This study compares the recidivism rates of two groups of Illinois drivers who had their driver's licenses revoked for alcohol-impaired driving and who received restricted driving permits. Drivers in both groups had more than two driving under the influence (DUI) actions against their record within 5 years or were classed as level III alcohol dependents. Drivers in one group were required to install breath alcohol ignition interlock devices in their vehicles and drivers in the other group were not. The research found that drivers with the interlock were one-fifth as likely to be arrested for DUI during the 1 year the device was installed as the comparison group, which did not have the device. However, once the ignition interlock was removed, drivers in this group rapidly returned to DUI arrest rates similar to those in the comparison group. These findings echo previous literature. Additionally, the study showed that this voluntary program in Illinois reached only 16% of the drivers who met the requirements for installing the interlock device. Finally, this study found that individuals who were removed from the interlock program and returned to revoked status continued to drive. Within 3 years, approximately 50% of this latter group were involved in a crash or were arrested for DUI or with an invalid driver's license. Conclusions drawn from the study suggest that the breath alcohol ignition interlock device is effective in preventing continued driving while impaired. However, the large-scale effectiveness of the device is limited since most of the drivers eligible for the device do not have it installed. To have a significant impact, the interlock device must represent a better alternative to drivers whose licenses were suspended or revoked because of alcohol arrests compared to remaining on revoked status without having the device installed. Finally the research suggests that, given the rapid return to predevice recidivism, the devices should remain installed until drivers can demonstrate an extended period of being alcohol free.
Correspondence: John M. Horan, Mailstop D-18, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (email: email@example.com).
Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data on health-related events for use in public health action to reduce morbidity and mortality and to improve health. More simply put, surveillance is about translating information into action. In the United States, much of the focus of public health surveillance has traditionally been on prevention and control of infectious diseases, an area where surveillance has been used to identify outbreaks, monitor emerging problems, and assess the impact of prevention measures. Another essential role of public health surveillance is monitoring causes of death, including premature mortality. In that context, injuries clearly emerge as a major public health problem. In 1999, unintentional injuries were the fifth leading cause of death in the United States and were the leading cause for persons in the age group 1-34 years. Unintentional injury, together with homicide and suicide, accounted for nearly 60 percent of all deaths among persons aged 1-34 years.
Following Congressional authorization in 1983, the National Research Council and the Institute of Medicine (National Academy of Sciences) produced the 1985 report Injury in America, which documented the burden of injury and became a major impetus for developing support for research and programs to address this important problem. A 1988 review of public health surveillance in the United States noted that recognition of intentional and unintentional injuries as major public health problems had led to the need for developing systems of public health surveillance for injuries. Additionally, as injury research and prevention programs have evolved, so has the need for surveillance data to identify populations at risk, determine programmatic priorities, support prevention activities, and evaluate prevention efforts. While there have been substantial advances in injury surveillance in recent years, there are still many challenges and needs. In this paper, focusing primarily on the United States, we provide an overview of current injury surveillance data sources and systems, and we review their use for surveillance of major categories of injury. We also present several new developments in injury surveillance and comment on some of the new challenges facing injury surveillance in an era of rapidly changing information technology and growing recognition of the need for effective integration of information systems.
Car seat heaters have gained popularity in America and worldwide. They offer comfort by heating the sitting surface to a soothing temperature. Several cases of heating-element malfunction resulted in burn injuries and have triggered recalls of thousands of cars by the manufacturers. We present a case of a 48-year-old patient with long-standing paraplegia who sustained third-degree burns on his buttock during the initial drive of a new car with seat heaters. Car seat heaters can cause severe burns. Patients with decreased sensation or immobility are at increased risk and should not use car seat heaters. This case illustrates the need for design modifications and consumer education regarding the risks associated with car seat heaters.
OBJECTIVES: To describe the frequency of low back injury in workers' compensation claims in the Virginia Workers' Compensation Commission (WCC) database; to analyze correlations of low back injuries to select demographic data and injury characteristics; and to describe the rehabilitation cost of the claims and to compare cost with other types of injury.
DESIGN: Cohort study. Setting: Database of claims submitted to the Virginia WCC.
PARTICIPANTS: Claims involving low back sprain, strain, or contusion (N=76,025) resulting in >/=7 days of missed work or total compensation paid of at least $1000 from 1985 to 2000.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Low back injury claim frequency and rehabilitation costs.
FINDING: The low back was the most common injury location (9.1%) in the database. The mean age of low back claimants +/- SD was 37.2+/-10.4 years with a peak at 34 years of age. The male to female ratio of low back claimants was 2:1. Injury to the low back was associated with mechanism of injury (chi(2)=42.26, P<.0001). Worker motion and exertion were the primary mechanisms of injury in 87% of low back claims versus 44% of all other injury claims, whereas motor vehicle collisions and falls were less often associated with back claims compared with other injuries. Cross-tabular analysis showed no meaningful predilection of back claims by industry, occupation, or sex compared with other injuries. Rehabilitation cost analysis showed low back claims had higher mean rehabilitation costs compared with other injuries ($388 vs $338, P<.05). Rehabilitation costs were associated with industry (P=.0016), with the highest relative cost in construction, agriculture, forestry, and fishing.
COMMENTS: This data describe nonspecific low back injury claims made to the WCC in Virginia. Injury prevention strategies should target worker motion and overexertion.
Comparison of fatal occupational injury surveillance systems between the European Union and the United States.
- Benavides FG, Delclos GL, Cooper SP, Benach J. Am J Ind Med 2003; 44(4): 385-391.
