bluuebunny/crossref_metadata_2025 huggingface dataset:
Work related spinal cord injury, Australia 1986–97
Authors: O'Connor P
Published: October 2002

Objectives—Little has been published before on the epidemiology and prevention of work related spinal cord injury (SCI). This study is the first national population based epidemiological analysis of this type of injury. It presents that largest case series ever reported.

Setting—The study utilises information from the Australian Spinal Cord Injury Register, which has full coverage of the population.

Methods—All newly incident cases of SCI from 1986 to 1997 were considered.

Results—Work related SCI accounted for about 13% of all traumatic cases of SCI over the period 1986–97. The labour force based incidence rate in Australia averaged four cases per million of population per annum over the period. The rate was highest among those aged 25–34 years (4.9/million) and among farmers (17.0/million). Nearly half of the cases studied received their injury due to a fall. Motor vehicle crashes were also common and vehicle rollover was the predominant crash type. A high proportion of cases did not receive any compensation for their SCI.

Conclusions—Although rare, SCI is one of the most severe and debilitating injuries that can be suffered in the workplace. As there is no cure for SCI, and the level of impairment does not improve substantially for the vast majority of cases even after rehabilitation, it is arguable that primary prevention should receive substantially greater emphasis.
How much outpatient care is provided for injuries?
Authors: Bishai D , Gielen A
Published: October 2002

Objective—To estimate the average number of outpatient visits, emergency department visits, and hospitalizations for injured patients.

Methods—The Medical Expenditure Panel Survey Household Component of 1996 is a weighted sample designed to represent the United States population. For each episode of injury the average number of office visits or outpatient contacts, emergency department visits, and hospitalizations were computed. Subsequently the ratio of outpatient to inpatient contacts for each type of injury was estimated.

Results—When asked to report on their medical problems for the previous six months, the majority of respondents who recalled injuries did not report contact with emergency departments or hospitalization. The average injury is associated with only 0.2 to 0.3 emergency department visits. Sports related injuries were associated with 0.03 hospitalizations. Gun related injuries were associated with 0.12 hospitalizations. All types of injury were related with more than one episode of outpatient or office based care. The ratio of emergency department visits and outpatient visits to hospitalizations varies according to the nature of the injury.

Conclusion—Policymakers interested in the cost of injury should account for the extensive outpatient utilization of injured patients.
Do safety practices differ between responders and non-responders to a safety questionnaire?
Authors: Kendrick D , Hapgood R , Marsh P
Published: October 2002

Objective—To compare reported safety practices between responders and non-responders to a safety survey.

Design—Cross sectional survey at baseline compared with safety practices reported at subsequent child health surveillance checks.

Subjects—Parents of children aged 3–12 months registered with practices participating in a controlled trial of injury prevention in primary care that did, and did not, respond to the baseline survey and who subsequently attended child health surveillance checks.

Results—No difference in safety practices was found between responders and non-responders to the survey at the 6–9 month check. Responders were more likely to report owning a stair gate (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.82 to 4.16) and socket covers (OR 2.16, 95% CI 1.53 to 3.04) at the 12–15 month check, and owning socket covers (OR 2.19, 95% CI 1.34 to 3.61) at the 18–24 month check. Responders were more likely to report greater than the median number of safety practices at the 18 month check.

Conclusions—Non-responders to a safety survey appear to be less likely to report owning several items of safety equipment than responders. Further work is needed to confirm these findings. Extrapolating the results of safety surveys to the population as a whole may lead to over estimation of safety equipment possession.
Banning the “A word”: where's the evidence?
Authors: Evans S A
Published: October 2002

Background—It is argued that use of the term “accident” has a negative effect on prevention efforts as the term implies that such events are due to chance.

Aim—To test the hypothesis that use of “injury” in place of “accident” can influence professional attitudes towards “accident/injury” prevention.

Setting—Leeds Health Authority area serving the population (n=740 000) of the city of Leeds in the Yorkshire region of England.

Method—A randomised comparative study. Altogether 183 health visiting staff in the Leeds area were randomised (by place of work) to one of two groups. Each group received a similar postal questionnaire assessing attitudes relating to accident/injury prevention. One group received a questionnaire using only accident terminology while the other used injury terminology throughout.

Results—Fifty responses in the accident group were received and 39 in the injury group. Analysis by Mann-Whitney U tests showed little difference in group responses. The only significant finding was that respondents in the “accident” group were more likely to rank “accident prevention” of higher importance relative to respondents in the “injury” group (median 2, 25%–75% quartiles 1.8–4.0 compared with median 4, 25%–75% quartiles 2.0–5.0, p=0.04). However, this may have been a chance finding due to the multiple comparisons made.

