Correspondence: Pauline Gulliver, Injury Prevention Research Unit, Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin, NEW ZEALAND; (email: pauline.gulliver@ipru.otago.ac.nz).
OBJECTIVE: To investigate whether aggression, parent and peer influences, and previous traffic-related experiences at ages 15 and 18 impacted on (a) differences between the perceived safe and estimated legal alcohol consumption limit, and (b) driving while impaired (DWI) behaviour at age 21.
METHOD: The study population was a birth cohort involved in a longitudinal investigation of health and development. At the ages of 15 and 18, study members completed questionnaires assessing parent and peer attachment, experience travelling with an alcohol impaired adult or youth, aggression, and previous crash experience. At age 21, study members were questioned about how much alcohol they perceived they could drink and still drive safely, and whether they had driven after 'perhaps consuming too much alcohol'. For each participant their legal alcohol consumption limit was estimated using their height and weight. Path analysis was used to determine whether variables measured at ages 15 and 18 predicted differences between the perceived safe and estimated legal alcohol consumption limit and driving while impaired, both measured at age 21.
FINDINGS: Insufficient females drove while impaired at age 21, who also had complete data on all other variables, to conduct path analysis for this outcome. For males, aggression at ages 15 and 18, travelling with an impaired youth at age 18, and previous crash experience at age 18 predicted DWI behaviour at age 21. Only aggression at age 15 predicted the difference between perceived safe and estimated legal alcohol consumption limit for the males. For females, aggression at ages 15 and 18, and travelling with an impaired adult at age 15 predicted the difference between perceived safe and estimated legal alcohol consumption limit.
COMMENTS: The results show that aggressive behaviours and adult and/or youth modelling of drink driving behaviours in mid- to late-adolescence are related to differences between perceived safe and estimated legal alcohol consumption limit for both genders and driving while impaired for males.
Collisions and traffic violations of alcohol, cannabis and cocaine abuse clients before and after treatment.
- Macdonald S, Mann RE, Chipman M, Anglin-Bodrug K. Accid Anal Prev 2004; 36(5): 795-800.
Correspondence: Scott Macdonald, Centre for Addiction and Mental Health, Suite 200, 100 Collip Circle, London, Ont., CANADA; (email: scotm@uwo.ca).
Prior research has shown that those with alcohol problems have significantly elevated rates of traffic events (i.e. traffic violations and collisions) than licensed drivers from the general population and that treatment is associated with reductions in alcohol-related collisions. However, very little research exists on traffic events and the impact of treatment for cannabis or cocaine clients. The objectives of this research are: (1) to determine whether clients in treatment for a primary problem of alcohol, cannabis or cocaine have significantly elevated rates of traffic events than a matched control group of licensed drivers; and (2) to assess whether a significant reduction in traffic events occurs after treatment for each client group compared to a control group. Driver records of patients admitted to substance abuse treatment in 1994 for a primary problem of alcohol (n = 117), cannabis (n = 80) or cocaine (n = 169) were accessed from the Ministry of Transportation for Ontario, Canada. A comparison group of 504 licensed drivers frequency matched by age, sex and place of residence, was also randomly selected. Data was collapsed into two 6-year time periods: 1988-1993 (i.e. before treatment) and 1995-2000 (i.e. after treatment). Six repeated measures analysis of variance tests were conducted where traffic violations and collisions of three treatment groups (i.e. alcohol, cannabis or cocaine) and a control group were compared before and after treatment. All three treatment groups had significantly more traffic violations than the control group and no significant interactions between time period and group membership were found. For collisions, there was a significant interaction between the alcohol and control groups and between the cocaine and control groups. The average number of collisions for the alcohol and cocaine groups decreased after completing treatment, whereas the number for the control group was stable over the same time periods. Neither the interaction term nor the between group effect was significant in the comparison of the cannabis and control groups. When rates of collisions were calculated based on the period that each driver had a valid license, the interaction term was still significant for the comparison of the alcohol and control groups but not for the cocaine and control groups. The results contribute to existing literature by demonstrating that cocaine and cannabis clients have a higher risk of traffic violations than matched controls and that reductions in collision risk was found after treatment for the alcohol and cocaine groups. More research is needed to better understand the reasons for the higher risk of traffic events and to determine reasons for declines.
The Emergency Care Setting for Screening and Intervention for Alcohol Use Problems Among Injured and High-Risk Drivers: A Review.
- Dill P, Wells-Parker E, Soderstrom C. Traffic Inj Prev 2004; 5(3): 278-291.
Correspondence: Patricia Dill, Mississippi State University, Social Science Research Center, Mississippi State Mississippi USA; (email: pdill@ssrc.msstate.edu).
Each year thousands of people are treated in emergency departments and trauma centers for alcohol-related injuries, including those sustained in drinking driving crashes. Emergency departments and trauma centers provide an opportunity to screen for alcohol use problems and intervene with injured or high-risk drivers to reduce future alcohol-related traffic and injury risk. Recently physicians have expressed interest in exploring screening and intervention for alcohol use problems in these venues as a means of improving clinical care. This article reviews the literature that has examined screening and brief interventions in acute care settings to reduce future alcohol consumption and alcohol-related injury. The methodological and practical issues inherent in conducting these studies as well as in actual practice are discussed. The chaotic environment of acute care, the large numbers of patients required to be screened to obtain an adequate study sample, and high attrition rates make study in these settings difficult at best and are methodological problems that should be addressed in future research. A basic question that has not been adequately answered by research to date is whether reduction in alcohol consumption will translate to reduced alcohol-related harm, such as driving while impaired, or injurious or fatal crashes. Long-term studies that assess records-based outcomes in addition to alcohol-consumption levels are needed.
