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30 September 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
  • Characteristics of intoxicated trauma patients.

    Blondell RD, Looney SW, Hottman LM, Boaz PW. J Addict Dis 2002; 21(4):1-12.

    Correspondence: Richard Blondell, University of Louisville School of Medicine, Department of Family and Community Medicine, KY, USA; (email: [email protected]).

    Of 1320 patients who were hospitalized for injuries, a total of 315 were known to be intoxicated with alcohol at the time of trauma. A retrospective chart review was performed to determine which biopsychosocial markers correlated with increasing severity of alcohol use disorders in a sample of 184 (58.4%) of these 315 patients. Markers associated with increased severity were: an increased mean corpuscular volume (MCV; p = 0.007), previous legal problems (p = 0.023), previous alcohol rehabilitation (p < 0.001), previous attendance at self-help meetings (p < 0.001), admitting to having an alcohol problem (p < 0.001), and a willingness to change drinking behavior (p < 0.001). Routine toxicology screening tests, simple questions about previous alcohol or drug abuse treatment, and direct questions about the patient's own perception of the severity of disease and readiness to change drinking behavior can identify many victims of major trauma who could potentially benefit from a referral for alcohol rehabilitation. (Copyright © 2002 American Society of Addiction Medicine)

  • Assessment of public opinion on legislation to deter drunk driving.

    Aekplakorn W, Suriyawongpaisal P. J Med Assoc Thai 2002; 85(7): 814-819.

    Correspondence: W. Aekplakorn, Community Medicine Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, THAILAND; (email: unavailable).

    Existing legislative measures on blood-alcohol control of drivers failed to show a substantial effect in reducing the incidence of crash injury and mortality. Recently, a government initiative to limit locations and operating time (service hours) of nighttime entertainment venues was introduced. A telephone interviewed-survey of 500 random-samples to assess public opinion on the initiative and other legislative measures was conducted in Bangkok. The results showed that 88 per cent of the respondents supported the idea of prohibiting alcohol sale to youngsters aged < 21 years old and 91 per cent agreed to limit the operating time of pubs, bars and nightclubs to no later than 2 a.m. The majority asserted that laws against drink driving were seldom enforced. More than half of the respondents agreed with the ideas of restricting medical care benefit for injured drunk drivers, and of prosecuting the related alcohol-sellers. Eighteen per cent of male respondents had drunk alcohol and driven in the past one month. A telephone survey is an efficient tool for providing timely information for policy decisions. More stringent enforcement of laws against drunk drivers should be implemented in parallel with traffic safety programs and other social control initiatives.

  • Increased risk of serious injury following an initial prescription for diphenhydramine.

    Finkle WD, Adams JL, Greenland S, Melmon KL. Ann Allergy Asthma Immunol 2002; 89(3): 244-250.

    Correspondence: William Finkle, Consolidated Research, Inc, Los Angeles, California 90024, USA; (email: [email protected]).

    BACKGROUND: Diphenhydramine may be associated with excess risk of injury relative to nonsedating H1-receptor antagonists.

    OBJECTIVE: This study sought to compare the risk of injury in patients exposed to diphenhydramine with the risk of injury in patients exposed to loratadine.

    METHODS: A retrospective cohort study of injury was carried out in 12,106 patients whose initial antihistamine prescription was for diphenhydramine and in 24,968 patients whose initial antihistamine prescription was for loratadine. Data were taken from a health care claims database that included employees, dependents, and retirees who filed claims from January 1991 through December 1998. Rates of six serious injuries in the diphenhydramine cohort after and before the first prescription were compared with rates in the loratadine cohort after and before the first prescription.