Conclusions—This study has shown little difference in health visitor responses when “accident” is replaced with “injury”. It is possible that the effect of changing terminology is more nebulous—influencing society at large. However, it would be as well to recognise the lack of evidence and clarity relating to the terminology debate. Otherwise, there is a danger that the “injury” believers may become alienated from the “accident” diehards.
The new Brazilian traffic code and some characteristics of victims in southern Brazil
Authors: Liberatti C L B , Andrade S M , Soares D A
Published: October 2002

Objective—The aim was to study characteristics of traffic accident victims before and after the implementation of the new Brazilian traffic code, in January 1998.

Subjects and methods—The study population was car and motorcycle occupants seen in a pre-hospital care service in Londrina, Paraná State (Brazil) before the introduction of the new Brazilian traffic code, from 22 January to 21 July 1997, and after its implementation during the same period in 1998. Victims were analyzed over the time periods according to helmet and seat belt use, gender, underage driving, and alcohol on the breath.

Results—Use of seat belts increased from 45% to 62.6% and of helmets from 31.2% to 66.2% after the introduction of the new Brazilian code. The proportion driving under age 18 and with perceptible alcoholic breath declined significantly only among motorcycle riders. There was a 20% decline in car occupant injuries along with a 9% reduction in motorcycle related injuries after the change of the law.

Conclusion—Results favor the hypothesis that rigorous legislation increases safer practices in traffic, at least during the first months of its implementation.
Self strangulation by hanging from cloth towel dispensers in Canadian schools
Authors: Le D , Macnab A J
Published: October 2002

Objective—To investigate a local “epidemic” of incidents of strangulation by hanging from continuous cloth towels in dispensers.

Method—The coroner's office in all provinces and territories were contacted. Five cases of hanging from continuous cloth towels in Canadian schools were identified and reviewed.

Results—There were four deaths, and one near-death, all males age 7 to 12. Two cases were attributed to a “choking game” that provides a sensation (impending loss of consciousness) described as “cool”. In three cases, the child was alone at the time. All deaths were due to strangulation from hanging and all occurred in school washrooms. One child (playing with two friends) recovered after admission to an intensive care unit.

Towel dispensers were removed from the two index schools. In one province the Ministry of Education encouraged removal of towel dispensers from all schools and education of students of the dangers of “choking games”.

Conclusions—Thrill seeking from partial asphyxiation appears to underlie these incidents. Awareness of such cases should prompt appropriate education strategies to highlight the serious consequences of this form of risk taking behavior in young males. In Canada, these incidents have resulted in changes in the design of, and legislation regarding, cloth towel dispensers.
Investigation of bias after data linkage of hospital admissions data to police road traffic crash reports
Authors: Cryer P C , Westrup S , Cook A C , Ashwell V , Bridger P , Clarke C
Published: October 2002

Research question—Does a database of hospital admission data linked to police road traffic accident (RTA) reports produce less biased information for the injury prevention policymaker, planner, and practitioner than police RTA reports alone?

Design—Data linkage study.

Study population—Non-fatal injury victims of road traffic crashes in southern England who were admitted to hospital.

Data sources—Hospital admissions and police RTA reports.

Main outcome measures—The estimated proportion of road traffic crashes admitted to hospital that were included on the linked database; distributions by age, sex, and road user groups: (A) for all RTA injury admissions and (B) for RTA serious injury admissions defined by length of stay or by nature of injury.

Results—An estimated 50% of RTA injury admissions were included on the linked database. When assessing bias, admissions data were regarded as the “gold standard”. The distributions of casualties by age, sex, and type of road user showed major differences between the admissions data and the police RTA injury data of comparable severity. The linked data showed smaller differences when compared with admissions data. For RTA serious injury admissions, the distributions by age and sex were approximately the same for the linked data compared with admissions data, and there were small but statistically significant differences between the distributions across road user group for the linked data compared with hospital admissions.

Conclusion—These results suggest that investigators could be misinformed if they base their analysis solely on police RTA data, and that information derived from the linked database is less biased than that from police RTA data alone. A national linked dataset of road traffic crash data should be produced from hospital admissions and police RTA data for use by policymakers, planners and practitioners.
National attitudes concerning gun carrying in the United States
Authors: Hemenway D , Azrael D , Miller M
Published: October 2002

Objectives—To determine public attitudes in the United States concerning gun carrying.

Setting—In the past 15 years, many state legislatures have passed laws making it easier for United States citizens to carry concealed firearms, not only on the street but into various locations, including churches and government buildings.