Correspondence: Fernando G. Benavides, Occupational Health Research Unit, Department of Health and Experimental Sciences, Pompeu Fabra University, Barcelona, SPAIN; (email: Fernando.firstname.lastname@example.org).
CONTEXT: Comparison of workplace injury statistics among countries is often problematic, mainly because work injury statistics are based on different national recording and notification systems.
METHODS: Definitions of fatal work-related injuries, identification of the reference population, and rates of fatal work-related injuries, from 1995 to 1998, were compared between the European Statistics on Accidents at Work (ESAW) and the United States (U.S.) Census of Fatal Occupational Injuries (CFOI).
FINDINGS: Similar definitions for workplace fatalities were found, but CFOI is based on an active search, and ESAW on passive notification. Daily fatal occupational injury numbers were similar in both: about 17 workers die per day, but average annual work-related death rates were higher in the U.S.
COMMENTS: There are enough differences to allow direct comparisons between both systems. CFOI is likely to be more comprehensive than ESAW. It is conceivable that the true number of fatal occupational injuries in the European Union (E.U.) could be higher, and thus the apparent difference in U.S. and E.U. fatal injury rates may be an artifact of the different surveillance systems.
CONTEXT: To describe cycle helmet owning and wearing among children in a deprived area and to investigate the association between helmet ownership and wearing and socioeconomic deprivation.
METHODS: Cross sectional survey in 28 primary schools in deprived areas of Nottingham; 1061 year 5 schoolchildren were studied.
FINDINGS: All year 5 children attending school on the day of the survey completed the questionnaire (87% of children registered at participating schools). Children residing in a deprived area were less likely to own a bike and more likely to ride it four days a week or more. Half the children owned a helmet (52%), but only 29% of these always wore their helmet. Children in deprived areas were less likely to own a helmet, but those that owned a helmet were not less likely to always wear one. Family encouragement and parental warning of dangers of not wearing a helmet were associated with increased helmet ownership rates. Family encouragement and best friends wearing a helmet were associated with higher rates of helmet wearing.
COMMENTS: Programmes aimed at preventing head injury among child cyclists will need to address the inequality in helmet ownership that exists between children residing in deprived and non-deprived areas. Strategies to increase family encouragement to wear a helmet may be useful, as may those recognising the importance of the attitudes and behaviours of peers, such as peer education programmes. Further work is required to assess how exposure to risk of cycling injury varies with deprivation.
Pedestrian injuries in Mexico: a multi-method approach.
- Hijar M, Trostle J, Bronfman M. Soc Sci Med 2003; 57(11): 2149-2159.
Corresondence: Martha Hijar, Center for Research in Health Systems, National Institute of Public Health (INSP), Av. Universidad 655. Col. Sta. Ma. Ahuacatitlan, Mor 62508, Cuernavaca, MEXICO; (email: email@example.com).
CONTEXT: Studies of road traffic injuries should identify social determinants amenable to intervention, and should attend to the problems of individual drivers and pedestrians. This is especially true in developing nations like Mexico, where traffic fatality rates are high and interventions ineffective.
OBJECTIVE: Combine qualitative and quantitative methods to analyze pedestrian injuries from motor vehicles in Mexico City, and identify their social, contextual and environmental determinants.
METHODS: (1) a cross-sectional analysis of mortality, producing crude and specific mortality rates and standardized mortality ratios (95% CI) by region; (2) Spatial analysis using a geographic information system to generate maps at different aggregation levels; (3) Observation with cameras to identify traffic patterns, spaces, behaviors, and patterned violations of regulations; and 4) Semi-structured in-depth interviews of pedestrians and drivers involved in an accident.
FINDINGS: The overall crude mortality rate was 7.14/100,000, (CI 6.85-7.42), with differences by sex and region. The highest concentration of deaths was observed in 10 neighborhoods, at specific types of street environments. The high-risk environments have wide avenues with abundant vehicular traffic, where spaces supposedly reserved for pedestrians are invaded by cars and vendors. Many pedestrians have never driven a motor vehicle, few know the traffic signs, and almost all events were "hit and run" cases.
COMMENTS: The combination of quantitative and qualitative methods allows us to see the specific importance of some determinants of pedestrian injuries. Spatial, epidemiological, and social perspectives help point out the local accident characteristics which must be considered before defining preventive interventions.
The per-mile accident rate of 16-year-old novices is approximately 10 times that of adults, a difference that has been attributed to the immaturity of youth and the errors of inexperience. Research separating the two influences shows that, over the first few years, the effects of experience greatly exceed those of age, with reductions of approximately two-thirds in the first 500 miles of driving. A study was undertaken to identify the behavioral antecedents of young driver accidents, including any subset of antecedents that could account for the inordinately high initial accident rate. Narrative descriptions of more than 2000 accidents involving 16-19-year-old drivers in two states were analyzed for behavioral contributors. The great majority of non-fatal accidents resulted from errors in attention, visual search, speed relative to conditions, hazard recognition, and emergency maneuvers, with high speeds and patently risky behavior accounting for but a small minority. Differences in the types of errors by first year novices and more experienced youth were relatively few in number and small in magnitude, indicating that the benefits of experience apply rather generally across all aspects of driving.
CONTEXT: There appears to be a significant prevalence of poisoning and adverse drug reactions in Singapore. However, the resources needed by physicians to assist them in the management of such cases are limited. This study examines the information resources currently utilised by medical professionals in assisting them in the management of poisonings and adverse drug reactions. The preferred features of an ideal Drug and Poison Information Centre in the local setting were also explored.
METHOD: A questionnaire survey involving all practicing physicians in Singapore to find out the current information resources utilised for Drug and Poison Information and the need for enhanced resources and its preferred form was looked at.
