effectiveness of various interventions embedded within the health promotion approach. Interventions considered part of the health promotion approach include: (1) economic interventions (2) organizational interventions, (3) policy interventions, and (4) health education interventions, including the use of media, school and community education, and public awareness programs. Effective health promotion strengthens the skills and capabilities of individuals to take action and the capacity of groups or communities to act collectively to exert control over the determinants of alcohol-impaired driving. There is strong evidence for the effectiveness of some components of health promotion, including economic and retailer interventions, alcohol taxation, reducing alcohol availability, legal and legislative strategies, and strategies addressing the servers of alcohol. There is also evidence for the effectiveness of sobriety checkpoints, lower BAC laws, minimum legal drinking age laws, and supportive media promotion programs. Other interventions with moderate evidence of effectiveness include restricting alcohol advertising and promotion, and actions involving counter advertising. Health education interventions alone that have insufficient evidence for effectiveness include passive server training programs, school drug and alcohol education programs, community mobilization efforts, and health warnings. Because each intervention builds on the strengths of every other one, ecological approaches to reducing alcohol-impaired driving using all four components of the health promotion model are likely to be the most effective. Settings such as schools, workplaces, cities, and communities offer practical opportunities to implement alcohol-impaired driving prevention programs within this framework.
Effects of Alcohol and Other Drugs on Driver Performance.
In the past century we have learned that driving performance is impaired by alcohol even in low dosage, and that many other drugs are also linked to impairment. This paper is a summary of some of the more relevant studies in the past fifty years an overview of our knowledge and unanswered questions. There is no evidence of a threshold blood alcohol (BAC) below which impairment does not occur, and there is no defined category of drivers who will not be impaired by alcohol. Alcohol increases not only the probability of collision, but also the probability of poor clinical outcome for injuries sustained when impaired by alcohol. This review samples the results of the myriad studies that have been performed during the last half century as experiments have moved from examination of simple sensory, perceptual and motor behaviours to more complex measures of cognitive functioning such as divided attention and mental workload. These more sophisticated studies show that significant impairment occurs at very low BACs (<0.02 gm/100 ml). However, much remains to be determined regarding the more emotional aspects of behaviour, such as judgment, aggression and risk taking. Considering that the majority of alcohol related accidents occur at night, there is a need for increased examination on the role of fatigue, circadian cycles and sleep loss. The study of the effects of drugs other than alcohol is more complex because of the number of substances of potential interest, the difficulties estimating drug levels and the complexity of the drug/subject interactions. The drugs of current concern are marijuana, the benzodiazepines, other psychoactive medications, the stimulants and the narcotics. No one test or group of tests currently meets the need for detecting and documenting impairment, either in the laboratory or at the roadside.
Program sustainability of a community-based intervention to prevent falls among older Australians.
- Barnett LM, Van Beurden E, Eakin EG, Beard J, Dietrich U, Newman B. Health Promot Int 2004; 19(3): 281-288.
Correspondence: Lisa Barnett, Health Promotion Unit, Northern Rivers Area Health Service, PO Box 498, Lismore, NSW 2480, AUSTRALIA; (email: lisab@nrahs.nsw.gov.au).
Multi-strategy interventions have been demonstrated to prevent falls among older people, but studies have not explored their sustainability. This paper investigates program sustainability of Stay on Your Feet (SOYF), an Australian multi-strategy falls prevention program (1992-1996) that achieved a significant reduction in falls-related hospital admissions. A series of surveys assessed recall, involvement and current falls prevention activities, 5 years post-SOYF, in multiple original SOYF stakeholder groups within the study area [general practitioners (GPs), pharmacists, community health (CH) staff, shire councils (SCs) and access committees (ACs)]. Focus groups explored possible behavioural changes in the target group. Surveys were mailed, except to CH staff and ACs, who participated in guided group sessions and were contacted via the telephone, respectively. Response rates were: GPs, 67% (139/209); pharmacists, 79% (53/67); CH staff, 63% (129/204); SCs, 90% (9/10); ACs, 80% (8/10). There were 73 older people in eight focus groups. Of 117 GPs who were practising during SOYF, 80% recalled SOYF and 74% of these reported an influence on their practice. Of 46 pharmacists operating a business during SOYF, 45% had heard of SOYF and 79% of these reported being 'somewhat' influenced. Of 76 community health staff (59%) in the area at that time, 99% had heard of SOYF and 82% reported involvement. Four SCs retained a SOYF resource, but none thought current activities were related. Seven ACs reported involvement, but no activities were sustained. Thirty-five focus group participants (48%) remembered SOYF and reported a variety of SOYF-initiated behaviour changes. Program sustainability was clearly demonstrated among health practitioners. Further research is required to assess long-term effect sustainability.
Lightning injuries--a mixture of electrical, thermal and multiple trauma.
- Huss F, Erlandsson U, Cooray V, Kratz G, Sjoberg F. Lakartidningen 2004; 101(28-29): 2328-2331.
Correspondence: Fredrik Huss, Dept of Plastic Surgery, Hand Surgery und Bums, BRIVA, Universitetssjukhuset, SE-581 85 Linkoping, SWEDEN; (email: fredrik.huss@lio.se).