Methods—National random digit dial telephone surveys conducted in 1996 and 1999 asked questions concerning the public's feelings of safety as more people in their community carry firearms, and whether, in the language of the question, respondents believe “regular” citizens should be allowed to carry guns into public or government buildings.

Results—Americans feel less safe rather than more safe as more people in their community begin to carry guns. By margins of at least nine to one, Americans do not believe that “regular” citizens should be allowed to bring their guns into restaurants, college campuses, sports stadiums, bars, hospitals, or government buildings.

Conclusions—The public believes that increased gun carrying by others reduces rather than increases their safety. Overwhelmingly, the public believes that in many venues gun carrying should be prohibited.
Impact of graduated driver licensing restrictions on crashes involving young drivers in New Zealand
Authors: Begg D J , Stephenson S , Alsop J , Langley J
Published: October 2002

Objective—To determine the impact on young driver crashes of the three main driving restrictions in the New Zealand graduated driver licensing (GDL) system: night-time curfew, no carrying of young passengers, and a blood alcohol limit of 30 mg/100 ml.

Method—The database for this study was created by linking police crash reports to hospital inpatient records (1980–95). Multivariate logistic regression was used to compare car crashes involving a young driver licensed before GDL (n=2252) with those who held a restricted graduated licence (n=980) and with those who held a full graduated licence (n=1273), for each of the main driving restrictions.

Results—Compared with the pre-GDL group, the restricted licence drivers had fewer crashes at night (p=0.003), fewer involving passengers of all ages (p=0.018), and fewer where alcohol was suspected (p=0.034), but not fewer involving young casualties (p=0.980). Compared with the pre-GDL drivers, those with the full graduated licence had fewer night crashes (p=0.042) but did not differ significantly for any of the other factors examined.

Conclusion—These results suggest that some of the GDL restrictions, especially the night-time curfew, have contributed to a reduction in serious crashes involving young drivers.
Exposure to violence and its relationship to psychopathology in adolescents
Authors: Ward C L , Flisher A J , Zissis C , Muller M , Lombard C
Published: October 2002

Objectives—This study aimed to establish prevalence of adolescents' exposure to violence and related symptoms in the South African context and to explore relationships between exposure and symptoms.

Setting—Four high schools in Cape Town, South Africa.

Methods—Self report questionnaires were administered to 104 students. Types of violence explored included: witnessing or being a victim of violence perpetrated by someone known to the child or in the home and witnessing or being a victim of violence perpetrated by a stranger. The Harvard Trauma Scale, Beck Depression Inventory, and Zung Self-Rating Anxiety Scale were used to assess potentially related symptoms.

Results—The majority of children had been exposed to at least one type of violence, and exposure to the one type of violence was related to the other type. Symptoms of post-traumatic stress disorder and depression appear to be related to most types of exposure to violence, but anxiety symptoms only to exposure to violence perpetrated by someone known to the child or in the home.

Conclusions—Rates of exposure to violence, and related symptoms, were unacceptably high. Symptoms were associated with exposure to violence.
Predictors of injury from fighting among adolescent males
Authors: Hammig B J , Dahlberg L L , Swahn M H
Published: October 2002

Objectives—To identify violence related behaviors associated with injuries among adolescent males involved in fights.

Methods—Data from the National Longitudinal Study of Adolescent Health were used to develop weighted estimates of injury prevalence and associations between injury and violence related behaviors.

Results—Forty seven per cent injured others and 18% were themselves injured in a fight among adolescent males in the preceding 12 months. Group fighting, fighting with strangers, and weapon use were predictive of injury in this sample.

Conclusions—These findings suggest that injuries associated with fighting are a health risk among adolescent males. Certain behaviors, such as fighting in groups and fighting with strangers, increase the likelihood of injuries requiring medical attention.
Accuracy of external cause of injury codes reported in Washington State hospital discharge records
Authors: LeMier M , Cummings P , West T A
Published: October 2002

Objective—To evaluate the accuracy of external cause of injury codes (E codes) reported in computerized hospital discharge records.

Methods—All civilian hospitals in Washington State submit computerized data for each hospital discharge to a file maintained by the Department of Health. In 1996, 32 hospitals accounted for 80% of the injury related discharges in this file; from these hospitals, we sampled 1260 computerized records for injured patients in a stratified, but random, manner. An expert coder then visited the 32 study hospitals, reviewed the medical records that corresponded to each computerized record, and assigned an E code for that hospitalization. The computerized E code information was compared with codes provided by the expert reviewer.