FINDINGS: A total of 1,071 practicing physicians responded forming 24% of all physicians in Singapore as of December 1997. Of these, 636 (61.3%) were general practitioners and the rest specialists. The main sources of poison information were Drug Index of Malaysia and Singapore or DIMS (73.7%), standard textbooks (70.1%), fellow colleagues (44.6%) and pharmacists (41.0%). In the opinion of most (82.4%), one well run and efficient Drug and Poison Information Centre was adequate for the whole island. The majority (58.9%) preferred that experienced individuals who could be consulted upon in times of need man such a service.
COMMENTS: The study shows the need for enhanced drug and poison information resources. The local physician community also expects guidance and expert advice from a specialist.With this in mind, it is worthwhile examining in depth the issues surrounding poison and adverse drug reaction management and the need for readily accessible Drug and Poison Information resources in Singapore.
A contextual mediated model was proposed to distinguish the distal (i.e. personality factors) and proximal (i.e. aberrant driving behaviors) factors in predicting traffic accident involvement. Turkish professional drivers (N=295) answered a questionnaire including various measures of personality factors, driver behaviors, and accident history. Results of the latent variable analysis with LISREL indicated that latent variables in the distal context (i.e. psychological symptoms, sensation seeking, and aggression) predicted at least one of the proximal elements (i.e. aberrant behaviors, dysfunctional drinking, and preferred speed) with relatively high path coefficients. While aberrant driver behaviors yielded a direct effect on accident involvement, psychological symptoms yielded an indirect effect mediated by driver behaviors. Further analyses revealed that personality factors had an impact on road accidents via their effects on actual driving-related behaviors although the path coefficients in predicting accidents were relatively weaker than those predicting risky driving behaviors and habits. Results were discussed considering the implications for classifying the accident correlates in a contextual framework and binominal-poisson distribution of self-reported accidents.
CONTEXT: To determine the types and patterns of injuries seen in personal watercraft (PWC) accidents.
DESIGN: A retrospective review of medical records and imaging studies.SETTING Level 1 and 2 trauma centers in San Diego County, California.
PATIENTS/PARTICIPANTS: Trauma patients treated for PWC-related injuries between 1984 and 1997.
MAIN OUTCOME MEASUREMENTS: Evaluation of injury patterns via chart review and imaging studies.
FINDINGS: A total of 62 patients were identified. The average age was 23 years (range 2-59 years). There were 41 males and 21 females. A total of 35 injuries (56%) involved another PWC. Of patients, 24 had loss of consciousness, with 8 closed head injuries. There were 17 chest injuries, with 10 pneumothoraces, and 16 lower extremity fractures (9 femur, 3 hip, 3 tibia-fibula, and 1 patella).
COMMENTS: Injuries related to PWC have increased dramatically over the past several years, becoming one of the leading causes of recreational water-sport injuries. This study supports a high level of awareness for significant blunt trauma to the chest and lower extremities in patients involved in PWC accidents.
Mechanisms and prevention of kitesurfing injuries.
Aim of this study was to analyze the mechanisms of windsurfing injuries. For this purpose we performed an internet based survey among 327 windsurfers in Germany. Overall 630 accidents have been registrated among all 327 athletes during the 2000 season. The majority of injuries were classified as minor injury. The most common injury was the bruise. 70 participants reported fractures, 26 participants ruptured a ligament. 280 injuries required medical treatment; in 67 cases even surgical treatment was necessary. The majority of accidents happened at wind power of 5 - 6 Beaufort after 2 hour exercise. A technical mistake was the most frequent cause for the accident. The most dangerous ma-noeuvres were difficult jumps (e. g. front loop, backward loop, 70 injuries). In 46 cases the weather conditions were underestimated. Only 10 windsurfer reported about broken material as cause for the injury. One half of the injuries happened in wave conditions. The analysis of injury mechanisms allows conclusions regarding injury prevention. A longer break after 60 minutes windsurfing might help to prevent injuries due to poor physical fitness. After one hour windsurfing without a break training of difficult manoeuvres should not be performed. The use of a helmet might prevent head injuries during training of difficult jumps. "Overpower situations" should be prevented by choosing the right board and sail size.
This article reviews the design and analysis of matched cohort studies of injuries where exposed study subjects are matched to others not exposed. We focus on the situation in which data are available for the matched groups with at least one member who had the study outcome, but data are absent or incomplete for matched groups that have no members with the outcome.
When matching is done in a case-control study, those with the outcome are matched to those without the outcome on certain confounder measures; this distorts the exposure status of the controls to be like that of the cases in regard to the matching variables (and perhaps other variables as well). As a consequence, the selected controls may not represent the exposure experience of the entire population from which the cases were derived. Therefore, matching is a source of selection bias in a case-control study. The bias it produces can be removed in the analysis by accounting for the matching since, conditional on the values of the matching variables, controls will be representative of the source population.
The consequence of one-to-one matching in a cohort study is different. A variable can be a confounder only if, in the study cohort, it is associated with but not affected by the exposure and is independently predictive of the outcome. If each exposed study subject is perfectly matched to an unexposed subject on the value of some variable, and if there is no subject loss or missing data, there will be no association of exposure with the matching variable in the data, and confounding by the matching variable will be eliminated. Confounding by the matching variable could still occur, however, if an imbalance arose between the exposed and unexposed study subjects; this might happen, for example, if follow-up were less complete for one group compared with the other, or if some records were omitted from the analysis because of missing data.