There are several misconceptions even among hospital personnel regarding damages and injuries caused by lightning. Few health care providers have experience from lightning injuries as they are rare and different (DC) from the more common high-voltage (AC) injuries. Furthermore, fatalities are uncommon. Burns do occur but are usually minor. Most lightning injuries occur in the summer season during outdoor leisure activities and in the vicinity of a tree or other large structures. In Sweden, on average, approximately seventeen persons per year are hospitalised and 0.2-0.8 persons per million inhabitants and year die due to lightning injuries. The primary treatment follows the general guidelines for other trauma, electrical, and burn injuries, i.e. as is described in the standardised ATLS, ABLS, or A-HLR programmes. However, there are some minor points that are different and may be stressed for a favourable outcome. In this paper these are addressed together with the epidemiology, effects and treatment of lightning injuries that are specific for Sweden. Unfortunately, little is known, apart from what is described in smaller case series, of the long time sequelae experienced by this patient population and further research is therefore particularly warranted in this respect.
Epidemiological findings point to very low blood alcohol levels heightening the risk of sleep-related fatal road crashes. This was further assessed using a full sized interactive car simulator. Twenty, sleep restricted, healthy young men underwent a 2 h simulated afternoon monotonous drive, having previously consumed nil alcohol or 3 units >90 min previously, and having near-zero breath alcohol (BrACs) at the start of the drive. In a repeated measures, double-blind, balanced design, driving performance, subjective sleepiness and EEG were monitored throughout. Compared with nil alcohol, the alcohol condition initially increased sleepiness-related driving impairment. However, this was not mirrored by subjective sleepiness or EEG. An unexpected reversal (i.e. improvement) in driving impairment occurred with the alcohol group, in the second hour of the drive. This was supported by a trend for improved subjective alertness. Alcohol continued to interact with sleepiness-related driving impairment after BrACs had reached zero. However, a lack of subjective perception of increased sleepiness, at this time, further points to the dangerous combination of even modest alcohol intake and sleepiness, and confirms the road crash findings. BrACs are a poor guide to driver impairment.
OBJECTIVE: To investigate the incidence and describe the nature of non-motorized scooter related injuries in children presenting to the ED.
SETTING: Paediatric ED of a metropolitan tertiary referral hospital.
METHODS: A prospective observational study of patients aged under 19 years presenting with injuries sustained while using a non-motorized scooter. Clinicians recorded the data in the patient record. Main outcome measures: type of injury sustained; period of experience on the scooter; the use of protective gear; the presence of adult supervision; the place of accident; and the patient outcome.
FINDINGS: Sixty-two eligible patients were recruited over an 18 month period. The incidence of scooter- related injuries was 1.3% of all paediatric trauma presentations. There was a fall in scooter injury presentations over the study period; however, this was not statistically significant. The most common injury sustained using a scooter was an upper limb fracture (41.9%). Closed head injury comprised 8.1% of all scooter related injuries. The majority of patients were not wearing protective gear and were unsupervised at the time of their accident. Most patients (79%) were managed in the ED and discharged.
COMMENTS: There has been no significant change in scooter injury presentations over the two summer periods of 2000 and 2001. Children presenting to the ED with a scooter related injury tend to be primary school aged, which may have implications on scooter design, age recommendations and safety guidelines.
Our objective was to compile data on the mechanism and severity of injuries associated with hot beverage burns in children. We identified 152 children over a 3-year period who attended a tertiary level burns center, representing 18% of all children treated. Their median age was 17.5 months and median body surface area burned was 4% (range, 0.25% to 32%). Significantly, 52% of children required admission, 18% received a split skin graft, and 26% required long-term scar management. In 70% of all cases, the mechanism of injury was the child pulling the hot beverage over himself or herself. In 80% of incidents, a primary care giver witnessed the injury. These findings indicate that scalding from hot beverages carries significant morbidity and is an important pediatric public health issue. It is clear that further research towards effective education programs for primary caregivers is warranted.
This study aimed to provide a detailed description of all work-related road deaths in Australia during 1989-1992, compare the results to a prior investigation of work-related road fatalities, and consider the use of data from the Australian Transport Safety Bureau (ATSB) as a possible source of information on work-related road deaths. Results show that there were on average 136 workers, 151 commuters, and 133 road bystanders who were fatally injured in vehicle incidents on a public roadway each year during the study timeframe, giving a rate of 1.7 per 100,000 workers per year for workers, a rate of 2.0 per 100,000 commuters per year, and a rate of 0.78 per 100,000 persons per year for road bystanders. Workers employed in the transport and storage industry had the highest rate of work-related road deaths (15.5 per 100,000 workers per year) in 1989-1992, although this was a decrease from 21.5 per 100,000 workers in 1982-1984. The type of vehicle crash differed by vehicle type and location. High speed, possible fatigue, and wet weather, and/or alcohol and drugs appeared to be factors in many of the incidents, especially those involving prime movers and rigid trucks. Work-related road deaths can be identified in the ATSB data, as long as underenumeration of certain types of vehicle incidents (i.e. those involving cars and vans, wagons, utilities, and four-wheel drives) are taken into account.
Glove use and the relative risk of acute hand injury: a case-crossover study.
Correspondence: Gary S. Sorock, Department of Occupational and Environmental Health, University of Michigan School of Public Health, Ann Arbor, Michigan, USA; (email: gsorock@jhsph.edu).
