24 June 2002
Alcohol-associated admissions to an adult intensive care unit: an audit.
- Mostafa SM, Murthy BV. Eur J Anaesthesiol 2002; 19(3):193-196.
Correspondence: S.M. Mostafa, Royal Liverpool University Hospital, Department of Anaesthesia and Intensive Therapy, UK; (email: fmostafa@rlbuh-tr.nwest.nhs.uk).
BACKGROUND: Excessive alcohol consumption is a major cause for premature death and preventable ill health in the whole population.
OBJECTIVE: We set out to audit admissions to the intensive care unit (ICU) of our large teaching hospital with respect to alcohol-related admissions.
METHODS: A prospective audit was conducted into alcohol-associated admissions to our university hospital adult ICU over 12 months. The following data were collected for each patient admitted: age, gender, diagnosis and amount of alcohol consumption, APACHE II score, and the probability of death.
RESULTS: Patients with definite alcohol consumption constituted 39.1% (124 patients) of all admissions (317 patients) to the ICU. In Group 1 (89 patients), the admission was directly associated with alcohol consumption, which included heavy alcohol consumption. Group 2 (35 patients) consisted of 'social drinkers'; and Group 3 was composed of patients who denied any alcohol intake. Group 1 had a high median APACHE II score of 19 (range 4-35) and a significantly higher mortality rate (41.6%) than Group 3 (18.4%, P < 0.001) or the entire sample studied (23.7%, P < 0.001). The results also demonstrated an incidence of pneumonia of 29.2% (26 patients) in alcohol-associated admissions compared with 22.8% (eight patients) in Group 2 and 21.8% (19 patients) in Group 3. Trauma admissions amounted to 11.4% of the patients studied (24/211 patients), 17 (70.8%) of whom were directly associated with alcohol and it included 11 pedestrians.
CONCLUSIONS: Alcohol may play a major role in the admission and mortality of ICU patients. Further investigations are warranted because our sample size is so small. (Copyright © 2002 Blackwell Publishing and the European Academy of Anaesthesiology)
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See L. Evans Abstract under Transportation
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No reports this week
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Locomotor milestones and babywalkers.
- Garrett M, McElroy AM, Staines A. BMJ 2002; 324(7352):1494.
Correspondence: Mary Garrett, University College, Dublin School of Physiotherapy, Mater Hospital, Dublin 7, IRELAND; (email: m.garrett@ucd.ie).
BACKGROUND: Investigations into the development of standing and walking in infants who used babywalkers (wheeled seats that allow infants to move around with their feet on the floor) obtained conflicting results.
METHODS: We performed a cross sectional survey of normal healthy infants born at term attending day care centers registered with the Foyle Health and Social Services Trust. A prestudy calculation identified a necessary sample size of 200. We asked parents to record the age at which their child reached the developmental milestones of raising the head when prone, rolling over, sitting with support, sitting alone, crawling, standing with support, walking with support, standing alone, and walking alone. Nine out of the 10 day centers chosen at random from 31 centers agreed to take part. Of 250 parents whose infants attended these nine day care centers 207 (83%) responded to a brief, circulated, anonymous, confidential questionnaire. We excluded 17 premature infants leaving 190 valid responses (83 boys and 107 girls). Given a standard deviation of 30 days, we designed the study to have 90% power to detect a two week difference in the mean age at achieving the developmental milestones. We performed linear regression and t tests.
RESULTS: One hundred and two infants used babywalkers (54%; 48 boys and 54 girls) starting at a median age of 26 (interquartile range 26-28) weeks and finishing at 54 (50-54) weeks. The median duration of use was 26 (22-29) weeks. Achieving crawling, standing alone, and walking alone occurred later in this group. Babywalker use was not associated with achieving sitting with support, sitting alone, standing with support, and walking with support. We found strong associations, however, between the amount of babywalker use and the extent of developmental delay. For example, each aggregated 24 hours of babywalker use was associated with a delay of 3.3 (95% confidence interval 2.5 to 4.1) days in walking alone and a delay of 3.7 (2.9 to 4.4) days in standing alone.
CONCLUSIONS: This study provides additional evidence that babywalkers are associated with delay in achieving normal locomotor milestones. Babywalkers are known to increase the risk of injuries in infancy. The use of babywalkers should be discouraged. (Copyright © 2002 British Medical Journal)
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Seasonal variations in injury rates during US Army Basic Combat Training.