Despite the potential of matching to prevent confounding in a cohort study and the potential of matching to sometimes increase study efficiency, it appears that this design is rarely used. For many cohort studies, matching exposed persons to one or several unexposed persons would be laborious. Furthermore, it might be wasteful in that matches might be unavailable for some potential cohort members. Today, cohort studies usually avoid matching, and the data are analyzed using regression methods that make it relatively easy to adjust for potential confounding factors that might otherwise be used for matching.
Application of behavior-change theories and methods to injury prevention.
Reducing the burden of injury is an international health goal, one that requires an interdisciplinary perspective. Injuries, whether self-inflicted, inflicted by others, or unintentional, have one thing in common: They are largely preventable. Behaviors that give rise to violence and injury are amenable to preventive intervention, just as are many of the behaviors that give rise to diseases. Thus, behavioral science is an integral part of a comprehensive injury prevention strategy.
Applications of behavioral science to injury prevention lagged behind other approaches during the last half of the 20th century. Despite recognition by injury control professionals of the importance of behavioral research in injury prevention, behavioral solutions to preventing injury were deemphasized until recently. Historically, little scholarly attention has been paid to understanding determinants of injury-related behaviors or how to initiate and sustain behavioral changes. Interventions often seemed to have been based on simplistic assumptions that changing people's awareness about the injury problem would change their behavior. Many authors have noted the need to improve behavioral interventions by using better empirical data about determinants of behavior as well as theories and frameworks pertaining to change in health behavior. A growing body of work is emerging that demonstrates the positive impact of using behavioral science approaches in order to both understand and reduce injury risk behaviors. In this paper, we describe the role of behavior change in injury prevention and illustrate how the application of selected behavior-change theories to injury problems, within the context of a health promotion framework, can contribute to the enhancement of injury prevention programs.
OBJECTIVES: To analyze human bites injuries of the face as seen in Benin City, Nigeria and to compare the results with similar studies. DESIGN: Prospective cross sectional study.
SETTING: Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.
SUBJECTS: Twenty patients with human bites to the face.
FINDINGS: The patients had a mean age of 36.0 years (range: 26 to 48 years), with a female to male ratio of 4:1. Matrimonial conflict related to polygamy was the commonest reason for assault, with females predominating as assailants. The lower lip was the commonest site of injury with 15 cases (75%). Eighteen patients (90.0%) presented at the clinic within 48 hours of injury with only 14 (70.0%) undergoing surgical repair within two to four days. Financial constraints accounted for the time lapse. None of the bite injuries became infected. This was attributed to early local wound care and systemic antibacterial therapy. None of the victims planned to seek legal redress for the bite injuries.
COMMENTS: This study showed that assaults during matrimonial conflicts led to most human bites to the face. It also showed that the Nigerian female was most often the victim and the assailant in such cases. Financial constraints were identified as the major cause of delay in the treatment of these injuries. However, delay in repair did not adversely affect the outcome of these injuries.
Costs of accidents make up an important part of the total external cost of traffic. A substantial proportion of accident costs is related to fatal accidents. In the evaluation of fatal accident costs the availability of an estimate of the economic value of a statistical life is pivotal. We present an overview of the empirical literature on the value of statistical life in road safety (VOSL), and use meta-analysis to determine variables that explain the variation in VOSL estimates reported in the literature. We show that the magnitude of VOSL estimates depends on the value assessment approach (particularly, stated versus revealed preference), and for contingent valuation studies also on the type of payment vehicle and elicitation format. We explain that VOSL estimates cannot simply be averaged over studies. The magnitude of VOSL is intrinsically linked to the initial level of the risk of being caught up in a fatal traffic accident and to the risk decline implied by the research set-up.
Epidemiology of turbulence-related injuries in airline cabin crew, 1992-2001.
BACKGROUND: The purpose of this study was to determine the rate of flight attendant turbulence-related injuries in Part 121 air carrier operations from 1992-2001, and to identify the significant epidemiological determinants of turbulence-related injuries.
METHODS: The National Transportation Safety Board's Aviation Accident Database was searched for the period from 1 January 1992 through 31 December 2001 for all records involving Part 121 air carrier turbulence-related accidents. Cases of turbulence-related flight attendant injuries were categorized by year and month of occurrence, aircraft type, air carrier, phase of flight, injury severity, type of injury, location in the aircraft where the injury occurred, status of the seat belt sign, and prevailing meteorological conditions. Continuous variables were analyzed by the Spearman rank-correlation method and ANOVA and categorical variables by the chi-square test.
FINDINGS: From 92 accident reports, 179 cases were identified. Of these cases, 82 (45.8%) involved serious injuries and 97 (54.2%) involved minor injuries. There was a non-significant upward trend in the rate of turbulence-related injuries, especially during the period from 1995 through 2000. Significant relationships were found between turbulence-related injuries and the phase of flight, location in the aircraft, seat belt sign illumination, aircraft type, and air carrier. The most frequent type of turbulence-related injury was lower extremity fractures, especially the ankle.
COMMENTS: The number of flight attendant turbulence-related injuries is on the rise, although mostly due to a corresponding increase in flight hours. The significant epidemiological determinants appear to be unrestrained cabin crew, aircraft type, and air carrier.
Population-based assessment of burn injury in southern Iowa: identification of children and young-adult at-risk groups and behaviors.
- Wibbenmeyer LA, Amelon MJ, Torner JC, Kealey GP, de Mola RM, Lundell J, Lynch CF, Aspelund T, Zwerling C. J Burn Care Rehabil 2003; 24(4): 192-202.
Correspondence: Lucy Ann Wibbenmeyer, College of Medicine, Department of Surgery, University of Iowa, Iowa City, Iowa 52242, USA; (email: unavailable).