OBJECTIVE: To describe seasonal effects on injury incidence at the community level and to assess the relative merits of cross-sectional or longitudinal surveillance for injuries in such a setting.
METHODS: This study took place in Bavi district, northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi. All non-fatal unintentional injuries which occurred in a sample of 24,776 people living in 5801 households were recorded during 2000. Four interview surveys per household were conducted continuously during 2000, each covering a 3-month period of recall. Injury morbidity data were analysed according to gender, age and circumstances of injury. Statistical analyses were based on monthly, quarterly and annual incidence rates with 95% confidence intervals. Significant differences between incidence rates were noted where the 95% confidence interval of the rate ratio excluded unity.
FINDINGS: There were 1917 persons who experienced a total of 2079 new non-fatal injuries during the period of observation, corresponding to an incidence of 89/1000 person-years. Seasonal variations were found in all types of injury. Overall, the highest incidence rates were observed in July and April, while the lowest monthly rates were found in May and November. Peaks were observed in February and April for traffic injuries, June for work-related injuries, July, August and October for home injuries. A significantly higher incidence rate was found in the third quarter survey (103/1000 person-years, p<0.05).
COMMENTS: There can be interesting and significant seasonal variations in injury incidence within a community such as seen here in rural Vietnam and these variations have important implications for the design and planning of injury surveillance activities. Seasonal effects may cause invalid assessments of an injury problem if only cross-sectional household surveys are used, demonstrating the need for longitudinal approaches to injury incidence surveillance.
Differences between children and adults with respect to exposure rates, absorption of chemicals, metabolism, and organ development make children uniquely vulnerable to environmental hazards. Moreover, biology does not exist outside of the social life of the child. At least two important implications flow from these findings. First, pediatricians must pay closer attention to the conditions of childhood and the specific details of a child's life in attempting a complete understanding of childhood diseases, particularly their sources in environmental and social conditions. At a minimum, pediatricians must inquire more carefully about environmental exposures and children's complaints in order to make accurate diagnoses. Perhaps equally critical, pediatricians must engage in more aggressive prevention efforts. While they often try to prevent exposure by educating parents about keeping household chemicals away from young children, they might likewise consider that the information they possess about children's special vulnerability to environmental risks could usefully inform political and social decisions to protect children from those risks. This includes, for example, supporting air pollution standards that are protective of children and advocating for stricter controls for certain chemicals to reduce health risks for this vulnerable group.
BACKGROUND: Annually, some 200,000 U.S. children require hospital emergency room treatment from injuries suffered on playground equipment. Most of these injuries (70%) are the result of falls. While standards for protective surfacing within the play zone areas are very adequate, standards for the prevention of falls are very inadequate. "Climbers" are responsible for the greatest percentage of injuries with most of these injuries the result of falls. Current standards are woefully lacking in regard to these climbers.
METHODS: This paper reviews the history of climber research and climber standards.
FINDINGS: It then presents recommendations for improved standards in this area based on the ergonomics of the users, children.
OBJECTIVES: To identify and describe the work related injuries in both the formal and informal work sectors captured in an emergency department based injury surveillance system in Managua, Nicaragua.
SETTING: Urban emergency department in Managua, Nicaragua serving 200-300 patients per day.
METHODS: Secondary analysis from the surveillance system data. All cases indicating an injury while working and seen for treatment at the emergency department between 1 August 2001 and 31 July 2002 were included. There was no exclusion based on place of occurrence (home, work, school), age, or gender.
FINDINGS: There were 3801 work related injuries identified which accounted for 18.6% of the total 20 425 injures captured by the surveillance system. Twenty seven work related fatalities were recorded, compared with the 1998 International Labor Organization statistic of 25 occupational fatalities for all of Nicaragua. Injuries occurring outside of a formal work location accounted for more than 60% of the work related injuries. Almost half of these occurred at home, while 19% occurred on the street. The leading mechanisms for work related injuries were falls (30%), blunt objects (28%), and stabs/cuts (23%). Falls were by far the most severe mechanism in the study, causing 37% of the work related deaths and more than half of the fractures.
COMMENTS: Occupational injuries are grossly underreported in Nicaragua. This study demonstrated that an emergency department can be a data source for work related injuries in developing countries because it captures both the formal and informal workforce injuries. Fall prevention initiatives could significantly reduce the magnitude and severity of occupational injuries in Managua, Nicaragua.
Fire fighter fatalities 1998-2001: overview with an emphasis on structure related traumatic fatalities.
Correspondence: T.J. Pizatella, Division of Safety Research, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, USA; (email: tjp2@cdc.gov).
OBJECTIVE: To review the causes of all fire fighter line-of-duty-deaths from 1998 through 2001, and present recommendations for preventing fatalities within the specific subgroup of structure related events.
METHODS: Fire fighter fatality data from the United States Fire Administration were reviewed and classified into three main categories of injury. Investigations conducted through the National Institute for Occupational Safety and Health (NIOSH) Fire Fighter Fatality Investigation and Prevention Program provided the basis for the recommendations presented in this paper.
FINDINGS: During the time period from 1998-2001, there were 410 line-of-duty deaths among fire fighters in the United States, excluding the 343 fire fighters who died at the World Trade Center on 11 September 2001. The 410 fatalities included 191 medical (non-traumatic) deaths (47%), 75 motor vehicle related fatalities (18%), and 144 other traumatic fatalities (35%). The latter group included 68 fatalities that were associated with structures which commonly involved structural collapse, rapid fire progression, and trapped fire fighters.
