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19 August 2002

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

Alcohol & Other Drugs Commentaray & Editorials
  • No reports this week

  • No reports this week

Occupational Issues
  • A survey of forest workers in New Zealand. Do hours of work, rest, and recovery play a role in accidents and injury?

    Lilley R, Feyer AM, Kirk P, Gander P. J Safety Res 2002; 33(1):53-71.

    Correspondence: Rebecca Lilley, Department of Preventive and Social Medicine, New Zealand Environmental and Occupational Health Research Center, Box 913, Dunedin, NEW ZEALAND; (email: [email protected]).

    (Copyright © 2002 Elsevier Science)

    BACKGROUND: A number of structural and organizational changes have occurred recently within the New Zealand Forestry Industry, with concerns being raised about the impact of these changes on the forestry worker in terms of fatigue, sleepiness, and compromised safety. This study explored the relationship of fatigue, and some of its key determinants, with accidents and injuries in a group of forestry industry workers in New Zealand.

    METHOD: A total of 367 forestry workers responded to a self-administered questionnaire.

    FINDINGS: Fatigue was found to be commonly experienced at work in the forest, with 78% of workers reporting that they experienced fatigue at least "sometimes." This study found that certain groups of workers reported long working hours, reduced sleep, compromised recovery time, and intensely paced work. The results of logistic regression analysis showed that recent sleep, number of breaks taken during the workday, and specific job/tasks were independently associated with reporting of high fatigue levels at work. Near-miss injury events were significantly more common among those reporting a high level of fatigue at work. Accidents and lost-time injury were associated with length of time at work, ethnicity, and having had near-miss injury events.

    DISCUSSION: Together, these results suggest that fatigue and aspects of work organization, which are likely to be fatiguing, may be associated with compromised safety for forest workers. With an already slim margin of error present in forest operations, an impairment due to increased fatigue may constitute a significant risk factor for accidents and injuries in this workforce. The results indicate the need for further examination of shift and workload management among forestry workers, as well as a role for improving industry awareness about the causes and consequences of fatigue.

Pedestrian & Bicycle Issues
  • Behavior Change Counseling in the Emergency Department to Reduce Injury Risk: A Randomized, Controlled Trial.

    Johnston BD, Rivara FP, Droesch RM, Dunn C, Copass MK. Pediatrics 2002; 110(2): 267-274.

    Correspondence: Brian D. Johnston, Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington 98104, USA; (email: [email protected]).

    (Copyright © 2002 American Academy of Pediatrics)

    OBJECTIVE: To determine whether a brief session of behavior change counseling (BCC), offered to injured adolescents in the emergency department (ED) as a therapeutic intervention, could be used to change injury-related risk behaviors and the risk of reinjury.

    METHODS: Design- A randomized, controlled trial. Participants- Adolescents between 12 and 20 years old who were undergoing treatment for an injury in the ED and who were cognitively able to participate in the intervention. Setting- An urban ED at a level 1 pediatric trauma center. Intervention- Study participants completed a baseline risk behavior prevalence assessment. Participants were then randomly assigned to receive BCC or routine ED care. Those in the treatment group underwent a brief session of BCC with a study social worker focused on changing an identified injury-related risk behavior (seatbelt use, bicycle helmet use, driving after drinking, riding with an impaired driver, binge drinking, or carrying a weapon). Participants were recontacted 3 months and 6 months after enrollment to assess the prevalence of positive behavior change and the interim occurrence of medically treated injuries.

    FINDINGS: We enrolled 631 participants (78% of those eligible) and obtained follow-up for 76% at 3 months and 75% at 6 months. The relative risk of a positive behavior change with respect to seatbelt use was 1.34 (95% confidence interval [CI]: 1.00, 1.79) at 3 months, favoring the intervention group. The relative risk for the same outcome was 1.47 (95% CI: 1.09, 1.96) at 6 months. A positive change in bicycle helmet use was 1.81 (95% CI: 1.02, 3.18) times more likely at 3 months and 2.00 (95% CI: 1.00, 4.00) times more likely at 6 months in the intervention group. There was no effect of the intervention on changes in other target behaviors. Over the 6-month follow-up period, the risk of reinjury requiring medical attention did not differ between treatment groups.

    DISCUSSION: Brief BCC can be delivered to adolescents undergoing treatment for injury in the ED and can be used to address injury-related risk behaviors. The intervention was associated with a greater likelihood of positive behavior change in seatbelt and bicycle helmet use. This effect lasted over 6 months of follow-up. BCC was not associated with changes in other risk behaviors and could not be shown to significantly reduce the risk of reinjury.

