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26 August 2002

We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.



Alcohol & Other Drugs Commentaray & Editorials
  • See Abstract #1 under Transportation.

Disasters
  • No reports this week

Occupational Issues Pedestrian & Bicycle Issues Poisoning
  • National Vehicle Emissions Policies and Practices and Declining US Carbon Monoxide-Related Mortality.

    Mott JA, Wolfe MI, Alverson CJ, Macdonald SC, Bailey CR, Ball LB, Moorman JE, Somers JH, Mannino DM, Redd SC. JAMA 2002; 288(8): 988-995.

    Correspondence: Joshua Mott, Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-17, Atlanta, GA 30333, USA; (email: [email protected]).

    BACKGROUND: Carbon monoxide (CO) has been reported to contribute to more than 2000 poisoning deaths per year in the United States.

    OBJECTIVES: To evaluate the influence of national vehicle emissions policies and practices on CO-related mortality and to describe 31 years (1968-1998) of CO-related deaths in the United States.

    DESIGN AND SETTING: Longitudinal trend analysis using computerized death data from the Centers for Disease Control and Prevention, US Census Bureau population data, and annual CO emissions estimates for light-duty vehicles provided by the US Environmental Protection Agency.

    MAIN OUTCOME MEASURE: All deaths in the US for which non-fire-related CO poisoning was an underlying or contributing condition, classified by intent and mechanism of death. Negative binomial regression was used to incorporate every year of data into estimated percentage changes in CO emissions and mortality rates over time.

    FINDINGS: During 1968-1998, CO-related mortality rates in the United States declined from 20.2 deaths to 8.8 deaths per 1 million person-years (an estimated decline of 57.8%; 95% confidence interval [CI], -62.4% to -52.6%). Following the introduction of the catalytic converter to automobiles in 1975, CO emissions from automobiles decreased by an estimated 76.3% of 1975 levels (95% CI, -82.0% to -70.4%) and unintentional motor vehicle-related CO death rates declined from 4.0 to 0.9 deaths per 1 million person-years (an estimated decline of 81.3%; 95% CI, -84.8% to -77.0%). Rates of motor vehicle-related CO suicides declined from 10.0 to 4.9 deaths per 1 million person-years (an estimated decline of 43.3%; 95% CI, -57.5% to -24.3%). During 1975-1996, an annual decrease of 10 g/mile of estimated CO emissions from automobiles was associated with a 21.3% decrease (95% CI, -24.2% to -18.4%) in the annual unintentional motor vehicle-related CO death rate and a 5.9% decrease (95%CI, -10.0% to -1.8%) in the annual rate of motor vehicle-related CO suicides.

    DISCUSSION: If rates of unintentional CO-related deaths had remained at pre-1975 levels, an estimated additional 11 700 motor vehicle-related CO poisoning deaths might have occurred by 1998. This decline in death rates appears to be a public health benefit associated with the enforcement of standards set by the 1970 Clean Air Act. (Copyright © 2002 American Medical Association)

Recreation & Sports
  • Nonfatal Sports- and Recreation-Related Injuries Treated in Emergency Departments --- United States, July 2000--June 2001

    Gotsch K, Annest JL, Holmgreen P, Gilchrist J. MMWR 2002; 51(33): 736-740.

    Correspondence: Karen Gotsch, Office of Statistics and Programming, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Mailstop K65, 4770 Buford Highway NE, Atlanta, GA 30341-3724, USA; (email: [email protected]).

    Complete report with editorial note, figures, tables, and references is available HERE.

    Each year in the United States, an estimated 30 million children and adolescents participate in organized sports, and approximately 150 million adults participate in some type of nonwork-related physical activity. Engaging in these activities has numerous health benefits but involves a risk for injury. CDC analyzed data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) to characterize sports- and recreation-related injuries among the U.S. population. This report summarizes the results of that analysis, which indicate that during July 2000--June 2001 an estimated 4.3 million nonfatal sports- and recreation-related injuries were treated in U.S. hospital emergency departments (EDs). Injury rates varied by sex and age and were highest for boys aged 10--14 years. Effective prevention strategies, including those tailored to specific activities and those aimed at children, adolescents, and adults, are needed to reduce sports- and recreation-related injuries in the United States.