COMMENTS: Structural fires pose particular hazards to fire fighters. Additional efforts must be directed to more effectively use what we have learned through the NIOSH investigations and recommendations from published experts in the safety community, consensus standards, and national fire safety organizations to reduce fire fighter fatalities during structural fire fighting.
A study of the relationship between occupational injuries and firm size and type in the Italian industry.
Correspondence: B. Fabiano, DICheP--Chemical and Process Engineering Department, "G.B. Bonino", University of Genoa, Via Opera Pia 15, 16145, Genoa, ITALY; (email: brown@unige.it).
This paper offers a perspective on the relationship between accident frequency and number of employees in the Italian industry, during the period from 1995 to 2000. The number of firms examined is 2,983,753 with a total number of non-fatal and fatal injuries corresponding to 3,321,960. A statistical significant reverse relationship (p<0.05) between firm size and number of days lost due to injuries was found in all industrial sectors, over the time span considered. Frequency index trends (defined as the ratio of number of injuries to one million worked hours) appear determined by non-severe accidents, which constitute 95.85% of the total injuries and exceed the severe cases by as much as one order of magnitude. When dealing with all injuries, only in the industrial sectors characterized by high degree of concentration, a statistically significant correlation was found between frequency index and firm size (p<0.001) with FI inversely associated with firm size. On the contrary, both the frequency index for accidents involving permanent disability and fatal accident frequency rate decrease as the firm size increases, even in those sectors that have a low concentration index. The results are consistent with decreased availability of occupational safety services in small companies and suggest the need of auditing, safety training activities, education and information, as well as of support to safety investments targeted to small-sized industries.
Toxicological features of deliberate self-poisonings.
- Bentur Y, Raikhlin-Eisenkraft B, Lavee M. Hum Exp Toxicol 2004; 23(7): 331-337.
Correspondence: Yedidia Bentur, Israel Poison Information Center, Rambam Medical Center, The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, ISRAEL; (email: d_bentur@rambam.health.gov.il).
BACKGROUND: Deliberate self-poisoning (DSP) is a major health problem with increasing incidence mainly among young people.
OBJECTIVE: To examine the clinical and toxicological characteristics of DSP, it is compared to unintentional (non-DSP) exposures and those characteristics which might be associated with increased toxicological risk are identified.
METHODS: Two-year retrospective poison centre chart review.
STATISTICS: chi2 analysis.
FINDINGS: 3802 DSP cases were reported. Most calls (95%) were made by physicians compared to 51% in non-DSP exposures, P <0.0001. There were almost twice as many females as males, contrary to unintentional exposures (P <0.001). Peak frequency involvement was at the age of 15-20 years for females and older for males. Only 19.8% of DSP calls were made within the first hour of exposure compared to 46% of the non-DSP calls (P < 0.001). Younger patients tended to present earlier. The vast majority of exposures occurred by ingestion and at home. Pharmaceuticals and chemicals were involved in 86% and 12% of DSP cases, respectively (compared to 29% and 44% in non-DSP exposures, respectively, P < 0.001). Psychiatric drugs were more commonly used in older age groups and analgesics among the younger. Insecticides, sodium hypochlorite and rodenticides were the most frequently used chemicals. Neurological involvement was observed in 48.2% of DSP patients compared to 16.9% in non-DSP exposures. DSP was associated with greater severity than non-DSP exposures (21% and 10% had moderate to severe toxicity, respectively, P <0.001). Severity was greater among males, aged older than 45 years, with time from exposure to consultation 8 hours or longer and with exposure to chemicals, psychiatric drugs or combinations.
COMMENTS: Most DSP patients were females, aged 15-20 years, used pharmaceuticals and had neurological involvement. Males, aged over 45 years, with longer time to toxicology consult and the use of chemicals were associated with increased severity. These parameters should alert the treating physician to the possibility of a poor course and hence to a more aggressive therapeutic approach.
BACKGROUND: The mechanisms for football injuries are largely unknown.
Aim: To describe the characteristics of injury situations in elite male football using a video-based method called football incident analysis.
STUDY DESIGN: Prospective cohort study.
METHODS: During the 1999 season, videotapes from 52 matches in the Icelandic elite football league were reviewed. Incidents (N = 95) were recorded when the match was interrupted by the referee because of a suspected injury. Team physical therapists recorded injuries prospectively (N = 28 time-loss injuries).
FINDINGS: Duels caused 84 of the incidents, mostly tackling duels (n = 54). The exposed player's attention appeared to be focused away from the opponent in 93% of the cases. The 3 main mechanisms observed were (1) breakdown attacks, tackling from the side or the front, attention focused on the ball (24%); (2) defensive tackling duels, attention focused on the ball or low ball control (20%); and (3) heading duels, attention focused on the ball in the air (13%).
COMMENTS: Most incidents and injuries occurred during breakdown attacks and when a player was involved in tackling duels. Player attention appeared to be focused mainly on the ball, not on the opponent challenging him to gain ball possession.
Injury patterns in big ten conference football.
- Albright JP, Powell JW, Martindale A, Black R, Crowley E, Schmidt P, Monroe J, Locy D, Aggler T, Davis WR, Salvaterra G, Miller D, Helwig D, Soboroff S, Nivens J, Carpenter J, Kovan J, Arndt E, Sweeney H, Lombardo J, Sebastianelli WJ, Krauss M, Landry G. Am J Sports Med 2004; 32(6): 1394-1404.
Correspondence: John Albright, University of Iowa Hospitals and Clinics, Department of Orthopaedic Surgery, 200 Hawkins Drive, Iowa City, IA 52242-1088, USA; (email: unavailable).
BACKGROUND: In 1998, the National Collegiate Athletic Association legislated a decrease in the number of scrimmages and full-contact practices allowed during the spring season.