Results—The incidence of hospitalization for injury based upon computerized hospital discharge data was very similar to that based upon chart review: incidence rate ratio 1.0 (95% confidence interval 1.00 to 1.02). Computerized hospital discharge data correctly ranked injuries in regard to both mechanism and intent. Overall agreement on coding was 87% for mechanism of injury, 95% for intent of injury, and 66% for the complete E code. The sensitivity of computerized hospital discharge data for identification of falls, motor vehicle traffic injuries, poisonings, and firearm injuries was 91% or better. The predictive value positive of coding for these four categories of injury ranged from 88% for motor vehicle traffic injuries to 94% for poisonings. The amount of agreement for intent coding ranged from 84% for firearm injuries to 99% for falls. Agreement on coding of the complete E code ranged from 57% for firearm injuries to 72% for poisonings.

Conclusions—Computerized hospital discharge data can be used with confidence to determine how many injuries are treated in a hospital setting and the relative magnitude of various categories of injury. E codes reported in hospital discharge data are a reliable source of information on the mechanism and intent of injury, the two types of information most often used for injury related analyses and priority setting. The detail codes (complete E codes) reported in hospital discharge codes are less reliable and must be used with caution.
Non-fatal occupational injuries and illnesses treated in hospital emergency departments in the United States
Authors: Jackson L L
Published: October 2002

Objectives—To estimate the number and rate of occupational injuries and illnesses treated in hospital emergency departments and to characterize the nature, event, and source of injury and illness.

Setting—Twenty four hour emergency departments in hospitals in the United States.

Methods—Surveillance for occupational injuries and illnesses was conducted in a national probability based sample of hospital emergency departments through the National Electronic Injury Surveillance System (NEISS). Worker demographics, nature of injury and disposition, and incident circumstances were abstracted from emergency department medical records, typically within 24–72 hours of treatment.

Results—Approximately 3.6 million occupational injuries and illnesses were treated in emergency departments in 1998. Younger workers, particularly males, continue to have the highest rates of work related injuries. Together, lacerations, punctures, amputations, and avulsions represented one fourth of the emergency department treated injuries, mostly to hand and fingers. Sprains and strains, largely to the trunk, also accounted for one fourth of the injuries. The three leading injury events were contact with objects, bodily reactions and exertions, and falls.

Conclusions—Despite apparent decreases in rates, youth continue to have a high burden of injury in the workplace. However, three fourths of all emergency department treated injuries occur to workers 20–44 years of age. Emergency department surveillance is particularly amenable to capture of young worker injuries and provides a wealth of injury details to guide prevention efforts—efforts that will likely reduce occupational injuries as these workers age. Emergency department surveillance also provides injury estimates with few demographic or employer constraints, other than the medical venue used.
The Fatality Assessment and Control Evaluation program's role in the prevention of occupational fatalities
Authors: Higgins D N , Casini V J , Bost P , Johnson W , Rautiainen R
Published: October 2002

Objectives—The objective of the Fatality Assessment and Control Evaluation (FACE) program is to prevent traumatic occupational fatalities in the United States by identifying and investigating work situations at high risk for injury and formulating and disseminating prevention strategies to those who can intervene in the workplace.

Setting—The FACE program is a research program located in the Division of Safety Research, a division of the National Institute for Occupational Safety and Health (NIOSH). NIOSH is an agency of the United States government and is part of the Centers for Disease Control and Prevention. NIOSH is responsible for conducting research and making recommendations for prevention of work related illnesses and injuries. FACE investigators conduct traumatic occupational fatality investigations throughout the United States and provide technical assistance to 15 state health or labor departments who have cooperative agreements with NIOSH to conduct traumatic fatality surveillance, targeted investigations, and prevention activities at the state level.

Methods—Investigations are conducted at the worksite using the FACE model, an approach derived from the research conducted by William Haddon Jr. This approach reflects the public health perspective that the etiology of injuries is multifactorial and largely preventable. FACE investigators gather information on multiple factors that may have contributed to traumatic occupational fatalities. Information on factors associated with the agent (energy exchange, for example, thermal energy, mechanical energy, electrical energy, chemical energy), host (worker who died), and the environment (the physical and social aspects of the workplace), during the pre-event, event, and post-event time phases of the fatal incident are collected and analyzed. Organizational, behavioral, and environmental factors contributing to the death are detailed and prevention recommendations formulated and disseminated to help prevent future incidents of a similar nature.

Results—Between 1982 and the present, more than 1500 fatality investigations have been conducted and reports with prevention recommendations distributed. Findings have been published in scientific and trade journals; safety professionals and policy makers have used FACE findings for prevention efforts; and working partnerships have been formed to address newly emerging safety concerns.

