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6 August 2001
Compliance of Dunedin school playground equipment with the New Zealand playground standard
Chalmers DJ, Parry ML, Crawford AI, Wright CS. Aust N Z J Public Health 2001; 25: 253-255.
Correspondence: David J. Chalmers, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand (email: david.chalmers@ipru.otago.ac.nz).
The purpose of this study was to examine progress towards achieving compliance with these requirements in Dunedin school playgrounds. Sixty-two schools were audited over the summer of 1997/98 and information recorded on equipment type, maximum fall height, surface type, and depth of loose-fill surface materials. Comparisons were made with audits conducted in 1989 and 1981. Substantial increases in the amount of playground equipment and in the provision of impact-absorbing surfaces were observed. A small increase in compliance with the requirement that the maximum fall height of equipment not exceed 2.5 meters was also observed. The authors conclude that any gains in safety achieved through increased compliance with the height and surface requirements of the New Zealand Standard have been counteracted by the substantial increase in the amount of equipment available in playgrounds.
The New Zealand rugby injury and performance project. VI. A prospective cohort study of risk factors for injury in rugby union football.
Quarrie KL, Alsop JC, Waller AE, Bird YN, Marshall SW, Chalmers DJ. Br J Sports Med 2001; 35(3):157-166
Correspondence: David J. Chalmers, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand (email: david.chalmers@ipru.otago.ac.nz).
Although the nature of rugby injury has been well documented, little is known about key risk factors. A prospective cohort study was undertaken to examine the association between potential risk factors and injury risk, measured both as an injury incidence rate and as a proportion of the playing season missed. The latter measure incorporates a measure of injury severity. METHODS: A cohort of 258 male players (mean (SD) age 20.6 (3.7) years) were followed through a full competitive season. At a preseason assessment, basic characteristics, health and lifestyle patterns, playing experience, injury experience, training patterns, and anthropometric characteristics were recorded, and then a battery of fitness tests were carried out. RESULTS: A multiple regression model identified grade and previous injury experience as risk factors for in season injury, measured as an injury incidence rate. A second model identified previous injury experience, hours of strenuous physical activity a week, playing position, cigarette smoking status, body mass index, years of rugby participation, stress, aerobic and anaerobic performance, and number of push ups as risk factors for in season injury, measured as proportion of season missed. CONCLUSIONS: The findings emphasize the importance of previous injury as a predictor of injury incidence and of missing play. They also show the importance of considering both the incidence rate and severity of injury when identifying risk factors for injury in sport. Injuries in whitewater kayaking
Fiore DC, Houston JD. Br J Sports Med 2001; 35 (4): 235-241.
Correspondence: David C. Fiore, Department of Family and Community Medicine, University of Nevada School of Medicine, Reno, NV 89557, USA (email: fiore@med.unr.edu).
A retrospective survey was distributed at whitewater events and club meetings, and made available and advertised on the world wide web, through postings and announcements to newsgroups, related sites, and search engines. Data on sex, age, experience, and ability were collected. Injury data collected included mechanism, activity, difficulty of rapid, and self reported severity. Of the 392 kayaking respondents included in the final analysis, 219 suffered 282 distinct injury events. The number of days spent kayaking per season was the only independent predictor of injury. The overwhelming majority of injuries occurred while the kayaker was still in the boat (87%). Striking an object was the most common mechanism of injury (44%), followed by traumatic stress and overuse (25% each). The most common types of injury were abrasion (25%), tendinitis (25%), contusion (22%), and dislocation (17%). The upper extremity, especially the shoulder, was the most commonly injured area of the body. Although half of injured kayakers sought medical care for their injury, and almost one third missed more than one month of kayaking because of the injury, almost all (96%) reported a complete or good recovery. Factors relating to likelihood of injury appear to be connected with exposure, namely the number of days a year that the sport was pursued. Except for class V (extreme) kayakers, reports of injuries paralleled the number of participants. Kayakers reported injuries predominantly on rivers that they assessed to be at a level appropriate to their skills.
- See Transportation: Driveway injuries in children ... (below)
- See Violence: Dating violence ... (below)
Driveway Injuries in Children: Risk Factors, Morbidity, and Mortality
Nadler EP, Courcoulas AP, Gardner MJ, Ford HR. Pediatrics 2001; 108(2): 326-328.
Correspondence: Henri R. Ford, Department of Surgery, Children's Hospital of Pittsburgh, DeSoto Wing, Room 4A480, Pittsburgh, PA 15213.
Injuries that occur around the driveway are not typically regarded as reportable to the police and thus are often under-recognized. The aim of this study was to characterize the pattern and consequences of motor vehicle collisions that occur in the driveway. Over the past 13 years, 64 patients admitted to the Children's Hospital of Pittsburgh sustained motor vehicle-related injuries in a driveway. These injuries resulted from a vehicle driven by an adult driver striking a child (group 1) or a child shifting an idle vehicle out of gear (group 2). We compared demographic variables and outcome measures between the 2 groups. There was no difference in gender, injury pattern, Injury Severity Score, length of stay, or operations performed between the groups. Patients in group 1 were younger, smaller, had a lower Glasgow Coma Scale, and had poorer outcomes. The majority of collisions (65%) in group 1 resulted from a truck or sport-utility vehicle going in reverse. -
Predictors of Hazardous Child Seating Behavior in Fatal Motor Vehicle Crashes: 1990 to 1998
Wittenberg E., Goldie SJ, Graham JD. Pediatrics 2001; 108(2): 438-442.
Correspondence: Eve Wittenberg, Harvard Center for Risk Analysis, Harvard School of Public Health, 718 Huntington Ave., Boston, MA 02115 USA (email: ewittenb@fas.harvard.edu).