- Knapik JJ, Canham-Chervak M, Hauret K, Laurin MJ, Hoedebecke E, Craig S, Montain SJ. Ann Occup Hyg 2002; 46(1): 15-23.
US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010, USA. (email: joseph.knapik@apg.amedd.army.mil).
OBJECTIVES: Previous literature suggests that injury rates during physical activity may be higher in the summer than in the fall or winter, possibly due to the greater amount or intensity of physical activity in the summer. This study examined seasonal differences in injury incidence during US Army Basic Combat Training, where physical activity was similar at all times of the year.
METHODS: Four independent groups of subjects (total n = 1543 men and 1025 women) were investigated, two training in the summer and two training in the fall. Injury data were obtained from a retrospective review of the subjects' medical records at the conclusion of the 8 week training program.
RESULTS: For men, the corrected relative risk of suffering an injury or a time loss injury in the summer was, respectively, 2.0 [95% confidence interval (CI) = 1.7-2.4] and 2.5 (95% CI = 1.9-3.0) times higher than in the fall. For women, the corrected relative risk of suffering an injury or time-loss injury in the summer was, respectively, 1.4 (95% CI = 1.3-1.6) and 1.7 (95% CI = 1.5-2.0) times higher than in the fall. These risks were essentially unchanged after adjustment for subject physical characteristics (age, stature, body mass, body mass index) and physical fitness (push-ups, sit-ups and 2 mile run), indicating that the summer season was an injury risk factor independent of these variables. Linear correlations (r-values) between maximal daily temperature and injury incidence ranged from 0.92 to 0.97, indicating a strong relationship between these two variables.
CONCLUSIONS: These data suggest that injury incidence among physically active individuals is higher in the summer than in the fall and that environmental temperature may provide a partial explanation for this finding. (Copyright © 2002 British Occupational Hygiene Society)
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Pedestrian risk decrease with pedestrian flow. A case study based on data from signalized intersections in Hamilton, Ontario.
- Leden L. Accid Anal Prev 2002 Jul;34(4):457-464.
Correspondence: Lars Leden,VTT Building and Transport, P.O. Box 1901, Sahkomiehentie 3, Espoo, FIN-02044 VTT, FINLAND; (email: lars.leden@vtt.fi).
A unique database provided information on pedestrian accidents, intersection geometry and estimates of pedestrian and vehicle flows for the years 1983-1986 for approximately 300 signalized intersections in Hamilton, Ont., Canada. Pedestrian safety at semi-protected schemes, where left-turning vehicles face no opposing traffic but have potential conflicts with pedestrians, were compared with pedestrian safety at normal non-channelized signalized approaches, where right-turning vehicles have potential conflicts with pedestrians. Four different ways of estimating hourly flows for left- and right-turning vehicles were explored. Hourly flows were estimated for periods of 15 min, hours, two periods a day (a.m. and p.m.) and the 'daily' period (7 h). Parameter estimates were somewhat affected by the time period used for flow estimation. However, parameter estimates seem to be affected far more by the traffic pattern (left- or right-turning traffic), even though approaches were selected such that the situation for left- and right-turning traffic was similar (no opposing traffic, no advanced green or other separate phases and no channelization). Left-turning vehicles caused higher risks for pedestrians than right-turning vehicles. At low vehicular flows right turns and semi-protected left turns seemed to be equally safe for pedestrians. When risks for pedestrians were calculated as the expected number of reported pedestrian accidents per pedestrian, risk decreased with increasing pedestrian flows and increased with increasing vehicle flow. As risk decreases with increasing pedestrian flows, promoting walking will have a positive effect on pedestrian risk at signalized intersections. (Copyright © 2002 Elsevier Science)
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No reports this week
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Parental permission for children's independent outdoor activities. Implications for injury prevention.
- Soori H, Bhopal RS. Eur J Public Health 2002; 12(2):104-109.
Correspondence: Hamid Soori, Department of Community Medicine, University of Ahwaz Medical Sciences, Ahwaz, IRAN; (email: 6IEA@aums.ac.ir).
BACKGROUND: Parental supervision is an important factor related to childhood injuries. However, little research has been done on; what outdoor activities children believe they are allowed or their parents allow them to do; parents' ideas about the age children can do activities, and the age they would allow their children to do them. This study described children's independent outdoor activities after-school, comparing age groups (school year 5 and 3), boys with girls, and the less socio-economically well off with the better off.
