Showing papers in "Injury Prevention in 2005"

Gender differences for non-fatal unintentional fall related injuries among older adults

Abstract: Objectives: To quantify gender differences for non-fatal unintentional fall related injuries among US adults age 65 years and older treated in hospital emergency departments (EDs). Methods: The authors analyzed data from a nationally representative sample of ED visits for January 2001 through December 2001, available through the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). For each initial ED visit, coders record one principal diagnosis (usually the most severe) and one primary part of the body affected. Results: Based on 22 560 cases, an estimated 1.64 million older adults were treated in EDs for unintentional fall injuries. Of these, approximately 1.16 million, or 70.5%, were women. Fractures, contusions/abrasions, and lacerations accounted for more than three quarters of all injuries. Rates for injury diagnoses were generally higher among women, most notably for fractures which were 2.2 times higher than for men. For all parts of the body, women's injury rates exceeded those of men. Rate ratios were greatest for injuries of the leg/foot (2.3), arm/hand (2.0), and lower trunk (2.0). The hospitalization rate for women was 1.8 times that for men. Conclusions: Among older adults, non-fatal fall related injuries disproportionately affected women. Much is known about effective fall prevention strategies. We need to refine, promote, and implement these interventions. Additional research is needed to tailor interventions for different populations and to determine gender differences in the underlying causes and/or circumstances of falls. This information is vital for developing and implementing targeted fall prevention strategies.

Fatal motor vehicle crashes in rural and urban areas: decomposing rates into contributing factors

Abstract: Objectives: Motor vehicle crash fatality rates have been consistently higher in rural areas than in urban areas. However, the explanations for these differences are less clear. In this study the decomposition method was used to explore the factors associated with increased fatal crash involvement rates in rural communities. Design: Using national databases, the fatal crash incidence density was decomposed into the product of three factors: the injury fatality rate, the crash injury rate, and the crash incidence density. Results: As expected, the fatal crash incidence density was more than two times higher in rural than in urban areas. This was driven primarily by the injury fatality rate, which was almost three times higher in rural areas. Conclusions: Further research should examine the relative roles of crash severity and the timely receipt of definitive medical care after a crash.

Cross national study of injury and social determinants in adolescents

Abstract: Objectives: To compare estimates of the prevalence of injury among adolescents in 35 countries, and to examine the consistency of associations cross nationally between socioeconomic status then drunkenness and the occurrence of adolescent injury. Design: Cross sectional surveys were obtained from national samples of students in 35 countries. Eight countries asked supplemental questions about injury. Setting: Surveys administered in classrooms. Subjects: Consenting students (n = 146 440; average ages 11–15 years) in sampled classrooms. 37 878 students (eight countries) provided supplemental injury data. Exposure measures: Socioeconomic status (material wealth, poverty) and social risk taking (drunkenness). Outcome measures: Specific types and locations of medically treated injury. Results: By country, reports of medically treated injuries ranged from 33% (1060/3173) to 64% (1811/2833) of boys and 23% (740/3172) to 51% (1485/2929) of girls, annually. Sports and recreation were the most common activities associated with injury. High material wealth was positively (OR>1.0; p Conclusion: The high prevalence of adolescent injury confirms its importance as a health problem. Social gradients in risk for adolescent injury were illustrated cross nationally for some but not all types of adolescent injury. These gradients were most evident when the etiologies of specific types of adolescent injury were examined. Prevention initiatives should focus upon the etiologies of specific injury types, as well as risk oriented social contexts.

Working conditions and fatigue in professional truck drivers at Israeli ports

Abstract: Background: Trucks represent 6% of all vehicles, but truck crashes account for 20% of road deaths in Israel, even though travel distances are usually short (<200 km) and overnight travel is uncommon. Objective: To determine occupational and individual predictors of fatigue, falling asleep at the wheel, and involvement in crashes with injuries and deaths in truck drivers. Setting and methods: We carried out field interviews of 160 port truck drivers regarding driver characteristics, workplace and driving conditions, employer-employee relations, medical conditions, sleep quality and fatigue, falling asleep at the wheel, and involvement in road crashes. Results: One day before interview, 38.1% of the drivers had worked more than the 12 hour legal limit. More than 30% reported falling asleep at the wheel recently, and 13% had prior involvement in a sleep related crash. Sixty seven (41.9%) drivers said that their employer forced them to work beyond the legal 12 hour daily limit. Involvement in a crash with casualties was associated with poor sleep quality (adjusted OR = 2.9; p = 0.042) and frequent difficulty finding parking when tired (OR = 3.7; p = 0.049). Self assessment of fatigue underestimated fatigue from the Pittsburgh Sleep Quality Questionnaire. However fatigue occurred in many drivers without sleep problems and many crashes occurred without fatigue. Conclusions: Prevention requires measures to reduce work stresses, screening drivers, speed control, and modal shifts. The work risks and adverse outcomes of truck drivers in large countries with long overnight journeys occur in a small country with small distances, relatively short work journeys, and little overnight travel.