    Sports- and recreation-related injuries included those occurring during organized and unorganized activities, whether work-related or not. An injury was defined as bodily harm resulting from exposure to an external force or substance. Each case was classified into one of 39 mutually exclusive sports- and recreation-related groups based on an algorithm that considered both the consumer products involved (e.g., bicycles or accessories, swings or swing sets, or in-line skating [activity, apparel, or equipment]) and the narrative description of the incident. Cases were excluded if 1) the principal diagnosis was an illness, pain only, psychological harm only, contact dermatitis associated with consumer products or plants, or unknown; 2) the ED visit resulted from the adverse effects of therapeutic drugs or surgical care; or 3) the injury was violence-related, including intentional self-harm, assault, or legal intervention. Because deaths are not captured completely by NEISS-AIP, persons who were dead on arrival or who died in the ED also were excluded.

    Each case was assigned a sample weight based on the inverse probability of selection; these weights were added to provide national estimates of sports- and recreation-related injuries. Estimates were based on weighted data for 70,060 sports- and recreation-related ED visits during July 2000--June 2001. Confidence intervals (CIs) were calculated by using a direct variance estimation procedure that accounted for the sample weights and complex sample design. Rates were calculated by using averaged 2000--2001 U.S. Census Bureau population data.

    During July 2000--June 2001, an estimated 4.3 million (95% CI=3.7--4.8 million) sports- and recreation-related injuries were treated in U.S. hospital EDs, comprising 16% of all unintentional injury-related ED visits. The percentage of all unintentional injury-related ED visits that were sports- and recreation-related was highest for persons aged 10--14 years (51.5% for boys, 38.0% for girls), and lowest for persons aged >45 years (6.4% for men, 3.1% for women). The overall rate of sports- and recreation-related injuries was 15.4 per 1,000 population. Rates were highest among persons aged 10--14 years (75.4 for boys, 36.3 for girls), and lowest among persons aged 0--4 years (11.1 for boys, 6.8 for girls) and persons aged >45 years (4.3 for men, 2.2 for women). Among all ages, rates were higher for males than for females.

    Types of sports- and recreation-related activities in which persons were engaged when injured varied by age and sex. For persons aged 0--9 years, the leading types were playground- and bicycle-related injuries. Both scooter- and trampoline-related injuries ranked among the top seven types of injuries for both boys and girls aged 0--9 years. For males aged 10--19 years, football-, basketball-, and bicycle-related injuries were most common. For females aged 10--19 years, basketball-related injuries ranked highest. For persons aged 20--24 years, basketball- and bicycle-related injuries ranked among the three leading types of injuries. Basketball-related injuries ranked highest for men aged 25--44 years. Exercise (e.g., weight lifting, aerobics, stretching, walking, jogging, and running) was the leading injury-related activity for women aged >20 years and ranked among the top four types of injuries for men aged >20 years.

    The most frequent injury diagnoses were strains/sprains (29.1%; 95% CI=25.2%--33.0%), fractures (20.5%; 95% CI=16.5%--24.5%), contusions/abrasions (20.1%; 95% CI=17.5%--22.8%), and lacerations (13.8%; 95% CI=11.9%--15.8%). The body parts injured most commonly were ankles (12.1%; 95% CI=10.9%--13.4%), fingers (9.5%; 95% CI=8.2%--10.8%), face (9.2%; 95% CI=7.9%--10.5%), head (8.2%; 95% CI=6.4%--10.1%), and knees (8.1%; 95% CI=6.8%--9.4%). Of an estimated 350,734 (95% CI=270,417--431,051) persons with sports- and recreation-related head injuries, approximately 199,050 (95% CI=127,947--270,153) had a brain injury diagnosed (i.e., diagnosis of concussion or internal injury). Overall, 2.3% (95% CI=1.5%--3.0%) of persons with sports- and recreation-related injuries were hospitalized.

Research Methods RISK FACTOR PREVALENCE
  • See Report Under Recreation & Sports

Injuries at Home Rural & Agricultural Issues School Issues
  • See Report Under Alcohol & Other Drugs

Suicide Transportation
  • Socioeconomic differences in road traffic injuries.