METHODS: A cross-sectional study using questionnaires completed by 476 children aged seven and nine years and 471 parents in nine primary schools in Newcastle-upon-Tyne, England.
RESULTS: Children reported they were permitted many outdoor activities such as cycling (78.8%), playing (78.6%) and roller skating in the street (62.7%). Parents of older children, boys, and more socio-economically deprived children were more likely than their comparison groups to allow children to do outdoor activities independently e.g. 34% of 9-year-olds were allowed to cross a road without an adult compared with 8% of 7-year-olds. Mostly, parents of boys and socio-economically deprived children, perceived children can do outdoor activities slightly younger than parents of girls and the socio-economically better off.
CONCLUSION: Children and parents value and support children's independent outdoor activity. Differences in children's and parents' understanding of what activities are permissible and in their judgments about the appropriate age for children's independent activities, may partly underline variations by sex, age and socio-economic status in injury patterns. (Copyright © 2002 Oxford University Press)
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No reports this week
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Injury inequalities: morbidity and mortality of 0-17 year olds in Israel.
- Gofin R, Avitzour M, Haklai Z, Jellin N. Int J Epidemiol 2002; 31(3): 593-599.
Correspondence: Rosa Gofin, Department of Social Medicine, Hadassah University Hospital, Ein Karem, Jerusalem 91120, ISRAEL; (email: gofin@cc.huji.ac.il).
OBJECTIVES: To determine whether there are inequalities in the incidence of fatal and non-fatal unintentional injuries among Jewish and Arab children in Israel.
METHODS: A nationwide random sample of injured children aged 0-17 attending emergency rooms (ER) during one year was selected (n = 11 058). The number of cases was weighted to 365 days and rates and odds ratios (OR) were calculated. Logistic regression was performed to study the OR of hospitalization in the total population and among Jews and Arabs controlling for independent variables.
RESULTS: The incidence of ER admissions among the Jews was 752.6/10 000 (95% CI: 738.1-767.1), 1.5 times higher than among the Arabs (492.8/10 000, 95% CI: 472.8-512.8). However, the rate of hospitalization was 1.1 times higher among Arabs than among Jews and the mortality rate was 3.2 times higher among Arabs than among Jews.
CONCLUSIONS: The differences in injury rates for fatal and non-fatal injuries may be due to differences in the severity of injuries or in the use of services by the two populations. A study is underway to elucidate this point. (Copyright © 2002 International Epidemiological Association)
Childhood burn injuries in north western Nigeria.
- Mungadi IA. Niger J Med 2002; 11(1):30-32.
Correspondence: I.A. Mungadi, Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, NIGERIA.
This 2-Year (1999-2000) prospective study was undertaken to determine the pattern and outcome of childhood burns at the Usmanu Danfodio University Teaching Hospital Sokoto, North Western Nigeria. A total of 108 children, 15 years and below, were seen. There were 67 males and 41 females giving a male to female ratio of 1.6:1. Domestic accidents were responsible for 100 (92.6%) cases. Hot liquids as the agents of injuries were recorded in 72 (66.7%) children. The mortality rate was 6.5% (7 cases), all males. Petrol explosion was responsible for 4 deaths. Another case is made for the reduction in the incidence, morbidity and mortality of burns by elevating the socio economic status of the community.
Differences in cause-specific patterns of unintentional injury mortality among 15-44-year-olds in income-based country groups.
- Ahmed N, Andersson R. Accid Anal Prev 2002; 34(4):541-545.
Correspondence: Niaz Ahmed, Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Norrbacka, S-171 76 Stockholm, SWEDEN; (email: niaz.ahmed@ks.se).
OBJECTIVES: The aim of the present study was to investigate the cause-specific patterns of unintentional injury mortality among 15-44-year-olds in various income-based country groups, and to analyze which specific causes contribute the most to the unintentional injury mortality in each country group.
METHODS: Cross-sectional data on the five most common causes of unintentional injury mortality by age-sex specific subgroups were compiled for 57 countries from the World Health Statistics Annuals for the year 1993 (1991-1994 if information for 1993 was unavailable). Data were categorized into four income-based country groups according to their gross national product (GNP) per capita for the year 1993. The differences between means and rate ratios of low, lower-middle, and upper-middle income countries were calculated by comparing them with those of the high-income countries. Regression analysis was performed to determine the trends in the direction of income for each specific cause of unintentional injury mortality by age-sex.