The effects of recall on reporting injury and poisoning episodes in the National Health Interview Survey.

Abstract: Objective: To examine effects of length of time between injury or poisoning and interview on the number of reported injury and poisoning episodes in the National Health Interview Survey (NHIS). (Hereinafter, both injuries and poisonings will be referred to as "injuries".) Design: The NHIS collects data continuously on medically attended injuries occurring to family members during the three months before interview. Time between injury and interview was established by subtracting the reported injury date from the interview date. Values were multiply imputed for the 25% of the episodes for which dates were only partially reported. Main outcome measures: An analysis of mean square error (MSE) was used to quantify the extent of errors in estimated annual numbers of injuries and to compare the contributions of bias and variance to these errors. Results: The lowest estimated MSEs for annualized estimates for all injuries and for less severe injuries were attained when the annualized estimates were based on 3–6 elapsed cumulative weeks between injury and interview. The average weighted number of injuries reported per week per year was 8% lower in later weeks (weeks 6–13) than in earlier weeks (weeks 1–5) for all episodes, and 24% lower in later weeks than in earlier weeks for contusions/superficial injuries, with both differences being statistically significant. For fractures, however, the averages in the two periods were statistically similar. Conclusions: The error associated with the estimated annual number of injuries was large with a three month reference period for all injuries and for less severe injuries. Limiting analysis to episodes with up to five weeks between injury and interview has statistical, intuitive, and analytic appeal for all injuries and for less severe injuries.

Should football players wear custom fitted mouthguards? Results from a group randomised controlled trial

Abstract: Objective: Head/orofacial (H/O) injuries are common in Australian rules football. Mouthguards are widely promoted to prevent these injuries, in spite of the lack of formal evidence for their effectiveness. Design: The Australian football injury prevention project was a cluster randomized controlled trial to evaluate the effectiveness of mouthguards for preventing H/O injuries in these players. Setting and subjects: Twenty three teams (301 players) were recruited from the largest community football league in Australia. Intervention: Teams were randomly allocated to either the MG: custom made mouthguard or C: control (usual mouthguard behaviours) study arm. Main outcome measures: All injuries, participation in training and games, and mouthguard use were monitored over the 2001 playing season. Injury rates were calculated as the number of injuries per 1000 person hours of playing time. Adjusted incidence rate ratios were obtained from Poisson regression models. Results: Players in both study arms wore mouthguards, though it is unlikely that many controls wore custom made ones. Wearing rates were higher during games than training. The overall rate of H/O injury was 2.7 injuries per 1000 exposure hours. The rate of H/O injury was higher during games than training. The adjusted H/O injury incidence rate ratio was 0.56 (95% CI 0.32 to 0.97) for MG versus C during games and training, combined. Conclusions: There was a significant protective effect of custom made mouthguards, relative to usual mouthguard use, during games. However, the control players still wore mouthguards throughout the majority of games and this could have diluted the effect.

Effect of recall on estimation of non-fatal injury rates: a community based study in Tanzania

Abstract: Study objective: To investigate the effect of recall on estimation of non-fatal injury rates in Tanzania. Design: Retrospective population based survey. Setting: Eight branches in an urban area and six villages in a relatively prosperous rural area in Tanzania. Subjects: Individuals of all ages living in households selected by cluster sampling. Main outcome measures: Estimated non-fatal injury rates calculated at each of the 12 recall periods (one to 12 months before the interview). Results: Out of a population of 15 223 persons, 509 individuals reported 516 injuries during the preceding year. Of these 313 (61.5%) were males and 196 (38.5%) females. The data showed notable declining incidence rates from 72 per 1000 person-years when based on a one month recall period to 32.7 per 1000 person-years for a 12 month recall period (55% decline). The decline was found for injuries resulting in fewer than 30 days of disability whereas rates for severe injuries (disability of 30 days or more) did not show a consistent variation with recall period. Decline in injury rates by recall period was higher in rural than in urban areas. Age, sex, and education did not notably affect recall. Conclusions: Longer recall periods underestimate injury rates compared with shorter recall periods. For severe injuries, a recall period of up to 12 months does not affect the rate estimates. It is essential that a recall period of less than three months be used to calculate injury rates for less severe injuries.

Driver dependent factors and the risk of causing a collision for two wheeled motor vehicles

Abstract: Objective: To assess the effect of driver dependent factors on the risk of causing a collision for two wheeled motor vehicles (TWMVs). Design: Case control study. Setting: Spain, from 1993 to 2002. Subjects: All drivers of TWMVs involved in the 181 551 collisions between two vehicles recorded in the Spanish registry which did not involve pedestrians, and in which at least one of the vehicles was a TWMV and only one driver had committed a driving infraction. The infractor and non-infractor drivers constituted the case and control groups, respectively. Main outcome measures: Logistic regression analyses were used to obtain crude and adjusted odds ratio estimates for each of the driver related factors recorded in the registry (age, sex, nationality, psychophysical factors, and speeding infractions, among others). Results: Inappropriate speed was the variable with the greatest influence on the risk of causing a collision, followed by excessive speed and driving under the influence of alcohol. Younger and older drivers, foreign drivers, and driving without a valid license were also associated with a higher risk of causing a collision. In contrast, helmet use, female sex, and longer time in possession of a driving license were associated with a lower risk. Conclusions: Although the main driver dependent factors related to the risk of causing a collision for a TWMV were similar to those documented for four wheeled vehicles, several differences in the pattern of associations support the need to study moped and motorcycle crashes separately from crashes involving other types of vehicles.