    Hyder AA, Ghaffar A. J Epidemiol Community Health 2002; 56(9): 719.

    Correspondence: Adnan Hyder, Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, 615 N Wolfe Street, Suite E-8132, Baltimore, Maryland 21205, USA; (email: [email protected]).

    Road traffic injuries are estimated to be the ninth leading cause of death for all ages globally and are expected to become the third leading cause by 2020. The loss of healthy life from injuries (measured in terms of disability adjusted life years per 100 000 people) is four times greater in low to middle income countries than in high income nations. Moreover, fatality rates from road traffic injuries are highest in the developing world, especially Africa.

    Empirical work is now being done in the developing world to understand the burden of road traffic injuries and its distribution related to population characteristics. Our work at national level in Pakistan has demonstrated that injuries are the fifth leading cause of loss of healthy life, and the second leading cause of disability. A 40 year analysis of public sector data in Pakistan demonstrates the public health impact—mortality, morbidity, and costs—to society in the developing nation. While a national health survey in Pakistan demonstrated the overlapping frequencies of childhood injuries and diarrhea in children for the first time in the early 1990s.

    We have conducted one of the first nationally representative injury surveys in Pakistan focusing on this neglected public health issue.8 Highlights of this sample of nearly 29 000 people interviewed in rural and urban areas will soon be published in a peer reviewed journal. The survey indicates that 70% of childhood injuries occurred to children whose mothers had no education, and this variable was used to reflect some measure of social and economic status. In addition, the relative risk of transport injuries was three time higher in those with manual labor as a profession, compared with those in the service sector. These findings reflect the beginnings of the type of inequality analysis proposed by Hasselberg et al, which is a challenge in resource poor settings.

    Such work from the developing world indicates the great need for better data on road traffic injuries, and especially disaggregated data that permit subanalysis. It is therefore critical that researchers in developing countries ensure that their study designs include aspects of equity analysis. (Copyright © 2002 Journal of Epidemiology and Community Health)

  • Impact of cataract surgery on motor vehicle crash involvement by older adults.

    Owsley C, McGwin G Jr, Sloane M, Wells J, Stalvey BT, Gauthreaux S. JAMA 2002; 288(7): 841-849.

    Correspondence: Cynthia Owsley, Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, 700 S 18th St, Suite 609, Birmingham, AL 35294-0009, USA; (email: [email protected]).

    BACKGROUND: Motor vehicle crash risk in older drivers is elevated in those with cataract, a condition that impairs vision and is present in half of adults aged 65 years or older.

    OBJECTIVE: To determine the impact of cataract surgery on the crash risk for older adults in the years following surgery, compared with that of older adults who have cataract but who elect to not have surgery.

    DESIGN, SETTING, AND PATIENTS: Prospective cohort study of 277 patients with cataract, aged 55 to 84 years at enrollment, who were recruited from 12 eye clinics in Alabama from October 1994 through March 1996, with 4 to 6 years of follow-up (to March 1999).

    MAIN OUTCOME MEASURE: Police-reported motor vehicle crash occurrence involving patients who elected to have surgery compared with those who did not.

    FINDINGS: Comparing the cataract surgery group (n = 174) with the no surgery group (n = 103), the rate ratio for crash involvement was 0.47 (95% confidence interval, 0.23-0.94), adjusting for race and baseline visual acuity and contrast sensitivity. The absolute rate reduction associated with cataract surgery was 4.74 crashes per million miles of travel.

    DISCUSSION: In our sample, patients with cataract who underwent cataract surgery and intraocular lens implantation had half the rate of crash involvement during the follow-up period compared with cataract patients who did not undergo surgery. Cataract surgery thus may have a previously undocumented benefit for older driver safety, reducing subsequent crash rate. (Copyright © 2002 American Medical Association)

  • Risk-taking attitudes among young drivers: the psychometric qualities and dimensionality of an instrument to measure young drivers' risk-taking attitudes.

    Ulleberg P, Rundmo T. Scand J Psychol 2002 Jul;43(3):227-237.

    Correspondence: Pal Ulleberg, Department of Psychology, Norwegian University of Science and Technology, Trondheim, NORWAY; (email: [email protected]).