Conclusions—FACE investigations identify multiple factors contributing to fatal occupational injuries, which lead to the formulation and dissemination of diverse strategies for preventing deaths of a similar nature.
Fire incidents involving regulators used in portable oxygen systems
Authors: Washenitz F , Stoltzfus J , Newton B , Kubinski L
Published: October 2002

Objectives—To address the causes and prevention of fire incidents involving aluminum bodied oxygen regulators used by firefighters or emergency medical technicians.

Methods—The National Institute for Occupational Safety and Health, the United States Food and Drug Administration, and an independent forensic investigator examined several incidents involving injury to firefighters and emergency medical technicians to determine why regulators in these incidents flashed.

Results—Data and test results from investigations revealed that aluminum was a contributing factor, and there were a number of safe handling techniques which firefighters and emergency medical technicians could use to reduce the risk of regulator fires. A provisional test method was proposed by the American Society for Testing and materials (ASTM) in late 2000 to identify designs that would have a propensity for flashing. Results of the test method show good correlation with actual fire incidents.

Conclusion—Development of the ASTM standard and associated testing will be helpful to oxygen regulator designers to design safer oxygen regulator systems. As well, there are a number of additional safe handling procedures that firefighters and emergency medical technicians can follow to reduce the risk of a regulator fire.
Height, surface firmness, and visual reference effects on balance control
Authors: Simeonov P , Hsiao H
Published: October 2002

Objectives—To investigate the effects of height, surface firmness, and visual reference on standing balance in construction workers.

Design—Controlled laboratory study with balanced repeated measures.

Participants—Twenty four construction workers.

Setting—Test subjects performed standing tasks at ground level as well as at 3 m and 9 m high balconies on firm or deformable surfaces with close visual references included or excluded from their visual field.

Methods—Standing balance was determined from center of pressure as measured by a force platform. Dependent variables were root mean square of sway in medial-lateral and anterior-posterior directions, area of sway, and velocity of sway.

Results—Heights without close visual references significantly increased all sway parameters. The effect of height in conditions without close visual references increased dramatically on deformable surfaces.

Conclusions—Elevated work environments and deformable work surfaces negatively affect balance and may be associated with increased risk of fall incidents. Appropriate close visual references increase the ability to maintain balance.
Evaluation of a child safety program based on the WHO Safe Community model
Authors: Lindqvist K , Timpka T , Schelp L , Risto O
Published: October 2002

Objectives: To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.

Study design: A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjölby municipality) areas, both in Östergötland county, Sweden.

Results: The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% CI 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3–6) injuries remained constant.

Conclusions: After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs.
State level estimates of the incidence and economic burden of head injuries stemming from non-universal use of bicycle helmets
Authors: Schulman J , Sacks J , Provenzano G
Published: October 2002

Objective: To develop national and state level estimates for preventable bicycle related head injuries (BRHIs) and associated direct and indirect health costs from the failure to use bicycle helmets.

Methods: Information on the effectiveness and prevalence of use of bicycle helmets was combined to estimate the avoidable fraction, that is, the proportion of BRHIs that could be prevented through the use of bicycle helmets. The avoidable fraction multiplied by the expected number of BRHIs gives an estimate of the number of preventable cases. Direct and indirect health costs are estimated from a social perspective for the number of preventable BRHIs to assess potential cost savings that would be achieved if all riders wore helmets.

Results: Approximately 107 000 BRHIs could have been prevented in 1997 in the United States. These preventable injuries and deaths represent an estimated $81 million in direct and $2.3 billion in indirect health costs. Estimates range from 200 preventable BRHIs and $3 million in health costs in Wyoming (population 480 000) to 13 700 preventable BRHIs and $320 million in health costs in California (population 32.3 million).

Conclusions: A number of successful approaches to increasing bicycle helmet use exist, including mandatory use laws and community based programs. The limited use of these strategies may be related to the fact that too little information is available to state agencies about the public health and economic burden of these preventable injuries. In conjunction with information on program costs, our estimates can assist state planners in better quantifying the number of preventable BRHIs and the costs and benefits of helmet promotion programs.
Understanding the knowledge and attitudes of commercial drivers in Ghana regarding alcohol impaired driving
Authors: Asiamah G , Mock C , Blantari J
Published: October 2002

Objectives: The knowledge and attitudes of commercial drivers in Ghana as regards alcohol impaired driving were investigated. This was done in order to provide information that could subsequently be used to develop antidrunk driving social marketing messages built upon the intrinsic values and motivation of these drivers.

Methods: Focus group discussions were held with 43 bus and minibus drivers in the capital city, Accra. A structured discussion guide was used to capture information related to values, risk perceptions, leisure time activities, and attitudes on alcohol impaired driving.