Welding related occupational eye injuries: a narrative analysis.

Abstract: OBJECTIVE: To determine the activities and circumstances proximal to a welding related occupational eye injury, a hybrid narrative coding approach derived from two well developed classification systems was developed to categorize and describe the activity, initiating process, mechanism of injury, object and/or substance, and the use of protective eyewear from the narrative text data reported for each injury. METHODS: Routinely collected workers' compensation claims over a one year period (2000) were analyzed from a large US insurance provider. An index term search algorithm of occupation, incident, and injury description fields identified 2209 potential welding related eye injury claims. After detailed review of these claims, 1353 welders and 822 non-welders were analyzed. RESULTS: During 2000, eye(s) as the primary injured body part accounted for 5% (n = 26 413) of all compensation claims. Eye injuries accounted for 25% of all claims for welders. Subjects were mainly male (97.1%) and from manufacturing (70.4%), service (11.8%), or construction (8.4%) related industries. Most injuries were foreign body (71.7%) or burn (22.2%) and 17.6% were bilateral. Common activities include welding (31.9%) and/or grinding (22.5%). Being struck by an airborne object occurred in 56.3% of cases. Non-welders showed similar patterns except that burns (43.8%) were more frequent and more often initiated by another worker (13.9%). CONCLUSIONS: Narrative injury text provides valuable data to supplement traditional epidemiologic analyses. Workers performing welding tasks or working nearby welders should be trained to recognize potential hazards and the effective use of proper safety equipment to prevent ocular injury.

An evaluation of state firearm regulations and homicide and suicide death rates.

Abstract: Objective: To determine if any of five different state gun laws were associated with firearm mortality: (1) "shall issue" laws permitting an individual to carry a concealed weapon unless restricted by another statute; (2) a minimum age of 21 years for handgun purchase; (3) a minimum age of 21 years for private handgun possession; (4) one gun a month laws which restrict handgun purchase frequency; and (5) junk gun laws which ban the sale of certain cheaply constructed handguns Design: A cross sectional time series study of firearm mortality from 1979 to 1998 Setting: All 50 states and the District of Columbia Subjects: All residents of the United States Main outcome measures: Firearm homicides, all homicides, firearm suicides, and all suicides Results: When a "shall issue" law was present, the rate of firearm homicides was greater, RR 111 (95% confidence interval 099 to 124), than when the law was not present, as was the rate of all homicides, RR 108 (95% CI 098 to 117), although this was not statistically significant No law was associated with a statistically significant decrease in the rates of firearm homicides or total homicides No law was associated with a statistically significant change in firearm suicide rates Conclusion: A "shall issue" law that eliminates most restrictions on carrying a concealed weapon may be associated with increased firearm homicide rates No law was associated with a statistically significant reduction in firearm homicide or suicide rates

Traffic calming policy can reduce inequalities in child pedestrian injuries: database study

Abstract: Objectives: To determine whether area wide traffic calming distribution reflects known inequalities in child pedestrian injury rates. To determine whether traffic calming is associated with changes in childhood pedestrian injury rates. Design: Small area ecological study, longitudinal analysis of injury rates with cross sectional analysis of traffic calming and method of travel to school. Settings: Two cities in the United Kingdom. Participants: 4–16 year old children between 1992 and 2000. Main outcome measures: Area wide traffic calming distribution by area deprivation status and changes in injury rate/1000. Results: The most deprived fourth of city A had 4.8 times (95% CI 3.71 to 6.22) the number of traffic calming features per 1000 population compared with the most affluent fourth. Injury rates among the most deprived dropped from 9.42 to 5.07 from 1992–94 to 1998–2000 (95% CI for change 2.82 to 5.91). In city B, the traffic calming ratio of the most to least deprived fourth was 1.88 (95% CI 1.46 to 2.42); injury rates in the deprived areas dropped from 8.92 to 7.46 (95% CI for change –0.84 to 3.77). Similar proportions of 9–12 year olds walked to school in both cities. Conclusions: Area wide traffic calming is associated with absolute reductions in child pedestrian injury rates and reductions in relative inequalities in child pedestrian injury rates.