Although nonfatal burn injuries vastly outnumber fatal injuries, their epidemiology is not well defined. We sought to determine the epidemiology of nonfatal burn injuries in a largely rural region of a midwestern state to target intervention efforts at populations and injury mechanisms at risk. Data were retrospectively collected on a population-based sample of medically treated burn injuries in 10 counties in southern Iowa from 1997 to 1999 using International Classification of Diseases, 9th Revision, Clinical Modification codes (ICD-9-CM, Ncode 940-949) to identify burn-related emergency room visits from computerized lists. A total of 1430 emergency room visits were identified, with 1382 records available for review. Injuries were grouped into etiology subcategories to better delineate common mechanisms and determine methods of prevention. Scald and hot-object contact and flame-related injuries were the leading causes of burn injury. Scald and contact injuries were subdivided into three major sets of scenarios, scald and contact injuries related to household food preparation and consumption, work-related scald and contact injuries. and injuries resulting from contact with nonfood and nonbeverage-related household objects. Children ages 0 to 4 had the highest population-based scald and hot-object contact injury rate of all age groups, with an average annual incidence rate of 35.9 per 10,000. Injuries in this age group were most commonly related to household objects (34.7%) followed by food preparation (25.3%). Children and young adults ages 5 to 24 were also the most likely to be injured by flame and fire-related causes secondary to open fires. Nonfatal burn injuries typically afflict children and young adults in definable patterns, suggesting intervention strategies. Future studies need to better delineate the contributing factors associated with these injuries to refine the intervention strategies.
OBJECTIVES: To study incidence characteristics and causes of injury, and its medical consequences in school children of China.
METHODS: A total of 2,553 school children aged 7-16 years were recruited from Shantou City in Gunagdong by cluster sampling method, and were investigated with questionnaires on cases of injuries occurred among them from October 1, 1996 to September 30, 1997.
FINDINGS: Injuries tended to increase with children's age, with an overall incidence rate of 37.96%, higher in boys than in girls (P<0.05); and 38.1% of children had more than two episodes of injury during this period. Falls took leading place of injury incidence both in boys and girls and in all age groups. Most injuries occurred when they were playing, sporting, riding and walking at home or in school. Self-inflicted injury ranked the first place of all injuries, followed by hurt caused by others (classmates, sibling or others). Moderate and serious injuries accounted for 8% of the total with a disability rate of 121.4/100,000.
COMMENTS: Currently, injury has become one of the serious public health problems in China. For the improvement of children survival, it is crucial to reduce their injury to strengthen research on child safety and to implement safety-promotion programs.
The health strategies of many nations include targets to reduce suicide rates. In several countries, because suicide rates are rising in young men but falling or unchanging in most other groups, achievement of target reductions might mask rises in potential years of life lost (PYLL). Analysis of routine mortality and census data for England and Wales, UK, shows that although age-standardised suicide rates fell by 18% (95% CI 15-21) between 1981 and 1998, the PYLL before age 65 years increased by 5% (4-6). National suicide reduction targets should focus on PYLL and overall suicide rates.
Increasing seasonality of suicide in Australia 1970-1999.
- Rock D, Greenberg DM, Hallmayer JF. Psychiatry Res 2003; 120(1): 43-51.
Correspondence: Daniel Rock, Centre for Clinical Research in Neuropsychiatry, Locked Bag No. 1, Western Australia, 6910, Claremont, AUSTRALIA; (email: firstname.lastname@example.org).
Previous studies have found that rates of suicide have a distinct annual rhythm with a peak in spring. Two recent European studies, however, have found that the amplitude of this rhythm has decreased over time. The purpose of this study was to examine whether such effects are found in Australia. Australian Bureau of Statistics data on all suicides in Australia 1970-1999 were analysed by spectral analysis. We found that suicide, violent suicide and suicide by males are seasonal and that the seasonal amplitude has increased over time. Males who use violent methods determine the seasonal effect. These results support previous findings that suicide and particularly violent suicide have a characteristic seasonal rhythm. However, the progressive increase in the amplitude of this rhythm over time in Australia is in direct contrast to other European findings. We suggest that this may be related to differences in patterns of anti-depressant use and also the effect of migration on the number of seasonally vulnerable individuals in Australia.
Towards a new perspective on deliberate self-harm in an area of multiple deprivation.
Based on 50 qualitative interviews with people who have repeatedly taken overdoses, this paper presents a new perspective for understanding deliberate self-harm. The perspective is new in the sense that it (1) avoids over-reliance on risk factors and (2) places agency at the centre of the analysis to document how the respondents' artfully constructed accounts of their lives minimise agency and constitute life in a perpetual present.
Subsequent mortality in medically serious suicide attempts: a 5 year follow-up.
Correspondence: Annette L. Beautrais, Canterbury Suicide Project, Christchurch School of Medicine & Health Sciences, PO Box 4345, Christchurch, NEW ZEALAND; (email: email@example.com).
(Copyright & 2003, Blackwell Publishing)
OBJECTIVE: To document mortality in a consecutive series of 302 individuals who made medically serious suicide attempts and were followed-up for 5 years.
METHOD: All sources of mortality were examined in a 5 year prospective study of 302 individuals who made medically serious suicide attempts. Mortality data were obtained by checks with the national mortality database and, for suicide and accidental deaths, were confirmed by review of coronial records.
FINDINGS: Within 5 years of making a medically serious suicide attempt, one in 11 (8.9%) participants had died. Most deaths (59.2%) were by suicide. Comparison of mortality in this series with rates expected in a comparable general population sample showed the excess mortality was attributable to death by suicide and by motor vehicle accidents.