The purpose of this study was to investigate the relationship between glove use and acute traumatic occupational hand injury. We used a case-crossover, within-subject study design to control for differences between individuals such as occupation, injury history, age, gender, risk-taking behavior, manual dexterity, and muscle strength. A total of 1166 hand-injured workers were interviewed regarding the use of gloves at the time of the injury. The self-reported average duration of glove use in the previous work month was the measure of expected exposure to wearing gloves. Nineteen percent of subjects reported wearing gloves at the time of the injury. The expected exposure to glove use in the past work month was 27.9%. Glove use was associated with a lower risk of lacerations and punctures but not crush, fractures, avulsions, amputations, dislocations; the risk of the former two injury types was estimated to be 60-70% lower while wearing gloves. Glove use is only one component of a comprehensive hand injury prevention approach that might include the identification and elimination of sharp hazards, engineering controls, safety warnings, training in high-risk situation awareness, and proper selection and timing of glove use.
Correspondence: Yinhai Wang, Department of Civil Engineering, University of Washington, P.O. Box 352700, Seattle, WA 98195-2700, USA; (email: yinhai@u.washington.edu).
Collisions between bicycles and motor vehicles have caused severe life and property losses in many countries. The majority of bicycle-motor vehicle (BMV) accidents occur at intersections. In order to reduce the number of BMV accidents at intersections, a substantial understanding of the causal factors for the collisions is required. In this study, intersection BMV accidents were classified into three types based on the movements of the involved motor vehicles and bicycles. The three BMV accident classifications were through motor vehicle related collisions, left-turn motor vehicle related collisions, and right-turn motor vehicle related collisions. A methodology for estimating these BMV accident risks was developed based on probability theory. A significant difference between this proposed methodology and most current approaches is that the proposed approach explicitly relates the risk of each specific BMV accident type to its related flows. The methodology was demonstrated using a 4-year (1992-1995) data set collected from 115 signalized intersections in the Tokyo Metropolitan area. This data set contains BMV accident data, bicycle flow data, motor vehicle flow data, traffic control data, and geometric data for each intersection approach. For each BMV risk model, an independent explanatory variable set was chosen according to the characteristics of the accident type. Three negative binomial regression models (one corresponding to each BMV accident type) were estimated using the maximum likelihood method. The coefficient value and its significance level were estimated for each selected variable. The negative binomial dispersion parameters for all the three models were significant at 0.01 levels. This supported the choice of the negative binomial regression over the Poisson regression for the quantitative analyses in this study.
Hydrogen peroxide is an oxidising agent that is used in a number of household products, including general-purpose disinfectants, chlorine-free bleaches, fabric stain removers, contact lens disinfectants and hair dyes, and it is a component of some tooth whitening products. In industry, the principal use of hydrogen peroxide is as a bleaching agent in the manufacture of paper and pulp. Hydrogen peroxide has been employed medicinally for wound irrigation and for the sterilisation of ophthalmic and endoscopic instruments.Hydrogen peroxide causes toxicity via three main mechanisms: corrosive damage, oxygen gas formation and lipid peroxidation. Concentrated hydrogen peroxide is caustic and exposure may result in local tissue damage. Ingestion of concentrated (>35%) hydrogen peroxide can also result in the generation of substantial volumes of oxygen. Where the amount of oxygen evolved exceeds its maximum solubility in blood, venous or arterial gas embolism may occur. The mechanism of CNS damage is thought to be arterial gas embolisation with subsequent brain infarction. Rapid generation of oxygen in closed body cavities can also cause mechanical distension and there is potential for the rupture of the hollow viscus secondary to oxygen liberation. In addition, intravascular foaming following absorption can seriously impede right ventricular output and produce complete loss of cardiac output. Hydrogen peroxide can also exert a direct cytotoxic effect via lipid peroxidation.Ingestion of hydrogen peroxide may cause irritation of the gastrointestinal tract with nausea, vomiting, haematemesis and foaming at the mouth; the foam may obstruct the respiratory tract or result in pulmonary aspiration. Painful gastric distension and belching may be caused by the liberation of large volumes of oxygen in the stomach. Blistering of the mucosae and oropharyngeal burns are common following ingestion of concentrated solutions, and laryngospasm and haemorrhagic gastritis have been reported. Sinus tachycardia, lethargy, confusion, coma, convulsions, stridor, sub-epiglottic narrowing, apnoea, cyanosis and cardiorespiratory arrest may ensue within minutes of ingestion. Oxygen gas embolism may produce multiple cerebral infarctions.Although most inhalational exposures cause little more than coughing and transient dyspnoea, inhalation of highly concentrated solutions of hydrogen peroxide can cause severe irritation and inflammation of mucous membranes, with coughing and dyspnoea. Shock, coma and convulsions may ensue and pulmonary oedema may occur up to 24-72 hours post exposure.Severe toxicity has resulted from the use of hydrogen peroxide solutions to irrigate wounds within closed body cavities or under pressure as oxygen gas embolism has resulted.Inflammation, blistering and severe skin damage may follow dermal contact. Ocular exposure to 3% solutions may cause immediate stinging, irritation, lacrimation and blurred vision, but severe injury is unlikely. Exposure to more concentrated hydrogen peroxide solutions (>10%) may result in ulceration or perforation of the cornea.Gut decontamination is not indicated following ingestion, due to the rapid decomposition of hydrogen peroxide by catalase to oxygen and water. If gastric distension is painful, a gastric tube should be passed to release gas. Early aggressive airway management is critical in patients who have ingested concentrated hydrogen peroxide, as respiratory failure and arrest appear to be the proximate cause of death. Endoscopy should be considered if there is persistent vomiting, haematemesis, significant oral burns, severe abdominal pain, dysphagia or stridor. Corticosteroids in high dosage have been recommended if laryngeal and pulmonary oedema supervene, but their value is unproven. Endotracheal intubation, or rarely, tracheostomy may be required for life-threatening laryngeal oedema. Contaminated skin should be washed with copious amounts of water. Skin lesions should be treated as thermal burns; surgery may be required for deep burns. In the case of eye exposure, the affected eye(s) shod eye(s) should be irrigated immediately and thoroughly with water or 0.9% saline for at least 10-15 minutes. Instillation of a local anaesthetic may reduce discomfort and assist more thorough decontamination.