  • An evaluation of an engineering control to prevent carbon monoxide poisonings of individuals on and around houseboats.

    Earnest GS, Dunn KH, Hall RM, McCleery RE, McCammon JB. Am Ind Health Assn J 2002; 63(3): 361-369.

    Correspondence: Gary Scott Earnest, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 4676 Columbia Parkway, Cincinnati, OH 45226, USA; (email [email protected]).

    (Published by the American Industrial Hygiene Association and Allen Press)

    From 1990 to 2000, a total of 111 carbon monoxide (CO) poisonings occurred on Lake Powell near the Arizona and Utah border. Seventy-four of the poisonings occurred on houseboats, and 64 were attributable to generator exhaust alone. Seven of the 74 houseboat-related CO poisonings resulted in death. Although many of the reported CO poisonings occurred to members of the general public, some poisonings involved workers performing houseboat maintenance. The National Institute for Occupational Safety and Health evaluated an engineering control retrofitted to a houseboat gasoline-powered generator to reduce the hazard of CO poisoning from the exhaust. The control consisted of a water separator and a 17-foot exhaust stack that extended 9 feet above the upper deck of the houseboat. When compared to a houseboat having no engineering controls, study results showed that the exhaust stack provides a dramatically safer environment to individuals on or near the houseboat. CO concentrations were reduced by 10 times or more at numerous locations on the houseboat. Average CO concentrations near the rear swim deck of the houseboat, an area where occupants frequently congregate, were reduced from an average of 606.6 ppm to 2.85 ppm, a reduction greater than 99%. CO concentrations were also reduced on the upper deck of the houseboat. Hazardous CO concentration in the confined area beneath the near swim deck were eliminated. Based on the results of this study, it is clear that houseboats having gasoline-powered generators that have been outfitted from the factory or retrofitted with an exhaust stack that extends well above the upper deck of the boat will greatly reduce the hazard of CO poisoning.

  • Discrepant advice from poison centres and their medical directors.

    Juurlink DN, Szalai JP, McGuigan MA. Can J Clin Pharmacol 2002; 9(2): 101-105.

    Correspondence: David N. Juurlink, Sunnybrook and Women's College Health Sciences Centre, Rm. G-106, 2075 Bayview Ave., Toronto ON M4N 3M5, CANADA; (email: [email protected]).

    (Copyright © 2002 Plusus Group and Canadian Society for Clinical Pharmacology)

    OBJECTIVES: To characterize the recommendations of the medical directors of North American poison information centers for gastrointestinal decontamination of a hypothetical poisoned patient, and to examine the extent to which those recommendations agree with the advice previously issued by their poison information centers for the same scenario.

    METHODS: The medical directors of 72 poison centers in the United States and Canada were contacted and invited to participate in a survey. Each participant was asked to provide specific advice for gastrointestinal decontamination of a hypothetical patient presenting 1 h after a potentially life-threatening ingestion (32.5 g) of enteric-coated acetylsalicylic acid. The directors were then presented with the recommendation their poison centers had previously issued for the same overdose scenario. The main outcome measures were perceived agreement with their own center's recommendation and director-center concordance for each method of gastrointestinal decontamination.

    FINDINGS: Sixty-seven of 72 (93%) medical directors participated in the survey. They issued 30 different management suggestions for our hypothetical patient, and were in full agreement with their own centers 27% of the time. Concordance was moderate for recommendations on syrup of ipecac (k=0.468, P < 0.001), and fair for whole bowel irrigation (k=0.348, P=0.005) and the use of sorbitol with activated charcoal (k=0.305, P=0.005). Concordance was poorest for advice on gastric lavage (k=0.093, P=0.445) and multidose charcoal (k=0.039, P=0.745).

    DISCUSSION: The medical directors of North American poison centers offer widely varying advice on gastrointestinal decontamination for a hypothetical patient who is acutely poisoned with enteric-coated acetylsalicylic acid. Their advice was often different from that previously issued by their respective centers.

Recreation & Sports Research Methods
  • No reports this week

  • 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): 541-551.

    Correspondence: Niaz Ahmed, Department of Public Health Sciences, Karolinska Institute, Stockholm, SWEDEN; (email: [email protected]).

    (Copyright © 2002 Elsevier Science)

    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.

    FINDINGS: 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.

  • Incidence and patterns of spinal cord injury in Australia.