Motor vehicle crashes are the leading cause of death in children ages 5 to 14. Children seated in the front seats of vehicles are at increased risk of death and injury in crashes, particularly in vehicles with passenger-side air bags. This study identifies factors associated with the seating of children in the front seats of vehicles involved in fatal crashes between 1990 and 1998. Using 1990 to 1998 data from the Fatal Analysis Reporting System, a US census of motor vehicle crashes involving a fatality, multivariable logistic regression was used to model the association between child seating behavior and vehicle, driver, and occupant characteristics. The proportion of vehicles carrying children in the front declined from 42% to 31% over the 9-year period. Controlling for driver and vehicle characteristics, the risk of front-seating declined between 1990 and 1998, and this risk was smaller in vehicles carrying only younger children (6 years) than in those carrying older children. In the 3 years after the introduction of dual air bags into a significant proportion of the passenger fleet in late 1995, dual air bags were associated with fewer children being seated in the front seat. By the end of 1998, traveling in a vehicle with dual air bags and only children age 6 or younger was associated with a 95% lower chance of a child being seated in the front (odds ratio = 0.05; 95% confidence interval: 0.04-0.08). An important factor in safer seating position was the presence of multiple passengers, especially an older one, and children were at higher risk of front-seating when they traveled alone with the driver. The 1990s saw a decline in front-seating of children in vehicles involved in fatal crashes among all types of vehicles and drivers. Although this trend is encouraging, children ages 6 to 12 and children traveling alone with the driver remain at higher risk of being seated in the front. These traveling situations should be targeted for behavioral safety interventions to improve child motor vehicle safety.
Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality
Silverman JG, Raj A, Mucci LA, Hathaway JE. JAMA 2001;286 (5): 572-579.
Correspondence: Jay G. Silverman, PhD, Division of Public Health Practice, Harvard School of Public Health, 1552 Tremont St, Boston, MA 02120 (e-mail: jsilverm@hsph.harvard.edu).
Intimate partner violence against women is a major public health concern. Research among adults has shown that younger age is a consistent risk factor for experiencing and perpetrating intimate partner violence. However, no representative epidemiologic studies of lifetime prevalence of dating violence among adolescents have been conducted. The authors report the results of a study to assess lifetime prevalence of physical and sexual violence from dating partners among adolescent girls and associations of these forms of violence with specific health risks. Female 9th through 12th-grade students who participated in the 1997 and 1999 Massachusetts Youth Risk Behavior Surveys (n = 1977 and 2186, respectively) were studied. Approximately 1 in 5 female students (20.2% in 1997 and 18.0% in 1999) reported being physically and/or sexually abused by a dating partner. After controlling for the effects of potentially confounding demographics and risk behaviors, data from both surveys indicate that physical and sexual dating violence against adolescent girls is associated with increased risk of substance use (eg, cocaine use for 1997, odds ratio [OR], 4.7; 95% confidence interval [CI], 2.3-9.6; for 1999, OR, 3.4; 95% CI, 1.7-6.7), unhealthy weight control behaviors (eg, use of laxatives and/or vomiting [for 1997, OR, 3.2; 95% CI, 1.8-5.5; for 1999, OR, 3.7; 95% CI, 2.2-6.5]), sexual risk behaviors (eg, first intercourse before age 15 years [for 1997, OR, 8.2; 95% CI, 5.1-13.4; for 1999, OR, 2.4; 95% CI, 1.4-4.2]), pregnancy (for 1997, OR, 6.3; 95% CI, 3.4-11.7; for 1999, OR, 3.9; 95% CI, 1.9-7.8), and suicidality (eg, attempted suicide [for 1997, OR, 7.6; 95% CI, 4.7-12.3; for 1999, OR, 8.6; 95% CI, 5.2-14.4]). Dating violence is extremely prevalent among this population, and adolescent girls who report a history of experiencing dating violence are more likely to exhibit other serious health risk behaviors. Mandatory reporting of domestic violence injuries to the police -- What do emergency department patients think?
Rodriguez MA, McLoughlin E; Nah G, Campbell JC. JAMA 2001; 286(5):580-583.
Correspondence: Michael A. Rodríguez, MD, MPH, University of California, San Francisco, Department of Family and Community Medicine, San Francisco General Hospital, San Francisco, CA 94110 (e-mail: mrodriguez@medsch.ucsf.edu).
Laws requiring mandatory reporting of domestic violence to police exist in 4 states. Controversy exists about the risks and benefits of such laws. The authors report the results of a study to examine attitudes of female emergency department patients toward mandatory reporting of domestic violence injuries to police and how these attitudes may differ by abuse status. A cross-sectional survey was conducted in 1996 of 1218 women patients (72.8% response rate) in 12 emergency departments in California (a state with a mandatory reporting law) and Pennsylvania (without such a law). Twelve percent of respondents (n = 140) reported physical or sexual abuse within the past year by a current or former partner. Of abused women, 55.7% supported mandatory reporting and 44.3% opposed mandatory reporting (7.9% preferred that physicians never report abuse to police and 36.4% preferred physicians report only with patient consent). Among nonabused women, 70.7% (n = 728) supported mandatory reporting and 29.3% opposed mandatory reporting. Patients currently seeing/living with partners (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.0), non-English speakers (OR, 2.1; 95% CI, 1.4-3.0), and those who had experienced physical or sexual abuse within the last year (OR, 2.2; 95% CI, 1.6-2.9) had higher odds of opposing mandatory reporting of domestic violence injuries. There were no differences in attitudes by location (California vs Pennsylvania). The efficacy of mandatory reporting of domestic violence to police should be further assessed, and policymakers should consider options that include consent of patients before wider implementation.
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