Education level inequalities and transportation injury mortality in the middle aged and elderly in European settings

Abstract: OBJECTIVE: To study the differential distribution of transportation injury mortality by educational level in nine European settings, among people older than 30 years, during the 1990s METHODS: Deaths of men and women older than 30 years from transportation injuries were studied Rate differences and rate ratios (RR) between high and low educational level rates were obtained RESULTS: Among men, those of low educational level had higher death rates in all settings, a pattern that was maintained in the different settings; no inequalities were found among women Among men, in all the settings, the RR was higher in the 30-49 age group (RR 146, 95% CI 132 to 161) than in the age groups 50-69 and > or = 70 years, a pattern that was maintained in the different settings For women for all the settings together, no differences were found among educational levels in the three age groups In the different settings, only three had a high RR in the youngest age group, Finland (RR 133, 95% CI 101 to 174), Belgium (RR 138; 95% CI 113 to 167), and Austria (RR 149, 95% CI 075 to 296) CONCLUSION: This study provides new evidence on the importance of socioeconomic inequalities in transportation injury mortality across Europe This applies to men, but not to women Greater attention should be placed on opportunities to select intervention strategies tailored to tackle socioeconomic inequalities in transportation injuries

Ability of parents to recall the injuries of their young children

Abstract: Objective: To estimate the ability of parents to recall the injuries of their children. Design: Comparison of parent recall with computerized medical records. Setting: A health maintenance organization in Washington State during 2003. Subjects: Parents of children younger than 6 years. Main outcome measures: The ratio of recalled injuries to injuries in computerized data. Results: Telephone interviews were completed with a parent of 1672 young children who had computerized medical data for at least one injury in the last year. Counting the three most recent treated injuries, the 1672 children had 1896 separate new injuries in the year before interview and parents recalled 1150 of these: recall ratio 0.61 (95% confidence interval (CI) 0.58 to 0.63). The recall ratio decreased from 0.82 (95% CI 0.79 to 0.85) for injuries one day before interview to 0.37 (95% CI 0.32 to 0.40) at 365 days before interview. For 341 major injuries the recall ratio was 0.80 (95% CI 0.76 to 0.84), for 202 minor injuries treated in an emergency department or hospital it was 0.77 (95% CI 0.71 to 0.82), for 597 minor injuries treated in urgent care it was 0.70 (95% CI 0.65 to 0.73), and for 756 minor injuries treated in a clinic it was 0.43 (95% CI 0.39 to 0.47). Conclusions: Recall decreased with time. Recall was best for major injuries, intermediate for minor injuries treated in a hospital, emergency department, or urgent care center, and worst for minor injuries treated in a clinic.

Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial

Abstract: Objective: To assess the long term effect of a home safety visit on the rate of home injury Design: Telephone survey conducted 36 months after participation in a randomized controlled trial of a home safety intervention A structured interview assessed participant knowledge, beliefs, or practices around injury prevention and the number of injuries requiring medical attention Setting: Five pediatric teaching hospitals in four Canadian urban centres Participants: Children less than 8 years of age presenting to an emergency department with a targeted home injury (fall, scald, burn, poisoning or ingestion, choking, or head injury while riding a bicycle), a non-targeted injury, or a medical illness Results: We contacted 774 (66%) of the 1172 original participants A higher proportion of participants in the intervention group (63%) reported that home visits changed their knowledge, beliefs, or practices around the prevention of home injuries compared with those in the non-intervention group (43%; p<0001) Over the 36 month follow up period the rate of injury visits to the doctor was significantly less for the intervention group (rate ratio = 074; 95% CI 063 to 087), consistent with the original (12 month) study results (rate ratio = 069; 95% CI 054 to 088) However, the effectiveness of the intervention appears to be diminishing with time (rate ratio for the 12–36 month study interval = 080; 95% CI 064 to 100) Conclusions: A home safety visit was able to demonstrate sustained, but modest, effectiveness of an intervention aimed at improving home safety and reducing injury This study reinforces the need of home safety programs to focus on passive intervention and a simple well defined message

Temporal factors in motor vehicle crash deaths

Abstract: Objective: To summarize fatal motor vehicle crash deaths in the United States by time of day, day of week, month, and season, and to determine why some days of the year tend to experience a relatively high number of deaths. Method: Crash deaths were identified and categorized using the Fatality Analysis Reporting System. Days of the year with relatively high crash deaths were compared to the two days that occurred exactly one week before and one week after. Results: On average, motor vehicle crashes in the United States result in more than 100 deaths per day, but there is much day-to-day variability. During 1986–2002 the single day fatality count ranged from a low of 45 to a high of 252. Summer and fall months experience more crash deaths than winter and spring, largely due to increased vehicle travel. July 4 (Independence Day) has more crash deaths on average than any other day of the year, with a relatively high number of deaths involving alcohol. January 1 (New Year's Day) has more pedestrian crash deaths on average, plus it has the fifth largest number of deaths per day overall, also due to alcohol impairment. On other days the high numbers of deaths are likely due to increases in holiday or recreational travel. Conclusion: Every day of the year results in many crash deaths, but certain days stand out as particularly risky. The temporal and geographic spread of crash deaths, as well as the view of driving as a routine task, inures the public to this continuing problem. Innovative strategies are needed both to raise awareness and to work toward a solution.