    RESULTS: In the 30 days after the first antihistamine prescription, the rate of all injuries was 308 per 1,000 person-years in the diphenhydramine cohort versus 137 per 1,000 person-years in the loratadine cohort. The rate ratio estimate adjusted for age and gender using Poisson regression was 2.27 (95% confidence limits [CL] 1.93, 2.66). In the corresponding 30 days of the preceding year, the injury rates in the diphenhydramine and loratadine cohorts were 128 and 125 per 1,000 person-years, and the adjusted rate ratio was 1.02 (CL 0.83, 1.26). Thus, the cohorts appeared to have similar preprescription injury rates. The differences between the cohorts declined with time from prescription: For all injuries, the estimated percentage decline in the rate ratio was 4.1% per day (CL 3.3, 4.9), and the estimated time from the initial prescription until the diphenhydramine cohort returned to baseline risk was 32.3 days (CL 26.9, 37.6).

    CONCLUSIONS: If these associations are causal, the percentage of the injuries attributable to diphenhydramine was 55% (CL 41, 65), implying a substantial number of excess injuries and costs incurred as the result of diphenhydramine use. The high use rates of this drug and the high incidence of injury suggest that further study of the association between injury and type of antihistamine is needed. (Copyright © 2002 American College of Allergy, Asthma, & Immunology)

  • Increased mortality among previously apprehended drunken and drugged drivers.

    Skurtveit S, Christophersen A, Grung M, Morland J. Drug Alcohol Depend 2002; 68(2): 143.

    Correspondence: Svetlana Skurtveit, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, NORWAY; (email: [email protected]).

    Most studies in the field of impaired driving have focused on the hazards imposed on society by the impaired drivers, whereas little attention has been paid to the future outcome of the drivers. The aim of the study was to identify mortality rates and causes of death among drunken and drugged drivers during the years after apprehension. Prospective cohort study on apprehended drunken and drugged drivers, follow-up period: 7.5 years, outcome variable: death. Apprehended drivers 20-39 years old who provided samples positive for alcohol (n=2531) or drugs other than alcohol (n=918) constituting the total national samples of these two driver categories in 1992. The mortality rate among male drunken drivers was higher than in an age-matched Norwegian population (standardized mortality ratio, SMR=3.7 (95% Cl 2.9-4.7). The SMR for drugged drivers was 18.1 (14.9-21.8) for men and 27.9 (14.4-48.8) for women. In a subgroup of male drugged drivers using heroin, SMR was 39.8 (28.8-53.6). The dominant causes of death among drunken and drugged drivers were drug poisoning/overdose, accidents and suicide. Apprehension for drunken or drugged driving and subsequent analytical verification, is an indicator of increased risk of future premature death in the age group 20-39 years, particularly for drugged drivers. To our knowledge this is a new finding, and studies to confirm it should be carried out in other countries. If verified, the results should lead to the consideration of new public health approaches towards apprehended impaired drivers.(Copyright © 2002 Elsevier Science)

  • Long-term trends in drinking habits among Swedish teenagers: National School Surveys 1971-1999.

    Andersson B, Hansagi H, Damstrom Thakker K, Hibell B. Drug Alcohol Rev 2002; 21(3):253-260.

    Correspondence: Barbro Andersson, Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, SWEDEN.

    The purpose of the study is to describe the long-term trends in drinking habits among Swedish students aged 15-16 years. Data were collected from 1971 to 1999, using self-administered questionnaires from nationally representative random cluster samples of school classes, totalling on average 6000 students per year.The highest proportion of alcohol consumers among both boys and girls, about 90%, was seen in the 1970s; this percentage decreased to about 80% in the 1980s and remained at that level through the 1990s. The estimated average annual consumption of pure alcohol was 4 litres for boys in 1977. It fell to 2.1 litres in 1988 and rose to 3.9 litres in 1999. The tendency was similar for girls, with 3.5 litres consumed in 1977, about 1.5 litres in the 1980s and 2.3 litres in 1999. Also frequent binge drinking and intoxication were reported by the largest proportions in the 1970s; the figures decreased in the 1980s and rose again among both boys and girls in the first part of the 1990s. Hence, although fewer of the students in this age group are alcohol consumers at the end of the 1990s compared with the 1970s, those who drink are approaching the high consumption levels of the 1970s. The beverages of choice are beer and spirits. (Copyright 2002 Taylor & Francis)

Commentaray & Editorials
  • No reports this week

  • Lightning-associated injuries and deaths among military personnel --- United States, 1998--2001.