Results: The majority of drivers expressed an understanding that drunk driving was a significant risk factor for crashes. There was a significant under-appreciation of the extent of the problem, however. Most believed that it was only rare, extremely intoxicated drivers who were the problem. The drivers also had a minimal understanding of the concept of blood alcohol concentration and related legal limits. Despite these factors, there was widespread support for increased enforcement of existing antidrunk driving laws.

Conclusions: In Ghana, commercial drivers understand the basic danger of drunk driving and are motivated to assist in antidrunk driving measures. There are misconceptions and deficits in knowledge that need to be addressed in subsequent educational campaigns.
Changes in injury mortality by intent and mechanism in Taiwan, 1975–98
Authors: Lu Tsung-Hsueh
Published: October 2002

Background: Most official mortality publications do not present the mechanism of injury (for example, cut/pierce, drowning, fall, poisoning, or suffocation) for intentional injuries (for example, suicide or homicide).

Objectives: To determine if the presentation of mechanism of injury for intentional injuries had different mechanism profiles.

Methods: Age adjusted injury mortality rates by intent and mechanism of injury for Taiwan were calculated for the years 1975 to 1998. TheInternational Classification of Diseasecodes for the matrix by intent and mechanism groupings were based on recommendations of the US Centers for Disease Control and Prevention.

Results: If rates for both groups (intentional and unintentional) are combined, the importance of poisoning and suffocation increase relative to their contribution for unintentional injuries alone. Given the same mechanism of injury, different intents showed different patterns of change during the study period and given the same intent, the changes over time differed for different mechanisms of injury.

Conclusions: It is important to include the mechanism of injury within intentional injuries because it provides different profiles of injury problems. Thus the simultaneous tabulation of injury mortality data by both intent and mechanism is a necessary step for identifying and prioritizing injury problems. The argument that good preventive measures could prevent both unintentional and intentional injuries was also confirmed.
Development and use of a population based injury surveillance system: the All Wales Injury Surveillance System (AWISS): Table 1
Authors: Lyons R A , Jones S , Kemp A , Sibert J , Shepherd J , Richmond P , Bartlett C , Palmer S R
Published: October 2002

This report details the development and use of a population based emergency room surveillance system in the UK. Despite some difficulties in accessing high quality data the system has stimulated a considerable number of research and intervention projects. While surveillance systems with high quality data collection and coding parameters remain the gold standard, imperfect systems, particularly if population based, can play a substantial part in stimulating injury prevention initiatives.
Association between state level drinking and driving countermeasures and self reported alcohol impaired driving
Authors: Shults R A , Sleet D A , Elder R W , Ryan G W , Sehgal M
Published: October 2002

Objectives:In 1999, alcohol related motor vehicle crashes in the United States claimed 15 786 lives and injured more than 300 000 persons. Drinking and driving behavior is shaped by individual and environmental level influences. In this study, the association between each state's driving under the influence of alcohol (DUI) countermeasures and self reported alcohol impaired driving was explored.

Methods:Mothers Against Drunk Driving's (MADD's)Rating the States 2000survey, which graded states on their DUI countermeasures from 1996–99, was used as an index of each state's comprehensive DUI prevention activities. Information on alcohol impaired driving from residents of each state was obtained from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey. The association between the MADD state grades and alcohol impaired driving was assessed using multiple logistic regression.

Results:Of the 64 162 BRFSS respondents who reported drinking any alcohol during the past month, 2.1% of women and 5.8% of men reported at least one episode of alcohol impaired driving in the past month. Those living in states with a MADD grade of “D” were 60% more likely to report alcohol impaired driving than those from states with a MADD grade of “A” (odds ratio 1.6, 95% confidence interval 1.3 to 2.1). The association existed for men and women.

Conclusion:These findings suggest that stronger state level DUI countermeasures are associated with lower rates of self reported alcohol impaired driving.
Personal and situational influences on drink driving and sober driving among a cohort of young adults
Authors: Morrison L , Begg D J , Langley J D
Published: October 2002

Objectives:To compare personal and situational influences on incidents involving drink driving with those involving sober driving.

Methods:Information on a range of road safety practices was sought in face to face interviews conducted with 969 members of the Dunedin Multidisciplinary Health and Development Study cohort at age 26 years. A total of 750 study members reported an incident that involved the opportunity to consume alcohol and also travel by motor vehicle. Of these, 87 were classified as “drink drive incidents” and 663 as “sober drive incidents”.