RESULTS: For any of the specific causes of unintentional injury mortality there was an inverse relationship between mortality rates and GNP per capita except for motor vehicle traffic (MVT) among the 15-24-year-old age group. MVT accidents were the most common cause and contributed 26-77% of all unintentional injury mortality. The second most common cause was poisoning in all country groups except low-income countries where drowning dominated for males and mixed causes for females. Upper-middle income countries represented the highest MVT mortality in all age-sex subgroups except among 15-24-year-old females for which high-income countries displayed the highest rate. For other causes, lower-middle income represented the highest rates with a few exceptions. In the 15-24-year age group, the rate ratio of motor vehicle traffic mortality was higher in high-income countries compared to low-income countries, while in the 35-44-year age group, all other country groups showed a higher rate ratio than high-income countries. Drowning for males and burns for females in the low and middle-income countries were significantly higher than in high-income countries. (Copyright © 2002 Elsevier Science)
Accidents in children do not happen at random: predictable time-of-day incidence of childhood trauma.
- Reinberg O, Reinberg A, Tehard B, Mechkouri M. Chronobiol Int 2002; 19(3):615-631.
Correspondence: Olivier Reinberg, Service de Chirurgie Pediatrique, Centre Hospitalier Universitaire Vaudois, Lausanne, SWTIZERLAND; olivier.reinberg@chuv.hospvd.ch).
In a prospective study, 15,110 childhood traumas were recorded by the Pediatric Surgery Service (CHUV, Lausanne) between January 1, 1990 and December 31, 1997. The exact clock hour when the injury occurred and other germane data were obtained. Time series thus obtained were analyzed by several statistical (ANOVA, cosinor, chi square, Table Curve, etc.) methods. High statistically significant circadian patterns were detected with a trough at night--almost no traumas/hour (t/h), and a peak in the afternoon (approximately 16:00h)--9.3 +/- 0.4 (SD) t/h. Such 24h variation was validated for the whole sample for the entire 8 yr study span as well as the data of each year. Neither gender- nor age-related differences in the 24h pattern were detected between children under 5 yr of age, who have not yet attended school and children from 5 to 16 yr of age, who attend school. Small but statistically significant differences in the 24h patterns were observed when categorized by the type of activity associated with the trauma and the place of trauma occurrence. The great stability of the 24h pattern in childhood trauma over the 8 yr study span suggests an endogenous origin in addition to the role presumably played by environmental factors. Periods of 12 and 8h were also detected in the time series. The afternoon peak time of childhood traumas differs from that of adults, which is located approximately 04:00h in rotating shift workers and automobile drivers and 06:00-08:00h in adult day-workers. The validation of a circadian pattern in childhood traumas with an afternoon peak should be taken into account in the design of children's preventative injury programs. (Copyright © 2002 International Society for Chronobiology and Marcel Dekker Publishing)
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Stories or statistics? Farmers' attitudes toward messages in an agricultural safety campaign.
- Morgan SE, Cole HP, Struttmann T, Piercy L. J Agric Saf Health 2002; 8(2): 225-239.
Correspondence: Susan E. Morgan, School of Communication, Information, and Library Studies, Rutgers University, 4 Huntington Street, New Brunswick, New Jersey 08901-1071, USA; (email: semorgan@scils.rutgers.edu).
Farming is the second most hazardous occupation in the U.S. The high mortality rate is due in large part to farm equipment hazards, particularly tractor overturns. Injuries and deaths associated with tractor overturns could be prevented with the use of a rollover protective structure (ROPS). In spite of the known dangers associated with overturn incidents, farmers are reluctant to retrofit ROPS on older tractors. Few agricultural safety campaigns target the issue of ROPS retrofits, and none have been evaluated systematically. This article reports a study that examines a set of messages that were central to the Community Partners for Healthy Farming project. This study indicates that narrative-based messages and messages incorporating fear appeals are more favorably evaluated by farmers than messages that simply inform farmers or messages that rely on statistics. (Copyright © 2002 American Society of Agricultural Engineers)
Childhood agricultural injury prevention: Progress report and updated national action plan from the 2001 Summit.
- Lee B, Gallagher S, Marlenga B. Hard D. (2002) Marshfield, WI: Marshfield Clinic, National Children's Center for Rural and Agricultural Health and Safety.
Available online: ( Download Document ).