HYPOTHESIS: A significantly increased risk of injury faced by the same player during the spring versus fall practice sessions does exist, but the National Collegiate Athletic Association regulations will not have the intended effect of reducing injury rates to equal or below those of the fall practice sessions.
STUDY DESIGN: Retrospectively analyzed, descriptive study of prospectively collected injury surveillance data followed by a prospective, controlled, repeated-measures study after the rule change.
METHODS: Phase 1: the Big Ten Conference Sports Injury Surveillance System database was reviewed from spring 1992 through fall 1997 for all reportable injuries. Phase 2: a prospective investigation was instituted from spring 1998 through fall 2000. This protocol was modified to also document updated individual player position descriptions and string as well as exposures for the old fall and spring practice categories (scrimmages, full contact, and limited contact) and the new spring practice designations (full pads with and without tackling, helmets only, spring game, and other scrimmages).
FINDINGS: Phase 1: There were 3950 fall injuries and 1007 spring injuries, with 469 of the 1007 attributable to the "spring risk factor." There was a statistically significant increase in injury rate in the spring (19.8) versus fall (10.6). Scrimmages (incidence density ratio = 2.4) and limited-contact practices (incidence density ratio = 2.5) showed more than twice the fall injury rate. Phase 2: There were 1502 fall injuries and 648 spring injuries, with 192 attributable to the spring risk factor. There was a 3-fold increase in injury rate in the spring (incidence density ratio = 3.2). Although the noncontact, helmets-only practices produced the lowest injury rates, the nonspring game scrimmages and the limited-contact practices defined as "practice with pads but without tackling" displayed the highest injury rates. In both spring and fall, nonplayers exhibited the highest injury rates for all string groups.
COMMENTS: There was and still is a statistically significant increase in spring practice injury risk. The 1998 rule change resulted in an even greater increase in spring practice injury risk. If the goal is to minimize the number of spring practice injuries, it will be best accomplished by limiting the number of scrimmages and limited-contact sessions.
Catastrophic injuries in high school and college baseball players.
- Boden BP, Tacchetti R, Mueller FO. Am J Sports Med 2004; 32(5): 1189-1196.
Correspondence: Barry Boden, The Orthopaedic Center, 9711 Medical Center Drive, #201, Rockville, MD 20850, USA; (email: BBoden@earthlink.net).
BACKGROUND: There are few epidemiologic studies of catastrophic baseball injuries.
OBJECTIVE: To develop a profile of catastrophic injuries in baseball players and to describe relevant risk factors.
STUDY DESIGN: Retrospective cohort study.
METHODS: The authors reviewed 41 incidents of baseball injuries reported to the National Center for Catastrophic Sports Injury Research from 1982 until 2002.
FINDINGS: There were an estimated 1.95 direct catastrophic injuries per year, or 0.43 injuries per 100,000 participants. The most common mechanisms of injury were a collision of fielders (9) or of a base runner and a fielder (8), a pitcher hit by a batted ball (14), and an athlete hit by a thrown ball (4). Catastrophic injuries included 23 severe head injuries, 8 cervical injuries, 3 cases of commotio cordis, and 2 cases each of a collapsed trachea and facial fractures. Three athletes sustained a severe head injury and facial fractures. Ten of the 41 injuries were fatalities.
COMMENTS: Suggestions for reducing catastrophic injuries in baseball include teaching proper techniques to avoid fielding and baserunning collisions, protecting the pitcher via a combination of screens and/or helmets with faceguards, continued surveillance and modifications of the bat and ball, eliminating headfirst slides, and continued analysis of chest protectors and automatic external defibrillators for commotio cordis.
Using narrative text and coded data to develop hazard scenarios for occupational injury interventions.
- Lincoln AE, Sorock GS, Courtney TK, Wellman HM, Smith GS, Amoroso PJ. Inj Prev 2004; 10(4): 249-254.
Correspondence: Andrew Lincoln, War-Related Illness and Injury Study Center, Washington DC Veterans Administration Medical Center, Department of Veterans Affairs, Washington, DC, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; (email: Andrew.Lincoln@med.va.gov).
OBJECTIVE: To determine whether narrative text in safety reports contains sufficient information regarding contributing factors and precipitating mechanisms to prioritize occupational back injury prevention strategies.
DESIGN, SETTING, SUBJECTS AND MAIN OUTCOME MEASURES: Nine essential data elements were identified in narratives and coded sections of safety reports for each of 94 cases of back injuries to United States Army truck drivers reported to the United States Army Safety Center between 1987 and 1997. The essential elements of each case were used to reconstruct standardized event sequences. A taxonomy of the event sequences was then developed to identify common hazard scenarios and opportunities for primary interventions.
FINDINGS: Coded data typically only identified five data elements (broad activity, task, event/exposure, nature of injury, and outcomes) while narratives provided additional elements (contributing factor, precipitating mechanism, primary source) essential for developing our taxonomy. Three hazard scenarios were associated with back injuries among Army truck drivers accounting for 83% of cases: struck by/against events during motor vehicle crashes; falls resulting from slips/trips or loss of balance; and overexertion from lifting activities.
COMMENTS: Coded data from safety investigations lacked sufficient information to thoroughly characterize the injury event. However, the combination of existing narrative text (similar to that collected by many injury surveillance systems) and coded data enabled us to develop a more complete taxonomy of injury event characteristics and identify common hazard scenarios. This study demonstrates that narrative text can provide the additional information on contributing factors and precipitating mechanisms needed to target prevention strategies.
Correspondence: Nelson Adekoya, Surveillance Systems Branch, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA; (email: NBA7@cdc.gov).
OBJECTIVE: The objective of this study was to describe fatal cases of traumatic brain injury (TBI) among West Virginia residents.