    Silverberg MJ, A Frommelt A, Lange JL, Brundage JF, Rubertone MV, Jones BH, Winterton BS. MMWR 2002; 51(38): 859-862.

    Full article, with tables, figures, and editorial comment, available on-line:

    After flooding, lightning is the second leading cause of weather-related death in the United States; approximately 300 injuries and 100 deaths are associated annually with lightning strikes in the United States (1--4). To characterize lightning-associated injuries and deaths among U.S. Armed Forces personnel, the U.S. Army and CDC analyzed data from the Defense Medical Surveillance System (DMSS). This report summarizes the results of that analysis, which indicate that the highest lightning-related injury rates during 1998--2001 occurred among male U.S. military members who were aged < 40 years, single, with a high school education or less, stationed near the Gulf of Mexico or the East Coast, and in the U.S. Army. The findings suggest that the risk for lightning-associated injury depends primarily on the frequency, timing, duration, and nature of outdoor exposure to thunderstorms. Military personnel should be aware of severe weather onset and take reasonable precautions to protect themselves and their companions from exposure to lightning.

    DMSS maintains hospitalization and ambulatory clinic visit data on U.S. Armed Forces personnel (both active-duty and reserve) and links health data with personnel data (e.g., age, race, sex, education, occupational specialty, and duty station). This analysis considered lightning-associated injuries or deaths among active-duty and reserve military personnel that occurred during 1998--2001. A lightning-associated injury or death was defined as a hospitalization or ambulatory clinic visit in the 50 states and the District of Columbia that was assigned a primary or secondary diagnosis of "effects from lightning, shock from lightning, or struck by lightning" according to the International Classification of Diseases, Ninth Clinical Modification (ICD-9-CM) code 994.0. Because isolated cloud-to-ground lightning strikes could not be distinguished from multiple lightning strikes at the same time and location, it was assumed that two or more lightning-associated injuries or deaths at the same time and location were caused by a single lightning strike. Descriptive statistics were analyzed, including event date, location, percentage of strikes causing injury resulting in hospitalization or death, casualties per strike, and military status (i.e., active or reserve) of affected persons. Because accurate denominator data were not available for reserve personnel, lightning casualty rates and relations of selected demographic factors to those rates were calculated for active-duty personnel only. Military personnel comprise a highly mobile population, and many duty assignments last for < 1 year; therefore, lightning-associated casualty rates were expressed as casualties per 100,000 person years. Rate ratios and 95% confidence intervals (CIs) were based on Poisson regression. The descriptive nature of this report precluded calculating adjusted estimates.

    During 1998--2001, a total of 142 lightning strikes caused 350 service member injuries and one service member death at U.S. military installations in the United States (Figure); 64 (18.0%) persons required hospitalization. The majority (123 [86.6%]) of lightning strikes injured either one or two persons; 12 (8.5%) strikes injured three to nine persons; and seven (4.9%) strikes injured >10 persons, including one that injured 44 persons during an outdoor training exercise. Three fourths (106 [74.6%]) of lightning strikes occurred during May--September, with a peak (71 [50.0%]) during July--August. Lightning strikes occurred more often near the coasts, particularly in southern and eastern areas. Active-duty personnel constituted the majority (246 [70.1%]) of lightning-associated casualties. Overall, the lightning strike casualty rate was 5.8 per 100,000 person years (Table 1). By state, Louisiana (39.6), Georgia (25.2), and Oklahoma (23.5) had the highest rates. Comparisons among age groups showed a strong inverse relation between age and risk for lightning-associated injury (Table 2). Men were 3.3 times more likely than women to be struck by lightning. Service members with a high school education or less and those in combat-related occupations (e.g., infantry or artillery) were at higher risk than their counterparts. Among the services, the Army had the highest lightning casualty rate (9.5), and the Navy had the lowest (1.4); the Army-to-Navy rate ratio was 7.0 (95% CI=4.4--11.7).

Occupational Issues Pedestrian & Bicycle Issues
  • An examination of the relationship between cycle training, cycle accidents, attitudes and cycling behavior among children.