Nearly 100 farmers, growers, researches, educators, physicians, and others participated in the 2001 Summit on Childhood Agricultural Injury Prevention. The goal of the Summit was to propose specific injury prevention strategies based on knowledge gained from research and interventions undertaken since the endorsement of the 1996 National Action Plan. The report presents 12 specific recommendations which are proposed within the framework of: non-working children, working children and adolescents, and infrastructure and leadership. The recommendations are based on three major goals: (1) adults will ensure that young children and non-working youth can grow, play, learn, and rest in protective environments that are free of agricultural hazards; (2) young workers will receive agricultural safety training, guidance on personal protective equipment and adult supervision based on child development principals; (3) a strong public/ private infrastructure will be maintained to insure the vision, leadership, and national commitment necessary to prevent childhood agricultural injuries.
Knowledge, attitude, practice, and toxicity symptoms associated with pesticide use among farm workers in the Gaza Strip.
- Yassin MM, Abu Mourad TA, Safi JM. Occup Environ Med 2002; 59(6):387-393.
Correspondence: J. M. Safi, Environmental Protection and Research Institute, EPRI-Gaza, Palestine, PO Box 1175, Gaza, PALESTINIAN NATIONAL AUTHORITY; (email: eprigaza@palnet.com).
OBJECTIVES: To assess knowledge, attitude, practice, and toxicity symptoms associated with pesticide use and exposure among 189 farm workers in the Gaza Strip.
METHODS: A cross section of agricultural farm workers in the Gaza Strip were asked to fill in a questionnaire on knowledge, attitudes, practice towards pesticide use, and associated toxicity symptoms.
RESULTS: Farm workers reported high levels of knowledge on the health impact of pesticides (97.9%). Moderate to high levels of knowledge were recorded on toxicity symptoms related to pesticides. Most farm workers were aware of the protective measures to be used during applying pesticides. However, no one took precautions unless they knew about the measures. Burning sensation in eyes/face was the commonest symptom (64.3%). The prevalence of self reported toxicity symptoms was dependent on mixing and use of high concentrations of pesticides. The highest percentage of self reported toxicity symptoms was found among the farm workers who returned to sprayed fields within one hour of applying pesticides.
CONCLUSIONS: Farm workers in the Gaza Strip used pesticides extensively. Despite their knowledge about the adverse health impact of the pesticides, the use of protective measures was poor. Most had self reported toxicity symptoms, particularly the younger workers. It would be useful to minimize the use of pesticides and encourage alternative measures. Prevention and intervention programs regarding the use of protective measures and monitoring the health status of farm workers should be implemented. (Copyright © 2002 Occupational and Environmental Medicine)
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The Relative Risks of School Travel: A National Perspective and Guidance for Local Community Risk Assessment.
- Committee on School Transportation Safety, National Research Council. Washington, DC: National Academy Press, 2002.
Available online: ( Download document ).
Children in the United States travel to and from school and school-related activities by a variety of modes. Because parents and their school-aged children have a limited understanding of the risks associated with each mode, it is unlikely that these risks greatly influence their school travel choices. Public perceptions of school transportation safety are heavily influenced by school bus (i.e. "yellow bus") services. When children are killed or injured in crashes involving school buses, the link to school transportation appears obvious. However, when children are killed or injured in events that occur when they are traveling to or from school by other modes, the risks are not recorded in a school-related category. Despite such limitations and the fact that estimates of the risks across school travel modes are confounded by inconsistent and incomplete data, sufficient information is available to make gross comparisons of the relative risks among modes used for school travel and to provide guidance for risk management.
Each year approximately 800 school-aged children are killed in motor vehicle crashes during normal school travel hours. This figure represents about 14 percent of the 5,600 child deaths that occur annually on U.S. roadways and 2 percent of the nation's yearly total of 40,000 motor vehicle deaths. Of these 800 deaths, about 2 percent -- 5 school-bus passengers and 15 pedestrians -- are school bus related. The other 98 percent occur in passenger vehicles or to pedestrians, bicyclists, of motorcyclists. A disproportionate share of these passenger vehicle-related deaths (55 percent) occur when a teenager is driving. About 80 percent of the 152,000 non-fatal travel injuries to school-age children during school travel hours occur in passenger vehicles and 11 percent to pedestrians and bicyclists.
This 180 page document provides estimates of the risk of injury from different travel modes, several recommendations for improving school travel safety, and a discussion of numerator and denominator issues in risk calculation. (Copyright © 2002 National Academy of Sciences)
Bullying in the school environment: an injury risk factor?
- Laflamme L, Engström K, Möller J, Alldahl M, Hallqvist J. Acta Psychiatr Scand Suppl 2002; 106(s412): 20-25.