The validity of a four week self-recall of sports injuries

Abstract: The ability of sports injury studies to provide reliable incidence estimates depends on accurate injury data. One of the most commonly used methods of collecting injury data is through self-report, but the validity of such information is largely unknown. This study validated a four week self-report sports injury recall against a range of external sources including hospital records, health practitioner records, and third parties. Cases were drawn from the larger, Western Australian Sports Injury Study (WASIS). This study demonstrates acceptable to good levels of agreement between self-report and more objective data in relation to details such as the nature and body part injured, and the level of injury treatment sought (kappa = 0.48 to 0.78). However, self-reported injury severity did not agree with the Injury Severity Score classification of severity.

Urban-rural variation in mortality and hospital admission rates for unintentional injury in ireland

Abstract: Objective: To explore urban-rural differences in the mortality and hospital admission rates for unintentional injuries in the Republic of Ireland. Design: Standardised mortality ratios (SMRs) in residents of urban and non-city areas (called rural areas) from all causes of unintentional injury were calculated using Central Statistics Office mortality data from 1980–2000. Hospital admission data (Hospital In-Patient Enquiry) from 1993–2000 were used to calculate standardised hospital admission ratios (SARs) in urban and rural residents. Population data were obtained from the 1981, 1986, 1991, and 1996 censuses. Results: The rate of unintentional injury mortality was significantly higher in rural residents for all-cause unintentional injury mortality (SMR 103.0, 95% confidence interval 101 to 105), and specifically for deaths related to motor vehicle trauma (MVT), drowning, machinery, and firearms. There were significantly higher SMRs in urban residents for falls and poisoning. The rate of unintentional injury hospital admission was significantly higher in rural residents for all-cause unintentional injury (SAR 104.6, 95% confidence interval 104 to 105) and specifically for injuries from falls, MVT, being struck by or against an object, injuries in pedal cyclists, fire/burn injuries, and machinery injuries. SARs were significantly higher in residents of urban areas for poisoning and injuries in pedestrians. Conclusions: There are urban-rural differences in mortality and admissions for injuries in Ireland. Possible reasons for the higher rural mortality rates are higher case fatality in MVT and rural exposure to hazardous farm machinery, firearms, and open areas of water. This information could assist in targeting prevention programmes under the proposed National Injury Prevention Strategy.

Heat related deaths to young children in parked cars: an analysis of 171 fatalities in the United States, 1995–2002

Abstract: Objective: To describe the circumstances surrounding heat related deaths to young children in passenger compartments of motor vehicles. Methods: Cases of heat related deaths to children aged ⩽5 years confined in parked vehicles were retrospectively identified using online news accounts from 1 January 1995 to 31 December 2002. A standardized data form was developed to collect information related to the victim, the vehicle and its design features, external temperature, length of time confined, and the responsible adults. Cases were categorized by whether the child gained access to the vehicle or was left by adults. Results: A total of 171 fatalities that met the case criteria were identified. Twenty seven percent (46) were children who gained access to unlocked vehicles and 73% (125) were children who were left by adults. More than a quarter of the adults were aware they were leaving children in the vehicles, while half were unaware or forgot. Forty three percent (54) of deaths to children who were left were associated with childcare: 32 children were left by family members who intended to take them to childcare but forgot and went to work instead; 22 children were left by child care providers or drivers. Conclusions: Many of the deaths reported in this study may have been prevented by keeping cars locked, educating parents, implementing informed child care transportation policies, passing relevant laws, and working with auto and child safety seat manufacturers to build in warnings and other design features. News sources can be useful for obtaining detailed information not otherwise identifiable through standard sources of fatality data.

United States pedestrian fatality rates by vehicle type.

Abstract: OBJECTIVE: To describe the relation between motor vehicle type and the risk of fatally injuring a pedestrian. DESIGN: The risk of killing a pedestrian was measured as the number of pedestrian fatalities per billion miles of vehicle travel by each vehicle type in the US in 2002 as reported by the National Highway Traffic Safety Administration's Fatality Analysis Reporting System. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Rates for each vehicle type by sex, age, and rural/urban roadway type and rate comparisons using relative risks (RR) and 95% confidence intervals (CIs). RESULTS: Passenger cars and light trucks (vans, pickups, and sport utility vehicles) accounted for 46.1% and 39.1%, respectively, of the 4875 deaths, with the remainder split among motorcycles, buses, and heavy trucks. Compared with cars, the RR of killing a pedestrian per vehicle mile was 7.97 (95% CI 6.33 to 10.04) for buses; 1.93 (95% CI 1.30 to 2.86) for motorcycles; 1.45 (95% CI 1.37 to 1.55) for light trucks, and 0.96 (95% CI 0.79 to 1.18) for heavy trucks. Compared with cars, buses were 11.85 times (95% CI 6.07 to 23.12) and motorcycles were 3.77 times (95% CI 1.40 to 10.20) more likely per mile to kill children 0-14 years old. Buses were 16.70 times (95% CI 7.30 to 38.19) more likely to kill adults age 85 or older than were cars. The risk of killing a pedestrian per vehicle mile traveled in an urban area was 1.57 times (95% CI 1.47 to 1.67) the risk in a rural area. CONCLUSIONS: Outcomes reflect the ways in which a vehicle's characteristics (mass, front end design, and visibility) and its degree of interaction with pedestrians affect its risk per mile. Modifications in vehicle design might reduce pedestrian injury. The greatest impact on overall US pedestrian mortality will result from reducing the risk from the light truck category.