COMMENTS: Mortality among those who make medically serious suicide attempts is high. These findings imply the need for the development of enhanced and long-term treatment, follow-up and surveillance programmes for those who make medically serious suicide attempts.
This article presents a series of 49 km/h sled tests using the Hybrid III 6-year-old dummy in a high-back booster, a low-back booster, and a three-point belt. Although a 10-year review at a level I trauma center showed that noncontact cervical spine injuries are rare in correctly restrained booster-age children, dummy neck loads exceeded published injury thresholds in all tests. The dummy underwent extreme neck flexion during the test, causing full-face contact with the dummy's chest. These dummy kinematics were compared to the kinematics of a 12-year-old cadaver tested in a similar impact environment. The cadaver test showed neck flexion, but also significant thoracic spinal flexion which was nonexistent in the dummy. This comparison was expanded using MADYMO simulations in which the thoracic spinal stiffness of the dummy model was decreased to give a more biofidelic kinematic response. We conclude that the stiff thoracic spine of the dummy results in high neck forces and moments that are not representative of the true injury potential.
Seat properties affecting neck responses in rear crashes: a reason why whiplash has increased.
Whiplash has increased over the past two decades. This study compares occupant dynamics with three different seat types (two yielding and one stiff) in rear crashes. Responses up to head restraint contact are used to describe possible reasons for the increase in whiplash as seat stiffness increased in the 1980s and 1990s. Three exemplar seats were defined by seat stiffness (k) and frame rotation stiffness (j) under occupant load. The stiff seat had k = 40 kN/m and j = 1.8°/kN representing a foreign benchmark. One yielding seat had k = 20 kN/m and j = 1.4°/kN simulating a high-retention seat. The other had k = 20 kN/m and j = 3.4°/kN simulating a typical yielding seat of the 1980s and 1990s. Constant vehicle acceleration for 100 ms gave delta-V of 6, 10, 16, 24, and 35 km/h. The one-dimensional model included a torso mass loading the seatback, head motion through a flexible neck, and head restraint drop and rearward displacement with seatback rotation. Neck displacement was greatest with the stiff seat due to higher loads on the torso. It peaked at 10 km/h rear delta-V and was lower in higher-severity crashes. It averaged 32% more than neck displacements with the 1980s yielding seat. The high-retention seat had 67% lower neck displacements than the stiff seat because of yielding into the seatback, earlier head restraint contact and less seatback rotation, which involved 16 mm drop in head restraint height due to seatback rotation in the 16 km/h rear delta-V. This was significantly lower than 47 mm with the foreign benchmark and 73 mm with the 1980s yielding seat. Early in the crash, neck responses are proportional to seat stiffness times vehicle displacement divided by torso mass, so neck responses increase with seat stiffness. The trend toward stiffer seats increased neck responses over the yielding seats of the 1980s and 1990s, which offers one explanation for the increase in whiplash over the past two decades. This is a result of not enough seat suspension compliance as stronger seat frames were introduced. As seat stiffness has increased, so have neck displacements and the Neck Injury Criterion (NIC). High-retention seats reduce neck biomechanical responses by allowing the occupant to displace into the seatback at relatively low torso loads until head restraint contact and then transferring crash energy. High-retention seats resolve the historic debate between stiff (rigid) and yielding seats by providing both a strong frame (low j) for occupant retention and yielding suspension (low k) to reduce whiplash.
Seat influences on female neck responses in rear crashes: a reason why women have higher whiplash rates.
Since the earliest crash investigations, whiplash has been found to occur more often in women than men. This study addresses seat properties that may explain a reason for the higher rates in women, and changes in whiplash in general over the past two decades. Three exemplar seats were defined on the basis of seat stiffness (k) and frame rotation stiffness (j) for rearward occupant load. Stiff seats have k = 40 kN/m and j = 1.8°/kN representing a foreign benchmark loaded by a male. One yielding seat had k = 20 kN/m and j = 1.4°/kN simulating a high-retention seat (1997 Grand Prix) and another k = 20 kN/m and j = 3.4°/kN simulating a 1980s to 1990s yielding seat (1990 Buick Park Avenue). Constant vehicle acceleration for 100 msec gave delta-V of 6, 10, 16, and 24 km/h. The one-dimensional model included a torso mass loading the seatback with flexible neck and head mass. Based on biomechanical data and scaling, neck stiffness was 5 kN/m and 3 kN/m for the male and female, respectively. Based on validation tests, seat stiffness was 25% less with the female. Occupant dynamics were simulated in a step-forward solution based on the differential displacement between the head, torso, and seat up to head restraint contact. Neck responses were 30% higher in the female than male through most of the rear impact and are proportional to (kF/mTF)/(kM/mTM), which is the ratio of seat stiffness divided by torso mass for the female and male. Neck displacements were higher with the stiff seat than the 1990 C car seat for both the female and male. They peaked at 10 km/h and dropped off for higher severity crashes due to the shorter time to head contact. Neck displacements were greater in the female than male for the lowest severity crashes with the stiff and 1990 C car seats, when displacement was scaled for equal tolerance. The female in 1997 W car seat had the lowest neck displacements. Stiff seats increased neck displacements over the yielding seats of the 1980s in rear crashes. The trend is similar in men and women, but early neck displacements are greater in women because of a higher ratio of seat stiffness to torso mass. This implies that seat stiffness is not sufficiently low in proportion to the female mass in comparison to males. The j and k seat properties influence neck biomechanics and occupant dynamics, but k is important in determining early response differences between males and females.