Correspondence: Lucy Laflamme, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, SE-171 76 Stockholm, SWEDEN, (e-mail: lucie.laflamme@phs.ki.se).
BACKGROUND: Injury research suggests that both structural factors, such as one's social and physical environment, and triggering factors influence injury occurrence and processes. Yet, little has been achieved that clarifies what these factors are, how they interact with one another, and whether they operate in the same manner for intentional and unintentional injuries. There is evidence that bullying - apart from being a widespread problem, both in Sweden and in other countries - could be an injury trigger. As different children react differently to the fact of being bullied, it can be expected that unintentional injuries could be triggered by exposure to bullying through flight from the bully or through inattention from worry. Intentional self-harm and interpersonal violence may also result. The effect of a trigger can be immediate of delayed by hours or days.
OBJECTIVES: To describe a research project assessing the role of bullying at school as an injury trigger and the modification effect of the socio-economic environment of the victims. Preliminary results are also presented.
METHODS: A case-crossover and a case-referent design were combined. The study base consisted of all children aged 10-15years residing in the Stockholm county in 2000-02. Cases were recruited at the county's children hospital and interviewed shortly after the injury, using a specially designed questionnaire.
RESULTS: Preliminary analyses (261 interviews) reveal that about two injured children out of 10 reported having been bullied during the school term. Also, one out of 10 had been bullied shortly enough before the injury for bullying to be considered as a trigger. The circumstances of occurrence of those injuries varied.
CONCLUSIONS: Bullying, apart from being frequent in the school environment, is quite likely to act as an injury trigger. (Copyright © 2002 Blackwell Publishing)
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Suicide by drowning: a 20-year review.
- Wirthwein DP, Barnard JJ, Prahlow JA. J Forensic Sci 2002; 47(1):131-136.
Southwestern Institute of Forensic Sciences, Dallas, TX, USA.
Drowning as a method of suicide is known to occur, but has primarily been described in environments with readily available access to water, such as coastal regions. In this study, we describe and analyze a series of suicidal drownings occurring in a noncoastal area of Texas. Between 1977 and 1996, 52 cases of suicidal drowning were investigated at the Southwestern Institute of Forensic Sciences in Dallas, Texas. Such deaths accounted for only 0.85% of all suicides and 4% of all drowning deaths. In contrast. suicidal drownings reportedly account for 2.8 to 8.9% of all suicides in regions with easy access to water. As with other studies of suicidal drowning, the victims are usually sober white males over the age of 40 years. Our results also confirm that certain individuals who commit suicide by drowning use weights to facilitate the process. A detailed analysis of the cases is provided. as is a synopsis of several questions that may aid in determining the manner of death in suicidal drowning cases. (Copyright © 2002 American Academy of Forensic Sciences)
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Traffic crashes: Measures to make traffic safer are most effective when they weigh the relative importance of factors such as automotive engineering and driver behavior.
- Evans L. Am Scientist 2002 90(3): 244-253.
Correspondence: Science Serving Society, 973 Satterlee Road, Bloomfield Hills, MI 48304 USA; (email: le@scienceservingsociety.com).
More than a million people are killed on the world's roads each year. The total number of traffic deaths is rising as nations depend increasingly on automobiles for transportation, but the number of traffic crash deaths per motor vehicle has declined over time. The pace at which fatality rates are declining varies greatly among different nations. Factors that affect fatality rates include road design, mechanical failure, the use of safety belts and driver behavior. A number of nations, including Canada, Britain, Australia and Sweden, have reduced their annual road fatalities to less than half their peak values, but U.S. fatalities are still within 24 percent of their all-time high. Indeed, since the mid 1960s, the United States has slipped from having the lowest traffic fatality rates in the world to 13th place. A disproportionate emphasis on vehicular factors affecting safety has distracted Americans from the importance of driver behavior. (Copyright © 2002 Sigma Xi, The Scientific Research Society)
Epidemiology of accidents among users of two-wheeled motor vehicles. A surveillance study in two Italian cities.
- LaTorre G, Bertazzoni G, Zotta D, van Beeck E, Ricciardi G. Eur J Public Health 2002; 12(2):99-103.
Correspondence: Giuseppe Latorre, Chair of Hygiene, University of Cassino, Viale Bonomi 8, 03043 Cassino, FR, ITALY; (email: latorre@unicas.it).