METHODS: The authors analyzed data from the National Center for Health Statistics Multiple Cause of Death tapes for the period 1989-1998. They compared West Virginia's annualized average TBI death rate with the rates of other states and with the rate among U.S. residents for the same period. U.S. Bureau of Census population estimates were used as denominators.
FINDINGS: A total of 4,416 TBI deaths occurred in West Virginia in 1989-1998, for an annual average death rate of 23.6 per 100,000 population. From 1989 to 1998, TBI death rates declined 5% (p=0.4042). Seventy-five percent (n=3,315) of fatalities occurred among men. Adults >/=65 years of age accounted for the highest percentage of fatal injuries (n=1,135). The leading external causes of fatal TBI were: firearm-related (39% of reported fatalities), motor vehicles-related (34%), and fall-related (10%). Firearm-related TBI became the leading cause of TBI fatalities in 1991, surpassing motor vehicle-related TBI. Seventy-five percent of firearm-related TBI deaths were suicides (n=1,302). West Virginia's TBI death rate (23.6 per 100,000) was higher than the national rate (20.6 per 100,000). In 23 states, the average TBI death rates over the 10-year period were higher than West Virginia's. Whereas modest declines in TBI death rates occurred for motor vehicle-related and firearm-related causes in West Virginia, a concomitant 38% increase occurred in the fall-related TBI death rate during the decade.
COMMENTS: Data presented in this report can be used to develop targeted prevention programs in West Virginia.
Epidemiology of 377 patients with chemical burns in Guangdong province.
- Xie Y, Tan Y, Tang S. Burns 2004; 30(6): 569-572.
Correspondence: Youfu Xie, Department of Burns, the Red Cross Hospital, 396 Tongfu Zhong Road, Jinan University, Guangzhou 510220, CHINA; (email: xiett@vip.sina.com).
A total of 377 patients with chemical burns from all over Guangdong province were admitted to the Guangzhou Red Cross Hospital during the period from January 1987 to December 2001. There were 296 males and 81 females with a male to female ratio of 3.65:1. The mean age of the patients was 26 years. The majority of patients (89.2%) were in the age range of 15-60 years. Professionally, 244 patients (64.7%) were workers, of whom, 232 (95%) of patients were peasant workers. Most of the chemical burns occurred at places away from home (94.4%), especially in the working environment (67.8%). Only 20 patients (5.5%) were injured at home. Chemical burns by accident and by criminal assault were 337 (88.5%) and 40 (10.5%). Strong acids (60.8%), mainly sulfuric acid, nitric acid, hydrofluoric acid, alkali (33.9%), mainly lime and sodium hydroxide were common causative agents. There was a relationship between the incidence of chemical burns and the season, with more patients in July-September and October-December. There were 215 (57.1%) patients who washed the burnsite with water immediately, but the volumes of water and time of washing were not adequate. Patients with total burn surface area (TBSA) of less than 10% comprised the majority of patients (72.7%), with 188 (65.7%) deep partial thickness burns, 116 (40.6%) with full thickness burns, and 60 (21%) with superficial burns. Extremities (lower limb 56.6% and upper limb 51.4%) were the most frequent area of injury. Ocular burns were the most common accompanying injury (14.7%). Operations of autografts and conjunctival flap were carried out on 159 (42.2%) patients. The average period of hospitalization was 22 days. Only 2 (0.7%) deaths occurred in this study. Counter measures to improve this situation must include safety productive education and professional training, use of protective clothing at work, enhancing the concept of legal responsibility, and restricting management and use of corrosive chemicals. Irrigation of the burnsite promptly with substantial volumes of water and an adequately long time will help reduce the morbidity from chemical burns.
Risk factors associated with sick leave due to work-related injuries in Dutch farmers: an exploratory case-control study.
- Hartman E, Franken K, Vrielinka HHEO, Nielend M, Metza JHM, Huirne RBM. Safety Science 2004; 42(9): 807-823.
Correspondence: Esther Hartman, Institute of Agricultural and Environmental Engineering (IMAG), P.O. Box 43, 6700 AA, Wageningen, THE NETHERLANDS; (email: esther.hartman@wur.nl).
Using data from an insurance company, the occurrence of sick leave among Dutch farmers due to work-related injuries, and the epidemiological risk factors were investigated. In this case-control study the cases had filed a sick leave claim for work-related injury from 1998-2001 and the controls had not filed any claim in this period. Most (74%) of all injuries were work-related. The most frequent types of injury (63%) were bruises, sprains/strains and fractures. Multivariable logistic regression analysis showed that farmers working in dairy farming (OR=2.6) or pig husbandry (OR=2.7), older farmers (OR=1.48 per 10 years) and smokers (OR=1.7) were at increased risk. Within dairy farming, a significant factor was contact with cows (OR=1.7 per 500 h); within pig husbandry, working > 60 h per week was a significant factor (OR=2.2). The population attributable risk was 24% for elimination of smoking, 23% for halving the number of hours' contact with cows in dairy farming and 18% for elimination of a working duration > 60 h per week in pig husbandry. Effective measures to prevent sick leave might be raising awareness that older farmers and smokers are at increased risk, and a focus on the risks of working with animals.
OBJECTIVE: This study was aimed to develop a WBI(Web Based Instruction) program on safety for 3rd grade elementary school students and to test the effects of it.
METHOD: The WBI program was developed using Macromedia flash MX, Adobe Illustrator 10.0 and Adobe Photoshop 7.0. The web site was http://www.safeschool. co.kr. The effect of it was tested from Mar 24, to Apr 30, 2003. The subjects were 144 students enrolled in the 3rd grade of an elementary school in Gyungju. The experimental group received the WBI program lessons while each control group received textbook-based lessons with visual presenters and maps, 3 times. Data was analyzed with descriptive statistics, and chi(2) test, t-test, and repeated measure ANOVA.