Youth participation in sports has increased greatly over the past 20 years. Consequently, there has been a rise in the number of sports injuries. A study was conducted to determine teen's level of physical activity, knowledge about risk factors for sports injuries, use of protective equipment, and parental involvement. Two groups of teens, one of which was required to take a physical education class, were given a self-administered, written survey. The study found that the teens in this small Virginia town have a high level of involvement in sports and other physical activity and good general knowledge of sports injury prevention. Improvement is needed in the use of protective equipment when participating in informal sports activities and in the provision of sports injury prevention education to parents. As advocates for student health, school nurses are in a unique position to educate students, parents, staff, and the community about prevention of sports-related injuries.
Community football players' attitudes towards protective equipment--a pre-season measure.
- Braham RA, Finch CF, McIntosh A, McCrory P. Br J Sports Med 2004; 38(4): 426-430.
Correspondence: C. Finch, NSW Injury Risk Management Research Centre, University of New South Wales, Sydney, NSW 2052, AUSTRALIA; (email: c.finch@unsw.edu.au).
BACKGROUND: The Australian football injury prevention project (AFIPP) was a randomised controlled trial examining the effects of protective equipment on injury rates in Australian Football.
OBJECTIVE: To present the results of the AFIPP baseline survey of community football players' attitudes towards protective equipment.
METHODS: Teams of players were recruited from the largest community football league in Victoria, Australia, during the 2001 playing season; 301 players were enrolled in the study and all were surveyed before the season began about their attitudes towards protective headgear and mouthguards.
FINDINGS: Almost three quarters of the players (73.6%) reported wearing mouthguards during the previous playing season (year 2000) compared with only 2.1% wearing headgear. The most common reasons for not wearing headgear and mouthguards (in non-users) were: "I don't like wearing it" (headgear: 44.8%; mouthguards: 30.6%), and "It is too uncomfortable" (headgear: 40.7%; mouthguards: 45.8%).
COMMENTS: The higher mouthguard usage reflects the favourable attitudes towards mouthguards by Australian football players generally. Similarly, the low headgear usage reflects the low acceptance of this form of protection in this sport. Further research should be directed towards establishing the reasons why players seem to believe that headgear plays a role in injury prevention yet few wear it.
The effect of rate denominator source on US fatal occupational injury rate estimates.
- Richardson D, Loomis D, Bailer AJ, Bena J. Am J Ind Med 2004; 46(3): 261-270.
Correspondence: David Richardson, Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; (email: david_richardson@unc.edu).
BACKGROUND: The Current Population Survey (CPS) is often used as a source of denominator information for analyses of US fatal occupational injury rates. However, given the relatively small sample size of the CPS, analyses that examine the cross-classification of occupation or industry with demographic or geographic characteristics will often produce highly imprecise rate estimates. The Decennial Census of Population provides an alternative source for rate denominator information. We investigate the comparability of fatal injury rates derived using these two sources of rate denominator information.
METHODS: Information on fatal occupational injuries that occurred between January 1, 1983 and December 31, 1994 was obtained from the National Traumatic Occupational Fatality surveillance system. Annual estimates of employment by occupation, industry, age, and sex were derived from the CPS, and by linear interpolation and extrapolation from the 1980 and 1990 Census of Population. Fatal injury rates derived using these denominator data were compared.
FINDINGS: Fatal injury rates calculated using Census-based denominator data were within 10% of rates calculated using CPS data for all major occupation groups except farming/forestry/fishing, for which the fatal injury rate calculated using Census-based denominator data was 24.69/100,000 worker-years and the rate calculated using CPS data was 19.97/100,000 worker-years. The choice of denominator data source had minimal influence on estimates of trends over calendar time in the fatal injury rates for most major occupation and industry groups.
COMMENTS: The Census offers a reasonable source for deriving fatal injury rate denominator data in situations where the CPS does not provide sufficiently precise data, although the Census may underestimate the population-at-risk in some industries as a consequence of seasonal variation in employment.
Costs of large truck-involved crashes in the United States.
- Zaloshnja E, Miller TR. Accid Anal Prev 2004; 36(5): 801-808.
Correspondence: Eduard Zaloshnja, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, MD 20705-3102, USA; (email: zaloshn@pire.org).
This study provides the estimates of the costs of highway crashes involving large trucks by type of truck involved. These costs represent the present value of all costs over the victims' expected life span that result from a crash. They include medically related costs, emergency services costs, property damage costs, lost productivity, and the monetized value of the pain, suffering, and lost quality of life that a family experiences because of death or injury. Based on the latest data available, the estimated cost of police-reported crashes involving trucks with a gross weight rating of more than 10,000 pounds averaged US$ 59,153 (in 2000 dollars). Multiple combination trucks had the highest cost per crash (US$ 88,483). The crash costs per 1000 truck miles however, were US$ 157 for single unit trucks, US$ 131 for single combination trucks, and US$ 63 for multiple combinations.
Profile of children with head injuries treated at the trauma unit of Red Cross War Memorial Children's Hospital, 1991 - 2001.