It might work in Oklahoma but will it work in Oakhampton? Context and implementation in the effectiveness literature on domestic smoke detectors.

Abstract: Objective: To explore data on factors affecting implementation processes in papers contributing to a Cochrane systematic review (SR) of smoke alarm interventions, supplemented by further papers not included in the review. Design: Screening for data on implementation on the basis of: (1) primary studies included in a Cochrane SR, (2) further papers relating to these and similar studies, and (3) approaches to authors of these and other relevant studies and reports. Results: Relatively few data were found to help people seeking to implement smoke alarm promotion interventions. Conclusions: For practitioners and policymakers to be able to build on research evidence, researchers and journal editors need to ensure that sufficient data are published, or are otherwise available to interested parties to move from understanding the evidence to using it.

Pediatric farm injuries involving non-working children injured by a farm work hazard: five priorities for primary prevention.

Abstract: Objectives: To describe pediatric farm injuries experienced by children who were not engaged in farm work, but were injured by a farm work hazard and to identify priorities for primary prevention. Design: Secondary analysis of data from a novel evaluation of an injury control resource using a retrospective case series. Data sources: Fatal, hospitalized, and restricted activity farm injuries from Canada and the United States. Subjects: Three hundred and seventy known non-work childhood injuries from a larger case series of 934 injury events covering the full spectrum of pediatric farm injuries. Methods: Recurrent injury patterns were described by child demographics, external cause of injury, and associated child activities. Factors contributing to pediatric farm injury were described. New priorities for primary prevention were identified. Results: The children involved were mainly resident members of farm families and 233/370 (63.0%) of the children were under the age of 7 years. Leading mechanisms of injury varied by data source but included: bystander and passenger runovers (fatalities); drowning (fatalities); machinery entanglements (hospitalizations); falls from heights (hospitalizations); and animal trauma (hospitalizations, restricted activity injuries). Common activities leading to injury included playing in the worksite (all data sources); being a bystander to or extra rider on farm machinery (all data sources); recreational horseback riding (restricted activity injuries). Five priorities for prevention programs are proposed. Conclusions: Substantial proportions of pediatric farm injuries are experienced by children who are not engaged in farm work. These injuries occur because farm children are often exposed to an occupational worksite with known hazards. Study findings could lead to more refined and focused pediatric farm injury prevention initiatives.

Effects on alcohol related fatal crashes of a community based initiative to increase substance abuse treatment and reduce alcohol availability

Abstract: Objective: This analysis tested whether comprehensive community interventions that focus on reducing alcohol availability and increasing substance abuse treatment can reduce alcohol related fatal traffic crashes. Intervention: Five of 14 communities awarded Fighting Back grants by The Robert Wood Johnson Foundation to reduce substance abuse and related problems attempted to reduce availability of alcohol and expand substance abuse treatment programs (FBAT communities). Program implementation began on 1 January 1992. Design: A quasi-experimental design matched each program community to two or three other communities of similar demographic composition in the same state. Main outcome measures: The ratio of fatal crashes involving a driver or pedestrian with a blood alcohol concentration of 0.01% or higher, 0.08% or higher, or 0.15% or higher were examined relative to fatal crashes where no alcohol was involved for 10 years preceding and 10 years following program initiation. Results: Relative to their comparison communities, the five FBAT communities experienced significant declines of 22% in alcohol related fatal crashes at 0.01% BAC or higher, 20% at 0.08% or higher, and 17% at 0.15% or higher relative to fatal crashes not involving alcohol. Conclusions: Community interventions to reduce alcohol availability and increase substance abuse treatment can reduce alcohol related fatal traffic crashes.

Child and adolescent injury as a result of falls from buildings and structures

Abstract: Objective: To examine incidence, demographic risk factors, and patterns of injury resulting from falls from buildings and structures in areas with and without a legislation based prevention programme. Design and setting: The Health Care Cost and Utilization Project (KID-HCUP) was used to produce national estimates of hospital admissions due to falls from buildings in the US. Areas of New York with and without window guard legislation were identified through the New York Statewide Planning and Research Cooperative System (SPARCS). Subjects: Children and adolescents aged 0-18 years. Interventions: Legislation based window fall prevention programme with enforcement. Main outcome measures: Hospitalization for injury as a result of falls from buildings and structures in areas with and without enforced mandatory window guard legislation. Results: New York City has a higher proportion of the population residing in multifamily dwellings with 10 or more units compared with the nation (53.8% v 12.6%, p,0.0001), but the incidence of injury resulting from falls from buildings is nearly half that observed in the US. For young children, warm weather risks begin earlier and extend later than previously reported. Incidence in very young minority children is nearly twice that of whites. Nearly 90% of children aged 0-4 years fall at home, but the proportion decreases linearly with age. Conclusions: Window guards are associated with reduced injury resulting from falls from buildings and should be mandated in multifamily dwellings where small children reside. Prevention programmes for young children should be initiated in early spring and continued through fall.