BACKGROUND: This paper describes a study on the epidemiology of accidents among users of two-wheeled motor vehicles in two Italian cities, Rome and Naples.
METHODS: A surveillance study was conducted, recruiting the victims of accidents among users of two-wheeled motor vehicles, visiting the emergency departments of two Italian hospitals. The registration form includes personal data of the involved person, circumstances of the accident, means of arrival at the hospital, type of vehicles involved, helmet use, and eventually third parties involved, and data on the specific injury diagnosis.
RESULTS: 736 injured drivers of two-wheeled motor vehicles were investigated for the study (65.1% males, 34.9% females). The mean age of the victims was 22.92 years; 42.9% of the injuries were the result of a single accident. In 35.5% of the injuries cars were involved and in 8.6% of the cases there was a passenger included. Only 12% of the injured people were wearing a helmet. Most of the lesions concerns the knee or lower leg (27.5%), followed by the head (17.5%), elbow and forearm (8.8%), wrist and hand (8.6%), shoulder and upper arm (8.4%) and ankle and foot (6.9%). Helmet use has a protective effect (OR = 0.23), whereas accidents in Naples and during dark hours are associated with an increased risk of head injury (respectively OR = 1.93, and OR = 1.46).
CONCLUSION: In this study the lower injury risk due to the use of the helmet on the frequency and severity of head trauma was confirmed. Moreover, the results confirm that Emergency Departments can provide essential epidemiological information, and they have already provided clear arguments in favor of extending the compulsory use of helmets to people above 18 years in Italy.(Copyright © 2002 Oxford University Press)
Road traffic accidents in the United Arab Emirates: trends of morbidity and mortality during 1977-1998.
- El-Sadig M, Norman JN, Lloyd OL, Romilly P, Bener A. Accid Anal Prev 2002; 34(4): 465-476.
Correspondence: Mohammed El-Sadig, Department of Community Medicine, Faculty of Medicine and Health Sciences, UAE University, UNITED ARAB EMIRATES, Al Ain; ( email: Msadig@uaeu.ac.ae).
High rates of serious road traffic accidents (RTAs) have been reported for several Arabian Gulf countries, including the United Arab Emirates (UAE). in recent years. This study aims to describe quantitatively the morbidity and mortality from RTAs in the UAE, to identify their trends during the period 1977-1998, to compare the results with those of developed countries, and to evaluate the information available on possible causes with a view to identifying the most useful direction for future research. Data were obtained from UAE's police and health sources and, for international comparison, from WHO Statistics reports and the published literature. Overall and cause-specific fatality and injury rates of RTAs were calculated. Estimates of trends were achieved by using linear regression. The characteristics of road users injured or killed were also analyzed. The results revealed that during the period 1977-1998, the rates of RTAs per 100,000 population and per 100,000 motor vehicles declined in the UAE by a trend component of -56.3 (P < 0.001: R2 = 0.69) an
d -521.8 (P< 0.001; R2=0.92), respectively. RTA fatality and injury rates based on the same denominators also declined by -1.1 (P < 0.001; R2 = 0.56) and -13.3 (P < 0.001; R2 = 0.47); and by -3.8 (P < 0.02; R2 = 0.23) and - 90.0 (P < 0.001; R2 = 0.59), respectively. Paradoxically, however, except for a short period (1977-1985), a steady increase in the risk of injury and death in each RTA accompanied these declines. Between 1985 and 1998 the severity rate (the ratio of fatalities and injuries per 1,000 RTAs) more than tripled in the UAE. The UAE's rates were high when compared with a number of selected countries. The cause for the increasing severity of RTAs is not clear but the most likely cause could lie in speeding, careless driving, the changing vehicle mix on the roads and the standard of immediate care available for victims. Further investigation is essential and will require close collaboration between police and health authorities. (Copyright © 2002 Elsevier Science)
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A public-health perspective on violence.
- Melinder K. Acta Psychiatr Scand Suppl 2002; 106(s412): 6-8.
Correspondence: Karin Melinder, Sweden's National Institute of Public Health, Stockholm, Sweden. (email: karin.melinder@fhinst.se).
OBJECTIVE: To describe how specific theories and methods used in public health, especially regarding injuries, are related to violence.
METHOD: Theories and preventive work in injury research (above accidents) are presented and related to violence.
RESULTS:: Registration of injuries and an interest in the environment are seen as specific for injuries. In prevention there is a focus on community work and the concept of 'a safe community' has been developed. Haddon's matrix offers a foundation for theoretical injury research. It is formed by cross-tabulating the trichotomy of host-agent-environment against a time dimension.