- Lalloo R, van As AB. S Afr Med J 2004; 94(7): 544-546.
Correspondence: R. Lalloo, Department of Community Oral Health, Faculty of Dentistry and World Health Organisation Collaborating Centre, University of the Western Cape, SOUTH AFRICA; (email: unavailable).
OBJECTIVE: To describe the profile of childhood head injury patients treated in a trauma unit.
DESIGN: A retrospective record-based study.
SETTING: The trauma unit of the Red Cross War Memorial Children's Hospital.
SUBJECTS: Children (under 13 years of age) presenting with head injuries between January 1991 and December 2001.
FINDINGS: Of the almost 94 000 records, more than one-third were children presenting with head injuries. Fifty-nine per cent were boys, with more than half the sample under 5 years of age. The majority of children presented with superficial lacerations and abrasions, mostly affecting the scalp and skull. Injuries were mainly caused by falls from a variety of heights, and traffic-related injuries. Almost two-thirds of traffic-related injuries involved children as pedestrians being struck by a motor vehicle. More than 60% of injuries occurred in or around the child's own home.
COMMENTS: Head injuries in children are a significant cause of morbidity. Prevention, especially in the home and on the streets, needs urgent attention.
Demographics of traumatic amputations in children. Implications for prevention strategies.
BACKGROUND: The demographics of traumatic amputations in children are not well known. The purpose of this review was to identify those demographics for use as a possible guide for prevention strategies.
METHODS: The study was a retrospective review of the data on children with traumatic amputation who had received care at one center in the upper midwestern United States from 1980 to 2000. The child's gender and age at the time of the amputation, the date and etiology of the amputation, and the amputation level were tabulated. Statistical analyses of seasonal variations were performed.
FINDINGS: There were 256 amputations in 235 children. The mean age (and standard deviation) at the time of the amputation was 7.9 +/- 5.0 years. The amputation involved one extremity in 217 children, two extremities in sixteen, and three and four extremities in one child each. Of the 256 amputations, 165 involved the lower extremity. The traumatic amputation was caused by a lawnmower in sixty-nine children, farm machinery in fifty-seven, a motor-vehicle accident in thirty-eight, a train in twenty, and miscellaneous mechanisms in fifty-one. The mean age at the time of the injury varied according to the mechanism of injury and ranged from 1.9 years for burns to 11.5 years for boating injuries. Fifty-four (78%) of the sixty-nine children with a lawnmower amputation were five years of age or less. There were significant seasonal variations: the mean date of the lawnmower injuries was June 10, the mean date of the farming injuries was September 2, and the mean date of the motor-vehicle-related injuries was July 16.
CONCLUSIONS: There are common patterns of traumatic amputations in children based on the mechanism of injury, the season, and the age of the child. The ideal time for an educational campaign for the prevention of lawnmower injuries appears to be March and April and should be directed toward parents. The best times for such a campaign for the prevention of farming-related accidents appear to be both the spring and the early fall, and the campaign should be directed toward both parents and older children.
Paediatric accidental deaths in Port Harcourt, Nigeria: a 10-year retrospective study.
BACKGROUND: Some studies on medicolegal autopsies have been conducted in Nigeria. This study was carried out to highlight the causes, peculiarities and possible factors responsible for paediatric accidental deaths in Port Harcourt, Nigeria. METHODS: All 3058 medicolegal autopsies referred to the coroner and performed in the department of Anatomical Pathology University of Port Harcourt Teaching Hospital, over a 10 year period covering January 1986 to December 1995 were analyzed. The accidental death subset was specially analyzed with respect to the paediatric age group of 0-16 years. RESULTS: A total of 3084 coroners autopsies were carried out during the study period. Of these 356 (11.5%) were paediatric accidental deaths. The commonest cause of death was road traffic accidents constituting 84.3% (n=300). The male:female ratio was about the same. The head was the commonest body region affected (n=90). Cars and buses were the commonest vehicles involved. Pedestrians were most at risk constituting 66 percent. Bulk of the cases occurred over the weekends. Drowning, electrocution and burns accounted for 8.7%, 2.8% and 4.2% respectively. CONCLUSION: Most of the deaths are avoidable. Parental monitoring, control of movements, legislation and general concern of the adult population for children's welfare will reduce these largely preventable deaths.
Nonfatal occupational injury among California farm operators.
- McCurdy SA, Farrar JA, Beaumont JJ, Samuels SJ, Green RS, Scott LC, Schenker MB. J Agric Saf Health 2004; 10(2): 103-119.
Correspondence: Sam Curdy, Department of Epidemiology and Preventive Medicine, University of California, Davis, California, USA; (email: samccurdy@ucdavis.edu).
We conducted a population-based telephone survey addressing farm-work-related (FWR) injuries among California farm operators. Of 1947 participants (80.4% response), 135 farm operators reported 160 FWR injuries in the preceding year, yielding a one-year cumulative incidence for any FWR injury of 6.9% (95% CI 5.8%-8.2%), or a mean 8.2 FWR injuries per 100 farmers in the preceding year (95% CI 6.8-9.7). Multiple injury events in the same individual occurred more frequently than predicted by chance. Sprains and strains (29.4%) were the most frequently reported injury and predominantly involved the back. Overexertion represented the most frequent external cause (24.2%), followed by machinery (14.3%), falls (13.0%), and animals (12.4%). Factors associated with FWR injury included white ethnicity (OR 3.19; 95% CI 1.38-7.36), increased annual hours worked on the farm, low levels of administrative work, and increased percentage of time working with livestock. FWR injury experience of California farm operators is comparable with that reported for other agricultural populations. Above-expected frequency of multiple injuries supports involvement of personal or environmental risk factors. Preventive efforts should focus on higher-risk groups and preventing overexertion and muscle strain and injury related to machinery, falls, and animals, especially livestock.