Results:Study members who were male, of lower socioeconomic status, had no school qualifications, or were dependent on alcohol or marijuana at age 21 were significantly more likely to report a drink drive incident at age 26. Compared with the sober drive incidents, the drink drive incidents were more commonly associated with driving alone, drinking at bars, and no advanced planning. For drink drive incidents the amount of alcohol consumed was influenced by the conviviality of the occasion, whereas for sober drive incidents it was the need to drive. One quarter of those reporting drink drive incidents stated they had used marijuana and/or LSD at the event at which they drank.

Conclusions:Drink drive and sober drive incidents differed, particularly with regard to decisions made before the event. Prevention efforts could usefully be targeted toward these decisions.
Sperm donor suffers years later from inherited disease
Authors: Gebhardt D O E
Published: October 2002

A case is described of a man who discovered years after donating sperm for artificial insemination, that he had a serious genetic disease, autosomal dominant cerebellar ataxia (ADCA). This manifests itself only years after puberty and occurs in 50% of the progeny. The sperm had been used for the conception of 18 children in 13 women. The parents were only told three years after the insemination. This long time interval was unavoidable since many of the parents had to be found and the hospital director wished first to discuss the matter with his legal advisors and other experts.

In future, in agreement with the new law only 10 inseminations will take place with sperm from one donor. This will reduce still further the availability of donor sperm.
Commentary on Skene and Parker: the role of a church (or other ideologically based interest group) in developing the law—a plea for ethereal intervention
Authors: Harris John , Holm Søren
Published: October 2002

This paper discusses the provocative views of Skene and Parker as to the role of religious or other ideologically based interest groups in law and policy making. We draw distinctions between doctrine and prejudice and between argument and ideology which we trust take the debate further. Finally we recommend an ethereal, democratic, and populist partial solution.
Commentary on Skene and Parker: the role of the church in developing the law
Authors: Gormally L
Published: October 2002

Skene and Parker are demonstrably mistaken in suggesting that theamicusrole of Catholic bishops in three cases has been concerned with “developing” the law. In contrast with Skene and Parker’s freestanding conception of legal principle, the Catholic understanding of law’s rational moral foundations has permitted Catholic bishops to defend longstanding legal principle as well as defending the integrity of the church’s health care and welfare services. It is shown that in the three cases under discussion Catholic bishops were providing needed argument otherwise unavailable to the courts in defence of existing statute. In face of the attempts by pressure groups to bypass the legislature and use the courts to subvert fundamental legal principles, the church is perhaps uniquely capable of continuing to provide to the courts rational defences of those principles.
Democracy, embryonic stem cell research, and the Roman Catholic church
Authors: Oakley J
Published: October 2002

The Roman Catholic Church in Australia has lobbied politicians to prohibit embryonic stem cell research, on the grounds that such research violates the sanctity and inherent dignity of human life. I suggest, however, that reasoned reflection does not uniquely support such conclusions about the morality of stem cell research. A recent parliamentary standing committee report recommended that embryonic stem cell research be allowed to proceed in certain circumstances, and there appears to be widespread support in the Australian community for this position. I argue that the moral value of democracy requires parliamentarians to acknowledge the informed views of the wider community here, and to resist lobbying by church leaders on this issue.
Ms B and Diane Pretty: a commentary
Authors: Singer P
Published: October 2002

In two recent court cases, Ms B, a paralysed competent adult, was allowed to end her life; Mrs Pretty, another paralysed competent adult, was not. In legal terms, the essential difference between the two cases is that Ms B was seeking the withdrawal of treatment, whereas Mrs Pretty was asking for assistance in ending her life. I argue that while this distinction may accurately state the law that governs these situations, it does not rest on a defensible moral basis. Both the women should have been allowed to choose the manner in which they would die.
The case of Ms B and the “right to die”
Authors: Slowther A
Published: October 2002

The High Court in England has ruled that doctors are acting illegally if they refuse to comply with a competent patient’s request to switch off their ventilator even if the result would be death. If doctors feel unable to do this then they must arrange for the patient to be transferred to the care of a colleague who is prepared to comply with the request.
Analogy in moral deliberation: the role of imagination and theory in ethics
Authors: Smith B
Published: October 2002

This paper develops themes addressed in an article by Eric Wiland in theJournal of Medical Ethics2000;26:466–8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel understanding of why analogy is an essential component in the attempt to justify moral beliefs. I seek to show how analogical argument both encapsulates and exercises the notions of rationality and imagination and that the construction, development, and comparison of analogies fundamentally underpins ethical argument. In so doing, it enables us to adopt imaginative and ethically illuminating perspectives but in a manner that does not relinquish any claims to intellectual rigour. I present a critique of a brand of “moral particularism” by showing how it cannot, if construed in a certain way, adequately conceive of how we use analogies and imaginary cases in ethics. Although such a particularism is thus impotent with regard to ethical debate, I show that the wider motivation behind particularism that can be extracted is of clear relevance and importance to medical practitioners.
Consent, sectionalisation and the concept of a medical procedure
Authors: Maclean A R
Published: October 2002