FINDINGS: First, the WBI group reported a longer effect on knowledge and practice of accident prevention than the textbook-based lessons, indicating that the WBI is more effective. Second, the WBI group was better motivated to learn the accident prevention lessons, showing that the WBI is effective. As a result, the WBI group had total longer effects on knowledge, practice and motivation of accident prevention than the textbook-based instruction.
COMMENTS: We recommend that this WBI program be used in each class to provide more effective safety instruction in elementary schools.
Weapon-carrying at Swiss schools? A gender-specific typology in context of victim and offender related violence.
- Kuntsche EN, Klingemann HK. J Adolesc 2004; 27(4): 381-393.
Correspondence: Emmanuel Kuntsche, Research Department, Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA), PO Box 870, Lausanne 1001, SWITZERLAND; (email: ekuntsche@sfa-ispa.ch).
After reviewing prevalence rates, this work tries to identify gender specific groups in which weapon-carrying occurs in the context of victim and offender related violent behaviours. k-Means cluster and logistic regression analyses were calculated, based on a cross-sectional survey of a national representative sample of 1549 15-year-olds as part of the Health Behaviour in School-Aged Children (HBSC) international collaborative study. The victims and offenders of violence concern mainly female bullies and physically violent boys. In the male victim-offender group, 17% had already taken a weapon to school. Another male group emerged in which 95% had already taken a weapon to school. Members of this group revealed an elevated level of acting violently but a low level of being the victim. Among the minority girls who were offenders and victims of physical violence, everyone has already taken a weapon to school. Based on these results, homogenous risk groups can be targeted for violence prevention.
Visual impairment has been implicated as a risk factor for falling and fractures, but results of previous studies have been inconsistent. The relationship between several aspects of vision and falling/fractures were examined in a prospective cohort study in 1509 older men and women. The analyses showed that impaired vision is an independent risk factor for both recurrent falling and fractures.
BACKGROUND: Falls and fractures are a major health problem among the elderly. Visual impairment has been implicated as a risk factor for both falls and fractures. However, results from studies are inconsistent. The inconsistency between findings can primarily be attributed to differences in the designs of these studies. Most studies have been cross-sectional or case-control studies, and many have not correctly adjusted for potential confounders. Furthermore, until now, the potential mediating effects of functional limitation, physical performance, and physical activity have not been examined.
METHODS: A total of 1509 people was examined in 1995-1996. Contrast sensitivity was assessed with the VCTS_6000-1 chart for near vision. In addition, self-reported visual impairment was assessed by questions on recognizing faces from a distance of 4 m, reading the small print in the newspaper, and problems with glare. Furthermore, many potential confounders and mediators were assessed. Falls and fractures were assessed prospectively during a 3-year follow-up period. The associations between the vision variables and falls and fractures were examined using Cox proportional hazards analyses.
FINDINGS: After adjustment for potential confounders, contrast sensitivity was shown to be associated with recurrent falling (hazard ratio [HR] = 1.5), and the question on recognizing faces was shown to be associated with fractures (HR = 3.1). Furthermore, functional limitations and physical performance were shown to be mediators in the relationship between vision variables and recurrent falling/fractures.
COMMENTS: The results indicate that impaired vision is an independent risk factor for falling and fractures, but different aspects of visual functioning may have different relationships to falling and fractures.
The relation between physical activity and mental health among Hispanic and non-Hispanic white adolescents.
- Brosnahan J, Steffen LM, Lytle L, Patterson J, Boostrom A. Arch Pediatr Adolesc Med 2004; 158(8): 818-823.
Correspondence: Jennifer Brosnahan, School of Public Health, Division of Epidemiology, University of Minnesota, Minneapolis, USA; (email: stree022@umn.edu).
OBJECTIVE: To assess the relation of physical activity (PA) with feelings of sadness and suicidal thoughts and behaviors among Hispanic and non-Hispanic white adolescent boys and girls.
DESIGN: Cross-sectional study using a modified 2001 Youth Risk Behavior Survey.
PARTICIPANTS: One thousand eight hundred seventy Hispanic and non-Hispanic white adolescents, aged 14 to 18 years, attending high school in Nueces County, Texas. Main Outcome Measure Logistic regression analysis was used to assess the relation between PA, including moderate and vigorous PAs, strength and toning, total PA, physical education class, and participation in team sports, and the dependent variables feelings of sadness and considering, planning, and attempting suicide.
FINDINGS: More boys reported participating in PA than girls (P<.001), and more girls than boys reported feelings of sadness and considering and planning suicide (P<.001). Greater attendance in physical education class was inversely related to feelings of sadness (odds ratio [OR], 0.80 [95% confidence interval (CI), 0.68-0.94]); participation in more total PA sessions per week was associated with a lower risk of considering suicide (OR, 0.72 [95% CI, 0.65-0.79]); and higher levels of vigorous PA (OR, 0.73 [95% CI, 0.57-0.93]), total PA (OR, 0.65 [95% CI, 0.48-0.87]), and strength and toning activity (OR, 0.64 [95% CI, 0.42-0.99]) were associated with a lower risk of planning suicide.
COMMENTS: These findings are consistent with a beneficial effect of PA on feelings of sadness and suicidal behaviors in Hispanic and non-Hispanic white boys and girls. Physical activity may be considered as part of an intervention strategy to improve adolescent health as a whole.
Implications of childhood trauma for depressed women: an analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization.