Prevalence of and risk factors for depressive symptoms among young adolescents.
- Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, Giedd JN. Arch Pediatr Adolesc Med 2004; 158(8): 760-765.
Correspondence: Gitanjali Saluja, National Institute of Child Health and Human Development, Rockville, MD 20892-7510, USA; (email: salujag@mail.nih.gov).
OBJECTIVE: To determine the prevalence, risk factors, and risk behaviors associated with depressive symptoms in a nationally representative, cross-sectional sample of young adolescents.
DESIGN: A school-based survey collected through self-administered questionnaires in grades 6, 8, and 10 in 1996.
SETTING: Schools in the United States.
PARTICIPANTS: 9863 students in grades 6, 8, and 10 (average ages, 11, 13, and 15).
MAIN OUTCOME MEASURES: Depressive symptoms, substance use, somatic symptoms, scholastic behaviors, and involvement in bullying.
FINDINGS: Eighteen percent of youths reported symptoms of depression. A higher proportion of females (25%) reported depressive symptoms than males (10%). Prevalence of depressive symptoms increased by age for both males and females. Among American Indian youths, 29% reported depressive symptoms, as compared with 22% of Hispanic, 18% of white, 17% of Asian American, and 15% of African American youths. Youths who were frequently involved in bullying, either as perpetrators or as victims, were more than twice as likely to report depressive symptoms than those who were not involved in bullying. A significantly higher percentage of youths who reported using substances reported depressive symptoms as compared with other youths. Similarly, youths who reported experiencing somatic symptoms also reported significantly higher proportions of depressive symptoms than other youths.
COMMENTS: Depression is a substantial and largely unrecognized problem among young adolescents that warrants an increased need and opportunity for identification and intervention at the middle school level. Understanding differences in prevalence between males and females and among racial/ethnic groups may be important to the recognition and treatment of depression among youths.
Prevalence of school bullying in Korean middle school students.
BACKGROUND: School bullying is the most common type of school violence. Victimization by or perpetration of school bullying has frequently been associated with a broad spectrum of behavioral, emotional, and social problems.
OBJECTIVE: To investigate the prevalence and demographic characteristics of victims, perpetrators, and victim-perpetrators in a Korean middle school sample.
METHODS: We evaluated 1756 middle school students in this cross-sectional study. Students provided demographic information and completed the Korean-Peer Nomination Inventory. Descriptive statistics and the Pearson chi(2) test were used.
FINDINGS: We found that 40% of all children participated in school bullying. By category, the prevalence of victims, perpetrators, and victim-perpetrators was 14%, 17%, and 9%, respectively. The most common subtypes of victimization were exclusion (23%), verbal abuse (22%), physical abuse (16%), and coercion (20%). Boys were more commonly involved in both school bullying and all 4 types of victimization. The prevalence of bullying was greater in students with either high or low socioeconomic status and in nonintact families.
COMMENTS: School bullying is highly prevalent in Korean middle school students. Demographic characteristics can help identify students at greater risk for participation in school bullying.
Traumatic Grief Among Adolescents Exposed to a Peer's Suicide.
- Melhem NM, Day N, Shear MK, Day R, Reynolds CF 3rd, Brent D. Am J Psychiatry 2004; 161(8): 1411-1416.
Correspondence: Nadine Melhem, Western Psychiatric Institute and Clinic, 3811 O'Hara St., BT 320, Pittsburgh, PA 15213, USA; (email: melhemnm@msx.upmc.edu).
OBJECTIVE: The phenomenology of grief among children and adolescents is not well studied. A syndrome of traumatic grief, distinct from depression and anxiety, has been described among bereaved adults. The purpose of this study was to describe the symptoms and course of traumatic grief among adolescents exposed to a peer's suicide and to examine the relationship between traumatic grief and depression and posttraumatic stress disorder (PTSD) in this population.
METHODS: A total of 146 friends and acquaintances of 26 suicide victims were included in this study. Subjects were interviewed at 6, 12-18, and 36 months after the peer's suicide. A subgroup was also interviewed 6 years afterward. The Texas Revised Inventory of Grief was administered at 6, 12-18, and 36 months; the Inventory of Complicated Grief was administered at the 6-year assessment.
FINDINGS: Principal component analysis of the Texas Revised Inventory of Grief resulted in two factors: one assessing a traumatic grief reaction and another assessing a milder or even normal grief reaction. The occurrence of traumatic grief was found to be independent from that of depression and PTSD. Traumatic grief at 6 months predicted the onset or course of depression and PTSD at subsequent assessments.
COMMENTS: Similar to adults, adolescents experience a traumatic grief reaction after exposure to a peer's suicide. Clinicians should be alerted to the occurrence of traumatic grief reactions among adolescents and the need to assess these reactions and address them in their treatment approaches.
Suicide risk in civilian PTSD patients: predictors of suicidal ideation, planning and attempts.
Correspondence: Nicholas Tarrier, Academic Division of Clinical Psychology, Education and Research Building (2nd Floor) University of Manchester Wythenshawe Hospital, Manchester M23 9LT, UK; (email: nicholas.tarrier@man.ac.uk).