    O'Connor P. Accid Anal Prev 2002; 34(4): 405-415.

    Correspondence: Peter O'Connor, AIHW National Injury Surveillance Unit, Research Centre for Injury Studies, Flinders University, Bedford Park, SA, AUSTRALIA; (email: [email protected]).

    (Copyright © 2002 Elsevier Science)

    The objective of this paper is to report on the epidemiology of spinal cord injury (SCI) based on the Australian SCI register and to discuss the implications for prevention. All adult cases of SCI are reported to the registry. The case reports for 1998/1999 were aggregated and described. The age adjusted rate of persisting SCI was 14.5 per million of population. Rates were highest in young adults and in males. The vast majority of cases (93%) were due to unintentional injury. Forty-three percent were due to motor vehicle crashes, principally from motor vehicle rollover. Cases of SCI from falls, aquatic activities, and working for income are also described. Incomplete cervical cord injuries were most common (38%), particularly as a result of motor vehicle crashes and low falls. The study indicates that the surveillance of SCI needs to be improved internationally so that comparative studies can be undertaken. It is recommended that the Centers for Disease Control case definition be adopted. Australia is one of the few countries that have a register based on that case definition, and the only one that has a register covering a full national adult population. The results presented on the basis of this data source provide some hitherto unavailable information on the incidence rates and patterns of SCI. National population based surveillance is fundamental to an understanding of the epidemiology, and hence the prevention, of this severe and costly health and welfare problem.

  • A statewide population-based study of gender differences in trauma: validation of a prior single-institution study.

    Gannon CJ, Napolitano LM, Pasquale M, Tracy JK, McCarter RJ. J Am Coll Surg 2002; 195(1): 11-18.

    Correspondence: Lena M. Napolitano, Department of Surgery, University of Maryland School of Medicine,10 N Greene St, Room 5C-122, Baltimore, MD 21201 USA; (email: [email protected]).

    (Copyright © 2002 American College of Surgeons)

    BACKGROUND: Women usually have lower mortality rates than men do at any age. This pattern is observed for most causes of death from chronic diseases. Significant controversy still exists about gender differences in outcomes in trauma. We previously reported no differences in in-hospital mortality based on gender in a large single-institution study (n= 18,892) that had a significant limitation in that it was not population based. This current study was performed to validate our earlier findings in a separate, statewide, population-based dataset of trauma victims.

    METHODS: Prospective data were collected on 22,332 trauma patients (18,432 blunt, 3,900 penetrating) admitted to all trauma centers (n = 26) in Pennsylvania over 24 months (January 1996 to December 1997). Gender differences in in-hospital mortality were determined for the entire dataset and for the subsets of blunt and penetrating injury patients. A second analysis examined all blunt injury patients and excluded all patients with a hospital length of stay of less than 24 hours, eliminating patients who expired soon after admission. The null hypothesis was that female gender is protective in trauma outcomes.

    FINDINGS: Multiple logistic regression analysis identified age (odds ratio [OR] 1.03, confidence interval [CI] 1.02 to 1.03), Injury Severity Score (OR 1.06, CI 1.05 to 1.06), non-Caucasian race (OR 1.72, CI 1.39 to 2.15), blunt injury type (OR 0.327, CI 0.26 to 0.41), and Revised Trauma Score (OR 0.44, CI 0.41 to 0.47) as independent predictors of in-hospital mortality in trauma. Preexisting diseases, including cardiac disease (OR 1.53, CI 1.12 to 2.09) and malignancy (OR 4.08, CI 1.64 to 10.17), were also identified as independent predictors of in-hospital mortality in trauma. Female gender was not associated with decreased mortality (OR 0.83, CI 0.67 to 1.03, p = 0.093). A second multiple regression analysis in blunt trauma patients admitted for longer than 24 hours (which eliminated early deaths and patients with minor injuries) determined that in-hospital mortality was not significantly different in male or female blunt trauma patients stratified by Injury Severity Score and age. The same factors that were predictive of in-hospital mortality in the total dataset were also significant in this secondary analysis.

    DISCUSSION: These population-based data confirm that female gender does not adversely affect in-hospital mortality in trauma when patients are appropriately stratified for other variables, including Injury Severity Score and age, that do significantly affect outcomes.

Injuries at Home
  • No reports this week

Rural & Agricultural Issues School Issues
  • No reports this week

Suicide Transportation Violence

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Rev. 17 Aug-2002 at 23:16 hours.