A new laboratory rig for evaluating helmets subject to oblique impacts.
Current requirements and regulations governing motorcycle helmets around the world are based on test results of purely radial impacts, which are statistically rare in real accidents. This study presents a new impact rig for subjecting test helmets to oblique impacts, which therefore is able to test impacts of increased statistical relevance to real motorcycle accidents. A number of different head-helmet interfaces have been investigated. A test rig was constructed to produce oblique impacts to helmets simulating those occurring in real motorcycle accidents. A Hybrid III dummy head was fitted with accelerometers to measure the accelerations arising during impact testing. The equipment used for data collection was validated in both translational and rotational acceleration. In order to better resemble the human head, an artificial scalp was fitted to the hybrid dummy. The same test rig was used to investigate the performance of a number of different helmets. Impact velocities ranging from 7.3 to 9.9 m/s were tested using a number of different impact angles and impact areas. This study shows that the new test rig can be used to provide useful data at speeds of up to 50 km/h and with impact angles varying from purely tangential to purely radial. The rotational accelerations observed differ greatly depending on both helmet and scalp designs. For example, a helmet with a sliding outer shell placed on an experimental head fitted with an artificial scalp (made to resemble the human scalp) reduces rotational accelerations of the head by up to 56%, compared with those of an experimental head fitted with a fixed scalp and conventional helmet. The degree of slippage between the skull and the scalp, and between the scalp and the helmet, leads to considerable variation in the results. This innovative test rig appears to provide an accurate method for measuring accelerations in an oblique impact to a helmet. In order to obtain a good level of repeatability in oblique impact testing, it is crucial that the helmet be fixed to the head in the exact same way in each individual test. Both the position and the angle of impact must be reproduced identically in each test. The test rig used here has shown that this type of rig can be used to compare different helmet designs, and it therefore is able to contribute to achieving safer helmets.
Socioeconomic background and road traffic injuries: a study of young car drivers in Sweden.
The aim of this study is to explore the manner in which different measures of original socioeconomic position (SEP) influence road traffic injuries (RTIs) among young car drivers in Sweden. The study consists of young people age 16-23. Subjects were taken from the Swedish Population and Housing Census of 1990 (n = 727,995), and followed up by a search for cases of injury to car drivers in Sweden's National Hospital Discharge Register over the years 1991-96 (n = 1,599). Household SEP was measured using social class, education, and disposable income. Relative risks were estimated by Poisson regression and population attributable risks were computed for each measure of SEP. Children of unskilled workers, of the self-employed, and of farmers, as well as children of parents with compulsory education only showed an increased risk of injury as car drivers compared to children in the highest socioeconomic group and children of highly educated parents. By contrast, level of household disposable income was found not to vary with RTI among young drivers. Twenty-five percent of the injuries could be avoided if all young people had the injury rate of the highest socioeconomic group, and 29% if all young people had the injury rate of those with highly educated parents. The reduction of risk differences based on household SEP calls for consideration of factors related to both differential exposure and differential susceptibility, which may be addressed in driver education.
Head and neck injuries in fatal motorcycle collisions as determined by detailed autopsy.
Detailed layer-by-layer autopsy of the head and neck was performed on a prospective series of 73 fatally injured motorcyclists in order to identify occult injuries, particularly soft tissue neck injuries such as hemorrhage of vertebral and carotid arteries. The fatal cases were gathered as part of a larger study of 1,082 on-scene in-depth motorcycle crash investigations in Thailand. Detailed neck dissection was done on nearly all fatal cases. Injuries were coded using the 1990 revision of the Abbreviated Injury Scale (AIS 90) and an Injury Severity Score (ISS) was determined for each case. Additional AIS codes are proposed for neck injuries that were often identified during the detailed autopsy procedures, but which are not listed explicitly among existing AIS codes. Helmet use was determined based on analysis of injury patterns and helmet damage with consideration also given to witness statements. Both helmeted and unhelmeted motorcyclists showed a high frequency of occult neck injuries such as hemorrhages in the carotid sheath or surrounding the vertebral arteries, phrenic nerve, or brachial plexus. These soft tissue neck injuries sometimes accompanied more obvious injuries to cervical vertebrae or spinal cord, but about one-third of riders had no obvious injury to suggest the presence of occult neck injury. Twenty-eight motorcyclists had been wearing a helmet at the start of the collision sequence, but only nine helmets remained in place through the entire collision event. Helmeted riders showed more severe somatic (below-the-neck) injuries than unhelmeted riders, suggesting helmeted riders are less likely to die in low-threat accidents with somatic injuries below AIS-3. The most significant finding of this study was the identification of serious internal neck injuries despite the absence of external physical evidence of trauma to the neck. Virtually all riders with significant head injuries showed some of these soft tissue neck injuries. Approximately one-third of the critically injured riders who survived at least a few hours before death showed serious occult soft tissue neck injuries.
A preliminary analysis of aortic injuries in lateral impacts.
- Franklyn M, Fitzharris M, Fildes B, Yang K, Frampton R, Morris A. Traffic Inj Prev 2003; 4(3): 263-269.
Injuries to the aorta are among the more serious injuries that result from vehicle impacts, and often may be fatal. This article examines the incidence of aortic injuries in the United States and United Kingdom by using two international databases of real-world crashes. The main outcome of interest was the level of risk associated with each principal direction of force for drivers and front-seat passengers with respect to sustaining aortic injuries. The results indicate that the risk of sustaining an injury to the aorta is greater for near-side crashes than for far-side crashes. Further it is apparent that, given a near-side crash, the risk of an aortic injury is greater on the left side of the body (and left side of the vehicle) than on the right. It also was found that the delta-V of crashes where occupants sustained an injury to the aorta was considerably higher than crashes where occupants did not sustain aortic injuries. It is speculated that the anatomical asymmetry of the thorax might play a role in the differences seen in injury risk associated with different impact directions. The results presented in this article could be of use to both the emergency physician treating patients involved in motor vehicle collisions as well as the engineer involved in occupant design countermeasures. Limitations and further planned research are discussed.