BACKGROUND: There appears to be a strong connection between suicidality and the experience of trauma. The study investigated suicidality in chronic civilian post-traumatic stress disorder (PTSD).
METHOD: Ninety-four participants suffering from chronic PTSD were assessed for suicidal ideation, plans and attempts since the index trauma as part of a comprehensive assessment. The prevalence of these was assessed and characteristics of those reporting suicide-related thoughts and behaviour were investigated through logistic and multinominal regression analyses.
RESULTS: Over half of the sample (56.4%) reported some aspect of suicidality with 38.3% reporting ideation, 8.5% reporting suicide plans and 9.6% having made suicide attempts since the trauma. Of the nine participants who reported suicide attempts, six had made more than one attempt. The proportions of participants who reported suicidality in this sample were significantly greater than reported within the general population, when comparisons were made with an epidemiological study. Logistic regression analysis indicated that a unit increase in life impairment (OR = 3.1) and depression (OR = 1.14) scores were independently and significantly associated with suicidality. Multinominal regression indicated that life impairment (OR = 2.71) and depression (OR = 1.13) scores were associated with the presence of suicidal ideation compared to no ideation, and life impairment (OR = 5.75), depression (OR = 1.2) scores and receiving psychotropic medication (OR = 10.6) were associated with the presence of plans and attempts compared to no suicidal behaviour.
COMMENTS: Suicide risk is elevated in those suffering from chronic PTSD and is associated with impaired functioning in combination with depression.
The purpose of this study was to investigate burn injuries resulting from frontal automobile crashes and to determine the effects of frontal airbags on the incidence of burn injuries. The study included 25,464 individual cases from the National Automotive Sampling System database files for the years 1993 to 2000. Occupants were at a significantly higher risk to sustain a burn injury when exposed to an airbag deployment (1.54%) compared with those who received a burn injury when not exposed to an airbag deployment (0.02%; P = 0.02). In contrast to previous publications, this study found that 1.53% of front seat occupants exposed to an airbag deployment sustained an airbag-induced burn injury. The vast majority of airbag-induced burn injuries were minor (98.7%); however, in cases with no airbag deployment, the burns were often much more serious, including fatal burns (29.6%). Occupant weight, height, sex, seatbelt use, and seat position were all found not to be significant in predicting the risk of airbag induced burn injury, whereas age and crash velocity were found to be significant.
The effect of rear-wheel position on seating ergonomics and mobility efficiency in wheelchair users with spinal cord injuries: A pilot study.
- Samuelsson KA, Tropp H, Nylander E, Gerdle B. J Rehabil Res Dev 2004; 41(1): 65-74.
Correspondence: Kersti Samuelsson, Department of Neuroscience and Locomotion, Section of Rehabilitation Medicine, Faculty of Health Sciences, SE-581 85 Linkoping, SWEDEN; (email: Kersti.Samuelsson@lio.se).
This study analyzed the effect of rear-wheel position on seating comfort and mobility efficiency. Twelve randomly selected paraplegic wheelchair users participated in the study. Wheelchairs were tested in two rear-wheel positions while the users operated the wheelchair on a treadmill and while they worked on a computer. Propulsion efficiency, seating comfort, and propulsion qualities were registered at different loads during the treadmill session. During the computer session, pelvic position, estimated seating comfort, and estimated activity performance were measured. The change in rear-wheel position affected wheelchair ergonomics with respect to weight distribution (p < 0.0001) and seat inclination angle (position I = 5 and position II = 12). These changes had a significant effect on push frequency (p < 0.05) and stroke angle (p < 0.05) during wheelchair propulsion. We found no consistent effect on mechanical efficiency, estimated exertion, breathlessness, seating comfort, estimated propulsion qualities, pelvic position, or activity performance.
Correspondence: S. Acierno, Robert Wood Johnson Clinical Scholars Program, H-220 Health Sciences Center, University of Washington, P.O. Box 359960, 325 Ninth Avenue, Seattle, WA 98104-1520, USA; (email: sacierno@u.washington.edu).
Light truck vehicles (LTV) are becoming more popular on US highways. This creates greater opportunity for collisions with passenger vehicles (PV). The mismatch in weight, stiffness, and height between LTV and PV has been surmised to result in increased fatalities among PV occupants when their vehicles collide with LTV. We reviewed cases of vehicle mismatch collisions in the Seattle Crash Injury Research and Engineering Network (CIREN) database to establish patterns and source of injury. Of the first 200 Seattle CIREN cases reviewed, 32 collisions with 41 occupant cases were found to involve LTV versus PV. The cases were reviewed by type of collision and vehicle of injured occupant: side impact of PV with LTV, front impact of PV with LTV, and front impact of LTV with PV. For each type of crash, injury patterns and mechanisms were identified. For side impact to PV, head and upper thorax injuries were frequently encountered due to LTV bumper frame contact above the PV side door reinforcement. For frontal impact to PV, severe multiple extremity fractures along with some head and chest injuries were caused by intrusion of the instrument panel and steering column due to bumper frame override of the LTV. Underriding of the PV when colliding with the LTV resulted in severe lower extremity fractures of the LTV occupant due to intrusion of the toe pan into the vehicle compartment of the LTV. The injuries and the sources identified in this case series support the need for re-designing both LTV and PV to improve vehicle compatibility. Revising Federal Motor Vehicle Safety Standard 214 to reinforce the entire door, consider adding side airbags, and re-engineering LTV bumpers and/or frame heights and PV front ends are possible ways to reduce these injuries and deaths by making the vehicles more compatible.