- Gladstone GL, Parker GB, Mitchell PB, Malhi GS, Wilhelm K, Austin MP. Am J Psychiatry 2004; 161(8): 1417-1425.
Correspondence: G. Gladstone, The Villa, Mood Disorders Unit, Prince of Wales Hospital, Randwick, NSW 2031, AUSTRALIA; (email: g.gladstone@unsw.edu.au).
OBJECTIVE: Data from depressed women with and without a history of childhood sexual abuse were used to characterize clinical features that distinguished the two groups and to examine relationships of childhood sexual abuse to lifetime deliberate self-harm and recent interpersonal violence.
METHODS: One hundred twenty-five women with depressive disorders were interviewed and completed self-report questionnaires. Path analysis was used to examine relationships of several childhood and personality variables with deliberate self-harm in adulthood and recent interpersonal violence.
FINDINGS: Women with a childhood sexual abuse history reported more childhood physical abuse, childhood emotional abuse, and parental conflict in the home, compared to women without a childhood sexual abuse history. The two groups were similar in severity of depression, but the women with a childhood sexual abuse history were more likely to have attempted suicide and/or engaged in deliberate self-harm. The women with a history of childhood sexual abuse also became depressed earlier in life, were more likely to have panic disorder, and were more likely to report a recent assault. Path analysis confirmed the contributory role of childhood sexual abuse to deliberate self-harm and the significance of childhood physical abuse for recent interpersonal violence.
COMMENTS: Childhood sexual abuse is an important risk factor to identify in women with depression. Depressed women with a childhood sexual abuse history constitute a subgroup of patients who may require tailored interventions to combat both depression recurrence and harmful and self-defeating coping strategies.
We propose a new mathematical model for relative collision safety in cars. Our present research is restricted to head-on crashes between two cars and we try to determine how much of the injury risk in a crash depends on the car make. Previous work shows that a person's age and sex influence the injury risk in accidents that are otherwise similar. To explore the relative risks between different car makes we build a model where we let the car mass, change of speed, design of the car and the driver's age and sex explain the injury outcome in the crashes. The mathematical model we use is a birth process where the states correspond to the injury classes. A database containing police reported traffic accidents and hospital information is used to explore the relationships in our model. Different models are compared and the "best" model is chosen by a likelihood ratio test. The estimated relative risks compensated for the driver's age and sex are compared to the relative risks with the driver population included. The uncertainties of the different estimates are studied by a bootstrap analysis.
Environmental factors associated with crash-related mortality and injury among taxi drivers in New South Wales, Australia.
This exploratory study aims to investigate the associations between some environmental factors and the increased risk of motor vehicle crash-related injuries among taxi drivers. Information utilised in the study are obtained from police reports of all road traffic accidents that occurred on the roads between 1996 and 2000 in New South Wales (NSW), Australia. Of the 7923 taxi drivers who involved in crashes, nearly 10% (n = 750) were killed or injured. Results indicate sex, and two environmental factors are significantly associated with an increased risk of crash-related mortality and injury among taxi drivers. The adjusted relative risk of crash-related mortality and injury is increased by 60% for those who work the night shift (OR = 1.59, 95%CI = 1.35-1.88), and by 20% for those who do not carry any passenger on board (OR = 1.20, 95%CI = 1.02-1.41) should these drivers involve in a crash. The increased relative risk of crash-related mortality and injury is nearly 2.5 times for female taxi drivers (OR = 2.30, 95%CI = 1.45-3.65) when compared with their male counterparts.
To what extent can theory account for the findings of road safety evaluation studies?
This paper proposes a conceptual framework that can be used to assess to what extent the findings of road safety evaluation research make sense from a theoretical point of view. The effects of road safety measures are modelled as passing through two causal chains. One of these, termed the engineering effect, refers to the intended effects of a road safety measure on a set of risk factors related to accident occurrence or injury severity. The engineering effect of road safety measures is modelled in terms of nine basic risk factors, one or more of which any road safety measure needs to influence in order to have the intended effect on accidents or injuries. The other causal chain producing the effects of road safety measures is termed the behavioural effect, and refers to road user behavioural adaptations to road safety measures. The behavioural effect is related to the engineering effect, in the sense that certain properties of the engineering effect of a road safety measure influence the likelihood that behavioural adaptation will occur. The behavioural effect of a road safety measure is modelled in terms of six factors that influence the likelihood that behavioural adaptation will occur. The nine basic risk factors representing the engineering effect of a road safety measure, and the six factors influencing the likelihood of behavioural adaptation can be used as checklists in assessing whether or not the findings of road safety evaluation studies make sense from a theoretical point of view. At the current state of knowledge, a more stringent evaluation of the extent to which theory can explain the findings of road safety evaluation studies is, in most cases, not possible.
Vehicle speed affects both pre-skid braking kinematics and average tire/roadway friction.
Vehicles decelerate between brake application and skid onset. To better estimate a vehicle's speed and position at brake application, we investigated how vehicle deceleration varied with initial speed during both the pre-skid and skidding intervals on dry asphalt. Skid-to-stop tests were performed from four initial speeds (20, 40, 60, and 80 km/h) using three different grades of tire (economy, touring, and performance) on a single vehicle and a single road surface. Average skidding friction was found to vary with initial speed and tire type. The post-brake/pre-skid speed loss, elapsed time, distance travelled, and effective friction were found to vary with initial speed. Based on these data, a method using skid mark length to predict vehicle speed and position at brake application rather than skid onset was shown to improve estimates of initial vehicle speed by up to 10 km/h and estimates of vehicle position at brake application by up to 8 m compared to conventional methods that ignore the post-brake/pre-skid interval.
Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: a comparison of sheltered and low-income housed women in Los Angeles County.
BACKGROUND: Violence against women, substance use and disorder, and HIV represent three significant threats to the health of women, yet little is known about the extent of these epidemics among indigent women. This study investigates and documents differences in the prevalence and co-occurrence of physical and sexual violence, substance use and disorder, and HIV risk behavior in sizable probability samples of sheltered homeless and low-income housed women.
METHODS: Retrospective self-reports were obtained through structured interviews with stratified random samples of women residing in shelters (N = 460) and low-income housing (N = 438) in Los Angeles County, California.
FINDINGS: Sheltered women were more likely than housed women to report experiencing physical and sexual violence, substance use and disorder, HIV risk behavior, and co-occurrence of these problems in the past year. Differences remained when propensity weights were used to equate the groups on demographic and background characteristics.
COMMENTS: Findings suggest remarkable need for services among communities of indigent women. Higher rates of problems among women in shelters highlight the importance of differentiating among subgroups of indigent women in community-based prevention and intervention activities and tentatively suggest a protective influence of housing.
Predicting abuse in adolescent dating relationships over 1 year: the role of child maltreatment and trauma.
- Wolfe DA, Wekerle C, Scott K, Straatman AL, Grasley C. J Abnorm Psychol 2004; 113(3):406-415.
Correspondence: David Wolfe, Department of Psychiatry, Centre for Addiction and Mental Health, London, ON, CANADA; (email: David_Wolfe@CAMH.net).
Three mediators of the relationship between childhood maltreatment and dating violence perpetration during midadolescence (i.e., trauma-related symptoms, attitudes justifying dating violence, and empathy and self-efficacy in dating relationships) were tested over 1 year with a sample of students from 10 high schools (N = 1,317). Trauma-related symptoms had a significant cross-time effect on predicting incidents of dating violence for both boys and girls. Attitudes and empathy and self-efficacy did not predict dating violence over time, although they were correlated with such behavior at both time points. Child maltreatment is a distal risk factor for adolescent dating violence, and trauma-related symptoms act as a significant mediator of this relationship. The importance of longitudinal methodology that separates correlates from predictors is discussed.
Exposure to community violence and violence perpetration: the protective effects of family functioning.
Correspondence: Deborah Gorman-Smith, Department of Psychiatry, University of Illinois at Chicago, Institute for Juvenile Research, USA; (email: debgs@uic.edu).
Although research has found that urban youth are exposed to excessive levels of community violence, few studies have focused on the factors that alter the risk of exposure to violence or the processes through which youth who are exposed to community violence do better or worse. This study investigates the risk of exposure to community violence and its relation to violence perpetration among a sample of 263 African American and Latino male youth living in inner-city neighborhoods. The study also examines the role that family functioning plays in moderating the risk. The study finds that youth from struggling families-those that consistently used poor parenting practices and had low levels of emotional cohesion-were more likely to be exposed to community violence. It also finds a relation between exposure to violence and later violence perpetration. However, youth exposed to high levels of community violence but living in families that functioned well across multiple dimensions of parenting and family relationship characteristics perpetrated less violence than similarly exposed youth from less well-functioning families.
Three year health outcomes among older women at risk of elder abuse: women's health Australia.
- Schofield MJ, Mishra GD. Qual Life Res 2004; 13(6): 1043-1052.
Correspondence: Margot Schofield, School of Health, University of New England, Armidale, New South Wales, AUSTRALIA; (email: mschofi2@pobox.une.edu.au).
BACKGROUND: Older women are at increasing risk of various forms of familial violence, yet detection is poor and very little is known of the long-term health effects of this psychosocial problem. The effectiveness of the 'Vulnerability to Abuse' Screening Scale (VASS) in predicting three year health outcomes was investigated among women enrolled in the Australian Longitudinal Study on Women's Health, now known as Women's Health Australia.
METHODS: The sample comprised a cohort of 10,421 women aged 73-78 who completed the 1996 and 1999 postal surveys (attrition rate 19.5%). The Time 2 sample had a small bias towards lower risk for elder abuse at Time 1 and better health on SF-36 and self-rated health. The VASS is a 12-item self-report measure with 4 factors: vulnerability, coercion, dependence and dejection.
FINDINGS: Overall, physical health (PCS) declined while mental health (MCS) increased over the three year period. Decline in physical health was predicted by only the dejection factor, but not by factors which seem to more directly measure abuse. The predictive validity of the VASS for three year mental health outcomes was given partial support. Three of the four VASS factors (dejection, vulnerability, and coercion) predicted decline in mental health at the univariate level, however, after adjusting for confounders, only one VASS factor (dejection) independently predicted decline in mental health.
COMMENTS: While the VASS shows some promise as a marker of health risk in older women, only the dejection factor proved consistently predictive of declining health status. Further research is needed to determine longer term predictive validity of the scale and to gain a clearer picture of how abusive experiences impact on older women's health.
Media violence research and youth violence data: why do they conflict?
Correspondence: Cheryl Olson, Harvard Medical School Center for Mental Health and Media, Massachusetts General Hospital Department of Psychiatry, 271 Waverley Oaks Rd., Waltham, MA 02452-8403, USA; (email: Cheryl_olson@hms.harvard.edu).
DOI: unavailable -- What is this?
OBJECTIVE: Contrary to media headlines and public perceptions, there is little evidence of a substantial link between exposure to violent interactive games and serious real-life violence or crime. COMMENTS: Further research is needed on whether violent games may affect less dramatic but real concerns such as bullying, fighting, or attitudes and beliefs that support aggression, as well as how effects may vary by child characteristics and types of games. There is also a need for research on the potential benefits of violent games for some children and adults.