    Colwell J, Culverwell A. Ergonomics 2002; 45(9): 640-648.

    Correspondence: John Colwell, Department of Psychology and Speech and Language Therapy, De Montfort University, Leicester LE7 9SU, UK; (email: unavailable)

    Around 40% of 10-11-year-old children receive cycle training every year in the UK, but concern has been expressed over the efficacy of training courses. One argument is that accidents occur too infrequently to be a viable evaluative criterion, and attitudes and behavior have been suggested as alternatives. A questionnaire that measured a number of variables including accidents, attitudes, and behavior was completed by 336 participants from two schools in the London Borough of Bromley. At least one cycling injury had been sustained by 58.3% of respondents, requiring hospital treatment in 19.1% of cases. Girls reported fewer accidents than boys. No relationship between training and accidents was found. A principal components analysis (PCA) of the attitudes items produced a 'safe attitudes' factor. Girls displayed 'safer' attitudes, but there was no evidence that training produced safer attitudes. A PCA of the cycling behavior scales produced two factors, 'safe cycling' and 'showing off'. Safe cyclists who obeyed basic safety rules were less likely to sustain cycle injuries, but showing off was not related to accidents. Girls were less likely to show off, but the safe behavior gender difference did not reach significance. Training did not relate to either factor. (Copyright © 2002 Taylor and Francis)

  • Safety education of pedestrians for injury prevention: a systematic review of randomized controlled trials: Discussion.

    Reading R. Child Care Health Dev 2002; 28(5): 432-433.

    Correspondence: Richard Reading, University of East Anglia Norwich Norfolk NR4 7TJ, UK; (email: [email protected]).

    Responding to:

    Duperrex O, Bunn F & Roberts I. (2002) British Medical Journal, 324, 1129-1131.

    Objectives: To quantify the effectiveness of safety education of pedestrians.

    Design: Systematic review of randomized controlled trials of safety education programs for pedestrians of all ages.

    Main outcome measures: Effect of safety education on pedestrians' injuries, behavior, attitude and knowledge, and on pedestrian/motor vehicle collisions.

    Results: We identified 15 randomized controlled trials of safety education programs for pedestrians; 14 trials targeted children, and one targeted institutionalized adults. None assessed the effect of safety education on the occurrence of pedestrian injury, but six trials assessed its effect on behavior. The effect of pedestrian education on behavior varied considerably across studies and outcomes.

    Conclusions: Pedestrian safety education can change observed road crossing behavior, but whether this reduces the risk of pedestrian injury in road traffic crashes is unknown. There is a lack of good evidence of effectiveness of safety education for adult pedestrians, especially elderly people. None of the trials was conducted in low- or middle-income countries.

    DISCUSSION: Although the three approaches to injury reduction, education, environmental change and legislation are described as complementary, they are usually considered separately. Those involved in local injury prevention programs often feel constrained to thinking solely or largely about educational interventions because the options of environmental change and influencing legislation and enforcement may seem beyond their capacity to influence. This paper shows that the evidence about the effect of such interventions is weak at best, and there is no evidence of an effect on injury reduction. A cautionary tale, perhaps, and it should focus more effort on changing the road environment, vehicle design and legislative change and enforcement of existing law to improve the safety of roads. However, there are questions about whether conventional randomized trials are the best way of evaluating complex interventions that may be part of a more general strategic approach to health promotion. Contamination of intervention to control subjects, national or local policy changes midway through the trial, the Hawthorne effect, and the difficulty of long-term follow-up observations can all sabotage the best efforts of trialists. (Copyright © 2002 Blackwell-Synergy).

  • No reports this week

Recreation & Sports
  • Soccer-related craniomaxillofacial injuries.

    Cerulli G, Carboni A, Mercurio A, Perugini M, Becelli R. J Craniofac Surg 2002; 13(5): 627-630.

    Correspondence: Giulio Cerulli, Via dei Giuochi Istmici n16, 00194, Rome, ITALY; (email: [email protected]).