Vehicular manslaughter: the global epidemic of traffic deaths.
Correspondence: Richard Dahl -- further contact information is unavailable
(This article is in the public domain and is available online at no cost: Read Full Article.)
The number of motorized vehicles is climbing exponentially in developing countries, and so is the number of people killed in accidents involving those vehicles. Traffic crashes in poorer nations tend to be fatal more often than those in developed countries because they often involve pedestrians and riders in less protected vehicles such as rickshaws, bicycles, or motorcycles. Such accidents are now a leading cause of death in the developing world, and policy makers and citizen advocates are searching for effective ways to help solve this growing public health problem.
See item 1 under Risk Factor Prevalence, Injury Occurrence and Costs
OBJECTIVE: To study the impact of intimate partner violence (IPV) on women's physical and psychological health. DESIGN: Cross-sectional study.Setting. Primary care centers in 3 Andalusian provinces.
PATIENTS: A total of 425 women, aged 18 to 65 years, were recruited following the same randomisation process in 6 primary care centers.
MEASUREMENTS: A self-administered structured questionnaire for this study was used to gather the information. As well as sociodemographic variables, the instrument included questions about IPV, physical health indicators (chronic disease and type, lifetime surgeries, days in bed), psychological health (psychological morbidity, use of tranquilizers, antidepressants, pain killers, alcohol and recreational drugs), self-perceived health and social support.
FINDINGS: Of 425 women, 31.5% ever experienced any type of partner violence. Women experiencing IPV were more likely to suffer a chronic disease. IPV was significantly associated with a number of adverse health outcomes, including spending more than 7 days in bed in the last three months (ORa=2.96; CI 95%, 1.00-8.76), psychological morbidity (ORa=2.68; CI 95%, 1.60-4.49) and worse self-perceived health (ORa=1.89; CI 95%, 1.04-3.43), after controlling for potential confounding variables.
COMMENTS: This study shows that ever experiencing IPV is associated with a worse psychological and self-perceived health. Physical injuries are not the only evidence of the presence of IPV. Primary health care proffessionals are in a privileged position to help women who are abused by their partners.
Social support factors as moderators of community violence exposure among inner-city african american young adolescents.
Using both surveys and the experience sampling method (ESM), community violence exposure, social support factors, and depressive and anxiety symptoms were assessed longitudinally among inner-city African American adolescents. Moderator models were tested to determine protective factors for youth exposed to community violence. Several social support factors emerged as protective-stabilizing forces for witnesses of violence both cross-sectionally and longitudinally, including maternal closeness, time spent with family, social support, and daily support (ESM). Contrary to hypotheses, several social support factors demonstrated a promotive-reactive effect such that, in conditions of high victimization, they failed to protect youth from developing symptoms. Effects did not differ by outcome or sex, though sex differences in findings emerged. Protective-stabilizing effects occurred more for witnessing violence, whereas promotive-reactive patterns occurred more for victimization. Results affirm social support factors as protective from the adverse effects of violence exposure, but they also suggest that some factors typically conceived as contributing to resilience might at times fail to protect youth in conditions of extreme risk.
Correspondence: Charles Felzen Johnson, Ohio State University College of Medicine, Child Abuse Program at Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA; (email: Cjohnson@chi.osu.edu).
Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.
Dating violence and associated sexual risk and pregnancy among adolescent girls in the United States.
- Silverman JG, Raj A, Clements K. Pediatrics 2004; 114(2): e220-225.
Correspondence: Jay Silverman, Division of Public Health Practice, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Ave, Boston, Massachusetts 02115, USA; (email: jsilverm@hsph.harvard.edu).
OBJECTIVES: To assess the annual prevalence of physical violence from dating partners among a representative sample of sexually experienced adolescent girls attending US public and private high schools, as well as sexual risk behaviors and pregnancy among this population.
DESIGN, SETTING, PARTICIPANTS, AND MEASURES: Female students (9th through 12th grade) (N = 6864) participating in the 2001 National Youth Risk Behavior Survey completed measures of physical dating violence during the previous year, as well as assessments of health risk behaviors. Annual rates of physical dating violence were estimated for sexually experienced (n = 3085) and inexperienced girls. Multiple logistic regression models were constructed to assess whether physical dating violence in the previous year was associated with sexual health risks and pregnancy, after controlling for effects of potentially confounding demographic features and risk behaviors.
FINDINGS: Slightly less than 1 of 5 sexually experienced US adolescent girls (17.7%) reported being intentionally physically hurt by a date in the previous year, and approximately 1 of 25 girls (3.7%) who reported no sexual experience reported such violence. Dating violence among sexually experienced adolescent girls was related to increased risks for both sexual risk behaviors (eg, recent multiple sexual partners: odds ratio: 2.0; 95% confidence interval: 1.3-3.1) and pregnancy (odds ratio: 1.8; 95% confidence interval: 1.3-2.4).
COMMENTS: Dating violence is prevalent among US adolescent girls, especially those reporting having had sexual intercourse. Adolescent girls intentionally hurt by a date in the previous year are more likely to experience sexual health risks, including those increasing vulnerability to human immunodeficiency virus infection and other sexually transmitted infections, and to have been pregnant. Dating violence should be integrated into sexual health and pregnancy prevention programs, and greater efforts to identify girls experiencing dating violence are needed among those providing care related to adolescent sexual and reproductive health.