Characterization of fatal occupational versus nonoccupational motor vehicle collisions in Kentucky (1998-2000)
Correspondence: Terry L. Bunn, Fatality Assessment and Control Evaluation (FACE) Program, Kentucky Injury Prevention and Research Center, University of Kentucky, Kentucky School of Public Health, 333 Waller Avenue, Suite 202, Lexington, KY 40504-2915, USA; (email: firstname.lastname@example.org).
Motor vehicle collisions (MVCs) are the leading cause of occupational fatalities in Kentucky as well as in the nation. The characteristics of and contributing factors for occupational versus nonoccupational MVC fatalities in the Commonwealth of Kentucky were examined from 1998 to 2000. Semi trucks were most frequently involved in fatal occupational MVCs, and passenger cars were most frequently involved in nonoccupational MVCs. More than half of the decedent drivers resided outside of Kentucky. The percentage of occupational fatalities occurring on a four-lane highway was double the percentage observed for nonoccupational MVC fatalities. In addition, an increased proportion of occupational MVC deaths occurred on limited access highways compared to nonoccupational fatalities. When human factors contributing to these fatal incidents were examined, the two primary human factors involved in occupational motor vehicle fatalities were driver distraction/inattention and falling asleep, whereas unsafe speed and alcohol were the primary human factors contributing to a nonoccupational fatality. These results suggest that semi drivers traveling on four-lane highways are more at risk for a fatal occupational injury in Kentucky. Therefore, additional epidemiological studies are needed to further examine human factors, the nature of the Kentucky highway system, and trucking controls (e.g., weigh station hours of operation) within the Kentucky transportation industry.
subjective assessment of patients admitted acutely to the orthopedic directorate revealed that there had been--over a short period of time--a small series of patients who had sustained fractures during the course of their employment as pizza delivery moped drivers. Consequently an observational study was performed in our district general hospital in order to investigate this further, and establish the demographic domain of the patients involved and the cost of their injuries. Our hospital has a patient catchment area of 350,000 and an emergency department that treats 95,000 patients annually. The patients in this series were described in terms of their injuries, ethnicity, and cost of injury treatment. The main findings were that pizza delivery personnel admitted acutely were male Afghans, with poor English language skills, who sustained significant fractures in moped accidents that were expensive to treat.
Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non-victims, and they evidenced a greater number of substance disorder symptoms compared with the non-victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance-using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.
Longitudinal model predicting partner violence among white, black, and Hispanic couples in the United States.
CONTEXT: A limited amount of information pertaining to ethnic-specific risk factors associated with intimate partner violence across time currently exists. The current study examines ethnic-specific longitudinal predictors of male-to-female and female-to-male partner violence (MFPV and FMPV) in white, black, and Hispanic couples in the U.S. general population.
METHODS: In 1995, a total of 1635 married or cohabitating couples 18 years of age or older living in households in the 48 contiguous states participated in a national survey that used a multistage probability sampling procedure with 100 primary sampling units and included oversamples of blacks and Hispanics. In 2000, the follow-up survey had an overall response rate of 72% and included 406 white, 232 black, and 387 Hispanic intact couples. Ethnic-specific regression models predicting MFPV and FMPV at follow-up were developed. The risk factors of interest included male and female reports of history of childhood abuse, exposure to parental violence, impulsivity, alcohol problems, frequency of drinking five or more drinks per occasion, volume of alcohol consumed per week in average standard drinks, approval of marital aggression and male-to-female and female-to-male partner violence at baseline. MFPV and FMPV in 1995 and 2000 were based on the Conflict Tactics Scale Form R. FINDINGS: Black and Hispanic couples were at approximately three times greater risk of MFPV and two times greater risk of FMPV at follow-up in comparison to white couples even after controlling for sociodemographic characteristics, alcohol consumption, and psychosocial variables. Extreme specific models indicated that among blacks, MFPV was a significant predictor of MFPV and FMPV at follow-up. In contrast, among Hispanics, FMPV was a significant predictor of FMPV and MFPV at follow-up.
COMMENTS: Ethnic-specific multivariate logistic regression models indicated that the predictors of MFPV and FMPV including psychosocial variables, alcohol use, and alcohol-related problems varied by ethnicity. These findings contribute to our continually growing knowledge base regarding ethnic differences associated with the development of intimate partner violence and have important implications for prevention and intervention.
Outcomes related to burn-related child abuse: a case series.
Nationally, approximately 10% of child abuse cases involve burning, and up to 20% of pediatric burn admissions involve abuse or neglect. Historically, these cases have been more difficult to prosecute than nonburn cases for multiple reasons. Between 1995 and 1999, there were 285 pediatric (under 18) patients admitted to the Spectrum Health Regional Burn Center. Of these cases, 18 of the alleged perpetrators were legally investigated for suspicion of child abuse, and 7 received punitive sentences. We found that men tended to be prosecuted and convicted more often than women and that cases involving multiple instances of injury tended to be prosecuted more frequently. Similarly, we found that cases involving more severe injuries tended to be prosecuted more successfully. There are many psychological and social factors involved in handling burn abuse cases. However, by successful prosecution of these crimes, victims tend to fare better both socially and psychologically.