Group interventions for the prevention of injuries in young children: a systematic review.

Abstract: Objective: This systematic review examined group based injury prevention interventions that targeted young children to determine the effectiveness of such strategies in enhancing children's safety behaviors. Methods: A comprehensive (manual and electronic) search of the literature was performed using the following study selection criteria: (1) intervention engaged children under the age of 6 years; (2) included a control group; (3) used a group intervention approach; (4) study written in English language; (5) addressed unintentional injuries; and (6) outcomes included injuries, knowledge, or safety behaviors. Data abstraction was performed independently by two researchers using a standardized approach. Results: Nine studies met the criteria that included safety interventions of road crossing (4), car restraint (2), spinal cord safety (1), poison safety (1), and 911/stranger danger/street crossing (1). The types of interventions included videos, interactive activities, cartoons, stories, puppets, singing, coloring, games, simulation games, demonstrations, modeling/role playing, and rehearsal practice using seat belts, models, and real street crossing. The intensity and duration of interventions varied substantially and only two studies randomly assigned participants. The review revealed a positive effect (knowledge, behaviour, and/or attitude) for five of the studies, three had mixed effect, and one reported no effect. Conclusions: Although no clear conclusions can be drawn from the limited number of studies of diverse design and rigor, researchers should attempt to minimize shortcomings occurring in community based research. Engaging community partners including teachers and parents who influence relationships and outcomes could provide opportunity for more rigorous, comprehensive, and integrated approach to longitudinal research that could identify key factors of successful strategies.

Incidence of sports and recreation related injuries resulting in hospitalization in Wisconsin in 2000.

Abstract: Objective: To describe the incidence and patterns of sports and recreation related injuries resulting in inpatient hospitalization in Wisconsin. Although much sports and recreation related injury research has focused on the emergency department setting, little is known about the scope or characteristics of more severe sports injuries resulting in hospitalization. Setting: The Wisconsin Bureau of Health Information (BHI) maintains hospital inpatient discharge data through a statewide mandatory reporting system. The database contains demographic and health information on all patients hospitalized in acute care non-federal hospitals in Wisconsin. Methods: The authors developed a classification scheme based on the International Classification of Diseases External cause of injury code (E code) to identify hospitalizations for sports and recreation related injuries from the BHI data files (2000). Due to the uncertainty within E codes in specifying sports and recreation related injuries, the authors used Bayesian analysis to model the incidence of these types of injuries. Results: There were 1714 (95% credible interval 1499 to 2022) sports and recreation-related injury hospitalizations in Wisconsin in 2000 (32.0 per 100 000 population). The most common mechanisms of injury were being struck by/against an object in sports (6.4 per 100 000 population) and pedal cycle riding (6.2 per 100 000). Ten to 19 year olds had the highest rate of sports and recreation related injury hospitalization (65.3 per 100 000 population), and males overall had a rate four times higher than females. Conclusions: Over 1700 sports and recreation related injuries occurred in Wisconsin in 2000 that were treated during an inpatient hospitalization. Sports and recreation activities result in a substantial number of serious, as well as minor injuries. Prevention efforts aimed at reducing injuries while continuing to promote participation in physical activity for all ages are critical.

Reaching an underserved population with a randomly assigned home safety intervention

Abstract: Objective: To access an underserved, mobile segment of a monolingual Spanish speaking population and to improve maternal self efficacy for home safety behaviors using a culturally appropriate intervention. Design: A pre- and post-test experimental design tested differences in maternal childhood injury health beliefs (MCIHB) and controllable safety hazards (CHS). Participants were randomly assigned to experimental and control groups. Baseline data assessed demographic and study variables comparability. The intervention included counseling, assessment of maternal safety practices, and provision of safety items. Setting: A non-urban area in Texas where low income, largely migrant Hispanics represent the majority of residents. Participants: Eighty two mothers of 1–4 year old children. Results: The 95% retention rate of an itinerant, hard to reach population suggests that minority participants may be receptive to culturally appropriate home visits. The intervention group demonstrated improved self efficacy for home safety behaviors (F (2, 77) = 7.50, p = 0.01). Mothers with stronger self efficacy and fewer perceived barriers had fewer accessible in-home hazards. Observed home hazard predictors were: (a) never being married; (b) poor home repair, (c) lower self efficacy for safety behaviors; and (d) control group status. Conclusions: Safety items coupled with a home visit tailored to child age and maternal culture was an effective intervention in a hard to reach population. This study contributes to designing research for a monolingual population with limited local language proficiency and community residency. Injuries represent a major source of health disparities in these neglected populations.