Consent transforms an otherwise illegitimate act into a legitimate one. To be valid, however, it must be adequately informed. The legal requirement is vague and provides little assistance in predicting when it will be satisfied. This is particularly so when a patient consents to a procedure and the physician subsequently varies one of the components of that procedure. Using three legal judgments and one General Medical Council (GMC) decision as a springboard, I have explored the concept of a medical procedure within the context of consent and developed a theoretical model to elucidate a more predictable and consistent informational requirement.
A study on the ethics of microallocation of scarce resources in health care
Authors: Fortes P A C , Zoboli E L C P
Published: October 2002

Objectives:This study attempts to analyse the ethical dilemmas arising from the microallocation of scarce health care resources, in terms of deontology and utilitarianism.

Methods:A group of 395 people were interviewed in the region of Diadema, greater San Paulo, Brazil, while visiting patients in the only state hospital in town. Each interviewee was given a list of eight simulated emergencies (see appendix). In each of the eight cases the interviewee had to choose which of the two patients described, both of whom suffered from exactly the same problem, should receive the only hospital bed currently available. The differences between the hypothetical patients were as follows: age, gender, family dependency, and lifestyle. Each interviewee was asked to justify one of their responses. These responses were then analysed.

Results:The results pointed to the co-existence of deontological and utilitarian orientations among the people interviewed. A tendency to give priority to the destitute was revealed throughout the research, contradicting the idea that society, valuing only productive people, wishes only such people to receive the most resources, thus maximising the benefits to be gained from resources. The results showed that people’s disapproval of the alcoholic was stronger than that of the nicotine abuser.
Implementation of service screening with mammography in Sweden: from pilot study to nationwide programme
Authors: Olsson S. , Andersson I. , Karlberg I. , Bjurstam N. , Frodis E. , Håkansson S.
Published: October 2002

Establishment of mammography screening in Sweden has progressed logically from pilot study through clinical trials to service screening. Screening with mammography for early detection of breast cancer has been provided by all Sweden's 26 county councils since 1997. It took 23 years from the initial pilot study through clinical trials to the establishment of mammography service screening through out Sweden.In the screening rounds completed by 1995–96, and provided by all but one county council, 1 040 000 women participated, corresponding to 81% of those invited. The national average recall rate was 2.2%, and consequently 23 000 women were recalled for additional investigations. Eleven county councils invited women aged 40–74, six invited women aged 50–69, the remaining eight invited women between both these age intervals.Mammography outside screening programmes—clinical mammography—is available throughout Sweden. About 100 000 women a year were referred for clinical mammography and about 50% of these were either younger or older than those invited for screening. A negative relation between the use of clinical mammography and participation in the screening programmes was noticed.
Use of the phenylalanine:tyrosine ratio to test newborns for phenylketonuria in a large public health screening programme
Authors: Eastman J.W. , Sherwin J.E. , Wong R. , Liao C.L. , Currier R.J. , Lorey F. , Cunningham G.
Published: October 2002

Objective To assess the benefits of using the phenylalanine:tyrosine ratio to screen newborns for phenylketonuria (PKU).

Setting Data were collected from all newborns in California during a ten month period (n = 404 381).

Methods Dried blood spot specimens were analysed at nine laboratories. To assure that the results reported from multiple sites were matched accurately, an automated methodology was chosen that included sample processing, analysis, telecommunications, reporting, and information technology. Phenylalanine and tyrosine concentrations were measured independently by continuous flow fluorometry, for which precision, recovery, detection limits, carryover, chemical specificity, reportable range, and number of repeats are reported.

Results In this study, 37% of the newborns were tested at less than 24 hours of age. For this population, using a phenylalanine only cut off of 200 μmol/l, there were 48 recalled infants per case of classic PKU. Using the phenylalanine:tyrosine ratio with a cut off of 1.50, screen positives could be reported with phenylalanine as low as 150 μmol/l and with only 12 recalls per case.

Conclusions The phenylalanine:tyrosine ratio can be measured accurately at multiple laboratories using two channel chemical analyses. Having applied the methods to the routine clinical screening of a large population, it was confirmed that the clinical sensitivity and specificity of the PKU screening test are higher when the phenylalanine:tyrosine ratio is incorporated into the cut off than when the cut off is based on the phenylalanine concentration alone.