    Adolescents are proportionately more frequently involved in traffic accidents than are other age groups. A strategy for promoting road safety is to change the attitudes likely to influence driving behavior. However, the lack of valid and reliable instruments to measure risk-taking attitudes makes it difficult to evaluate the effects of measures aimed at changing attitudes among young drivers and their passengers. The present study tested the psychometric qualities of a scale intended to measure adolescents' risk-taking attitudes to driving. The results are based on a self-completion questionnaire survey carried out among 3,942 adolescents and young adults, aged 16-23 years, in Norway in 1998/1999. Using both exploratory and confirmatory factor analyses, 11 dimensions of risk-taking attitudes were identified. Parametric as well as nonparametric methods were applied to test the homogeneity of items within each attitude dimension. The reliability and validity of the dimensions were satisfactory. The attitude dimensions were significantly correlated with self-reported driving behavior, as well as accident frequency. The application of the new measurement instrument in studies aimed at evaluating safety campaigns is discussed. (Copyright © 2002 Blackwell Publishers)

  • Traffic safety among older adults: Recommendations for California.

    California Task Force on Older Adults and Traffic Safety. San Diego, California: Center for Injury Prevention Policy and Practice, 2002.

    Available online: HERE.

    The California Task Force on Older Adults and Traffic Safety, convened by the California Office of Traffic Safety, developed recommendations to prevent traffic crashes among older adults in California and to prepare for the growing senior population. This report lays the groundwork for a coordinated, comprehensive, and lasting approach to improving traffic safety for older Californians.

    The Task Force incorporated numerous critical concerns in the development of the recommendations, including: the increase in the number of older adults in California; the increase in the number of older drivers; the increase in the number of trips and mileage traveled by older drivers; variability among older adults (as people age they actually become more different from one another); the need for individualized assessment; older adults vulnerability to injury and mortality from crashes; improving traffic safety for older adults should improve traffic safety for people of all ages; and the need to address the multifaceted issues of individuals, vehicles and the traffic environment.

    The Task Force recommendations provide a strategic framework to improve traffic safety for older Californian’s. The report details the nature and scope of the problem, goals, action items, timeframes and recommended partners for each recommendation. The Task Force recommendations are: A) Institutionalize a statewide system for the prevention of traffic-related injuries among older adults; B) Institutionalize effective and equitable driver assessment and licensing practices within the California Department of Motor Vehicles; C) Facilitate older adult risk identification and risk reduction practices; D) Improve the ability of health care and service providers to assess traffic safety risk and minimize the impact of health impairments on safe mobility; E) Establish roadway infrastructure and land use practices that promote safety; F) Promote safer motor vehicle designs; and G) Expand the existing research and knowledge base about older adult traffic safety.

  • Human factors analysis of accidents involving visual flight rules flight into adverse weather.

    Goh J, Wiegmann D. Aviat Space Environ Med 2002; 73(8):817-822.

    Correspondence: Juliana Joo Hong Goh, University of Illinois at Urbana-Champaign, Aviation Human Factors Division, USA; (email: [email protected]).

    BACKGROUND: General aviation (GA) accident statistics indicate that visual flight rules (VFR) flight into instrument meteorological conditions (IMC) is a major safety hazard. However, little research has been conducted to identify the factors that influence VFR pilots' decisions to risk flying into deteriorating weather. The purpose of the present study was to further examine the causes of GA accidents associated with VFR flight into IMC. METHOD: A comprehensive review of GA accident reports maintained by the National Transportation Safety Board (NTSB) was conducted to identify accidents involving VFR flight into IMC between January 1990 and December 1997. These accidents were compared with other GA accidents that occurred during the same time period. FINDINGS: Analyses of these accidents revealed that VFR flight into IMC accidents were more likely to involve less-experienced pilots and to have passengers aboard the accident aircraft compared with the other GA accidents. In addition, most VFR flight into IMC accidents were considered by the NTSB to have involved intentional flight into adverse weather by the pilot. DISCUSSION: These findings are interpreted in terms of their implications for the underlying causes of VFR flight into IMC, including situation assessment, risk perception, and social pressure. Intervention programs that address all of these factors are needed. (Copyright © 2002 Aerospace Medical Association)

Violence

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Rev. 24-Aug-2002.