    The authors assessed the rate of craniomaxillofacial fractures in soccer and the areas where they occur, describing above all the injury pattern of this sport. Over a 5-year period (1995-2000) 46 cases of 329 with fractures associated with different sports activities have been surgically operated at the maxillofacial surgery department of the Policlinico "Umberto I" Hospital, University "La Sapienza" of Rome. All data collected have been selected on the basis of sex, age, anatomic site of the fracture, and the practiced sport. Information on injury patterns, severity, and play circumstances have been documented. The department examined 7 sports disciplines, but soccer was responsible for sports-related maxillofacial fractures in 34 of 46 cases (73.9%). All 34 fractures occurred to men. In soccer, the zygomatic and nasal regions are mainly involved. In fact the authors examined zygomatic fractures in 15 cases and nasal fractures in 10 cases. Direct contact between players generally causes soccer-related maxillofacial fractures: head-elbow impacts (21 cases) or head-head impacts (14 cases). The male:female ratio is 6.6:1, while the average age is 25 years for males and 23 years for females. In comparison with other sports (rugby, football, etc.) where physical contact occurs more frequently and the higher incidence of traumatic events justifies the use of protective measures, soccer is not a particularly violent sport. In soccer, maxillofacial traumas are caused by violent impacts between players that take place mainly when the ball is played with the forehead. In this moment there can be an elbow-head impact or a head-head impact. The authors believe that the low incidence of fractures, severity of the lesions, and discomfort caused by possible protective masks make their use unjustified. The data collected during this study witness that in soccer 21 of 34 cases of maxillofacial fractures are caused by elbow-head impacts. This fact suggests a preventive strategy against violent behavior in soccer play. Because the use of any sort of helmet proved impossible, the introduction of more severe penalties and a greater respect for the rules of the game by the players could reduce the percentage of impacts during matches. Impacts cause the most serious and frequent lesions in the maxillofacial region. (Copyright © 2002 Lippincott Williams & Wilkins)

  • Mechanisms of snowboarding-related severe head injury: shear strain induced by the opposite-edge phenomenon.

    Nakaguchi H, Tsutsumi K. J Neurosurg 2002; 97(3): 542-548.

    Correspondence: Hiroshi Nakaguchi, Department of Neurosurgery, Suwa Central Hospital, Chino city, Nagano, JAPAN; (email: [email protected]).

    OBJECT: To date, there has been no published study in which the focus was on the mechanisms of head injuries associated with snowboarding. The purpose of this study was to identify these mechanisms.

    METHODS: The patient population consisted of 38 consecutive patients with snowboarding-related major head injuries who were treated at two hospitals in Japan, where for years many winter sports injuries have been treated. The skill level of the snowboarder, the cause of the accident, the direction of the fall, the site of impact to the head, and the condition of the ski slope were examined. The injuries were classified as coup, contrecoup, or shear injuries.

    RESULTS: The predominant features of snowboarding-related major head injuries included: falling backward (68% of cases), occipital impact (66% of cases), a gentle or moderate ski slope (76% of cases), and inertial injury (76% of cases [shear injury in 68% and contrecoup injury in 8% of the patients]). Acute subdural hematoma frequently occurred after a patient fell on the slope (p = 0.025), fell backward (p = 0.0014), or received an occipital impact (p = 0.0064). Subcortical hemorrhagic contusions frequently occurred after the patient fell during a jump (p = 0.0488), received a temporal impact (p = 0.0404), or fell on the jump platform (p = 0.0075). Shear injury frequently occurred after a fall that occurred during a jump or after simple falls on the ski slope, and contact injury was frequently seen after a collision (p = 0.0441).

    CONCLUSIONS: The majority of severe head injuries associated with snowboarding that occur after a simple fall on the slope are believed to involve the opposite-edge phenomenon, which results from a fall backward on a gentle or moderate slope causing occipital impact. The use of a device to protect the occiput is proposed to reduce head injuries associated with snowboarding. (Copyright © 2002 American Association of Neurological Surgeons)

Research Methods RISK FACTOR PREVALENCE Injuries at Home Rural & Agricultural Issues School Issues
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Suicide Transportation
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