CONCLUSION: One practical and one theoretical model on how violence might be seen as an injury have been demonstrated. No clear evaluation has been made of the practical model up to now. The theoretical model has the advantage that the model makes it easier to get a more comprehensive picture of how different factors influence violence. (Copyright © 2002 Elsevier Science)
Adolescents murderers: abuse and adversity in childhood.
- Hill-Smith AJ, Hugo P, Hughes P, Fonagy P, Hartman D. J Adolesc 2002; 25(2):221-230.
Correspondence: Andrew J. Hill-Smith, Frimley Children's Centre, Church Rd, Frimley, Camberley, Surrey, GU16 5AD, UK.
With rising rates of juvenile violence, an improved understanding of its causes is much needed. The relative absence of controlled studies based on British populations of murderers further increases the need for information in this area. This case control study examines a group of 21 imprisoned males, convicted of murder whilst aged 18 years or less, and compares them on a range of psychosocial variables to 21 convicted non-violent burglars. The groups were matched for age at interview and race. Results showed that lower socio-economic status, harsh parenting from both mother and father, and exclusion from school were significantly more common for murderers. Harsh parenting from the mother than from the father appeared to contribute more strongly. When factors were combined in a general adversity index, a significant difference was found between the two groups. The study confirms that multiple environmental factors are associated with murderous behavior in young men. (Copyright © 2002 The Association for Professionals in Services for Adolescents and Elsevier Science)
Do juveniles bully more than young offenders?
- Ireland JL. J Adolesc 2002; 25(2): 155-168.
Correspondence: Jane L. Ireland, Psychology Department, Ashworth Hospital, Parkbourn, Liverpool L31 1HW, UK; (email: Irelan-J@ashworth.nwest.nhs.uk).
This study compares bullying behavior among juvenile and young offenders and incorporates two different methods to measure bullying. Ninety-five male juvenile and 196 male young offenders completed two questionnaires, one that measured bullying directly and one that measured behaviors indicative of "being bullied" or of "bullying others". Juveniles perceived a higher extent of bullying than young offenders. Juveniles reported significantly more physical, psychological or verbal and overall direct forms of bullying behavior than young offenders. A number of differences were found between juveniles and young offenders with regard to the types of prisoners likely to become victims, who they would advise a victim to speak to and how bullying could be prevented. The results are discussed in relation to developmental theories of aggression and how bullying behavior can be defined and measured among prisoners. (Copyright © 2002 The Association for Professionals in Services for Adolescents and Elsevier Science)
Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: a retrospective study.
- Mahajna A, Aboud N, Harbaji I, Agbaria A, Lankovsky Z, Michaelson M, Fisher D, Krausz MM. Lancet 2002; 359(9320): 1795-800.
Correspondence: Michael M Krausz, Department of General Surgery, Rambam Medical Center, POB 9602, 31096 Haifa, ISRAEL; (email: m_krausz@rambam.health.gov.il).
BACKGROUND: Low-velocity rubber bullets were used by Israeli police to control riots by Israeli-Arabs in early October, 2000. We aimed to establish the factors that contribute to severity of blunt and penetrating injuries caused by these missiles.
METHODS: We analyzed medical records of 595 casualties admitted. We assessed relation of severity of injury to type of bullet, anatomical region of injury, and final outcome. Severity of injury was established by the abbreviated injury scale, and we calculated injury severity score.
RESULTS: 151 males and one female (age range 11-59 years) were included in the study, in whom 201 proven injuries by rubber bullets were detected. Injuries were distributed randomly over the body surface and were mostly located in the limbs (n=73), but those to the head, neck, and face (61), chest (39), back (16), and abdomen (12) were also frequently noted. 93 (61%) patients had blunt injuries and 59 (39%) penetrating ones. Severity of injury was dependent on ballistic features of the bullet, firing range, and anatomic site of impact. Two casualties died after a penetrating ocular injury into the brain and one died as a result of postoperative aspiration after a knee injury.
CONCLUSIONS: Resistance of the body surface at the site of impact (elastic limit) is the important factor that ascertains whether a blunt or penetrating injury is inflicted and its severity. Inaccuracy of rubber bullets and improper aiming and range of use resulted in severe injury and death in a substantial number of people. This ammunition should therefore not be considered a safe method of crowd control. (Copyright © 2002 The Lancet)
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