Factors associated with bicycle helmet use among young adolescents in a multinational sample.

Abstract: Objective: To determine factors associated with variation in bicycle helmet use by youth of different industrialized countries. Design: A multinational cross sectional nationally representative survey of health behaviors including symptoms, risk taking, school setting, and family context. Setting: School based survey of 26 countries. Subjects: School students, ages 11, 13, and 15 years totaling 112 843. Outcome measures: Reported frequency of bicycle helmet use among bicycle riders. Results: Reported helmet use varied greatly by country from 39.2% to 1.9%, with 12 countries reporting less than 10% of the bicycle riders as frequent helmet users and 14 countries more than 10%. Reported helmet use was highest at 11 years and decreased as children’s age increased. Use was positively associated with other healthy behaviors, with parental involvement, and with per capita gross domestic product of the country. It is negatively associated with risk taking behaviors. Countries reported to have interventions promoting helmet use, exemplified by helmet giveaway programmes, had greater frequency of reported helmet use than those without programmes. Conclusions: Bicycle helmet use among young adolescents varies greatly between countries; however, helmet use does not reach 50% in any country. Age is the most significant individual factor associated with helmet for helmet using countries. The observation that some helmet promotion programmes are reported for countries with relatively higher student helmet use and no programmes reported for the lowest helmet use countries, suggests the possibility of a relation and the need for objective evaluation of programme effectiveness.

Severity of playground fractures: play equipment versus standing height falls.

Abstract: Aim: To compare the severity of fractures from playground equipment falls to the severity of fractures from standing height falls occurring on the playground. Methods: This case control study used data on all children presenting to the Hospital for Sick Children (Toronto) from 1995 to 2002 with a fracture due to a playground fall. Cases were children who fell from a height off playground equipment. Controls were children who fell from standing height on a playground. Fractures were major if they required reduction and minor if they did not. Results: Fractures from equipment falls were 3.91 (95% CI 2.76 to 5.54) times more likely to require reduction than were fractures from standing height falls. Conclusions: Major fractures were strongly associated with falls from playground equipment, whereas minor fractures came from both play equipment and standing height falls. Efforts to prevent major fractures should target playground equipment and the impact absorbing surface beneath it.

Evaluating Gun Policy

Abstract: Edited by Jens Ludwig and Philip J Cook. Washington, DC: Brookings Institution Press, 2003. The United States has a big problem with gun injuries: it suffers tens of thousands of gun related deaths and injuries annually; its gun related death and injury rates dwarf those in other developed nations. The United States also has a big problem with addressing gun deaths and injuries: there is wide public support for many policies aimed at reducing the toll, but little political will to undertake policy changes. Both problems have gotten a bit better in the past decade, but both remain quite serious indeed. The premise behind Evaluating Gun Policy is that the second problem may diminish in the face of clear information on the effects of policies designed to reduce gun injuries. The editors—both eminent American economic scholars with a longstanding interest in violence and criminology—undertook to summarize current policies related to guns, and to present current assessments of the effectiveness of policies that have been put in place over the past decade or so. The resulting book is a valuable review and reference, which should be on the shelf of everyone in the United States who works on gun injury reduction and related policy development. It is likely also to be informative for those working on reducing deaths and injuries from small arms and light weapons around …

Comparison of fatalities from work related motor vehicle traffic incidents in Australia, New Zealand, and the United States

Abstract: Objective: To compare the extent and characteristics of motor vehicle traffic incidents on public roads resulting in fatal occupational injuries in Australia, New Zealand (NZ), and the United States (US). Design and setting: Information came from separate data sources in Australia (1989–92), NZ (1985–98), and the US (1989–92). Methods: Using data systems based on vital records, distributions and rates of fatal injuries resulting from motor vehicle traffic incidents were compared for the three countries. Common inclusion criteria and occupation and industry classifications were used to maximize comparability. Results: Motor vehicle traffic incident related deaths accounted for 16% (NZ), 22% (US), and 31% (Australia) of all work related deaths during the years covered by the studies. Australia had a considerably higher crude rate (1.69 deaths/100 000 person years; 95% confidence interval (95% CI) 1.54 to 1.83) compared with both NZ (0.99; 95% CI 0.85 to 1.12) and the US (0.92; 95% CI 0.89 to 0.94). Industry distribution differences accounted for only a small proportion of this variation in rates. Case selection issues may have accounted for some of the remainder, particularly in NZ. In all three countries, male workers, older workers, and truck drivers were at higher risk. Conclusions: Motor vehicle traffic incidents are an important cause of work related death of workers in Australia, NZ, and the US. The absolute rates appear to differ between the three countries, but most of the incident characteristics were similar. Lack of detailed data and inconsistencies between the data sets limit the extent to which more in-depth comparisons could be made.