bluuebunny/crossref_metadata_2025 huggingface dataset:
A prospective epidemiological study of injuries in four English professional football clubs.
Authors: Hawkins R D , Fuller C W
Published: December 2008

OBJECTIVE: To define the causes of injuries to players in English professional football during competition and training. METHOD: Lost time injuries to professional and youth players were prospectively recorded by physiotherapists at four English League clubs over the period 1994 to 1997. Data recorded included information related to the injury, date and place of occurrence, type of activity, and extrinsic Playing factors. RESULTS: In all, 67% of all injuries occurred during competition. The overall injury frequency rate (IFR) was 8.5 injuries/1000 hours, with the IFR during competitions (27.7) being significantly (p < 0.01) higher than that during training (3.5). The IFRs for youth players were found to increase over the second half of the season, whereas they decreased for professional players. There were no significant differences in IFRs for professional and youth players during training. There were significantly (p < 0.01) injuries in competition in the 15 minute periods at the end of each half. Strains (41%), sprains (20%), and contusions (20%) represented the major types of injury. The thigh (23%), the ankle (17%), knee (14%), and lower leg (13%) represented the major locations of injury, with significantly (p < 0.01) more injuries to the dominant body side. Reinjury counted for 22% of all injuries. Only 12% of all injuries were caused by a breach of the rules of football, although player to player contact was involved in 41% of all injuries. CONCLUSIONS: The overall level of injury to professional footballers has been showed to be around 1000 times higher times higher than for industrial occupations generally regarded as high risk. The high level of muscle strains, in particular, indicates possible weakness in fitness training programmes and use of warming up and cooling down procedures by clubs and the need for benchmarking players' levels of fitness and performance. Increasing levels of injury to youth players as a season progresses emphasizes the importance of controlling the exposure of young players to high levels of competition.
Cardiac assessment of veteran endurance athletes: a 12 year follow up study.
Authors: Hood S , Northcote R J
Published: December 2008

OBJECTIVES: Sustained aerobic dynamic exercise is beneficial in preventing cardiovascular disease. The effect of lifelong endurance exercise on cardiac structure and function is less well documented, however. A 12 year follow up of 20 veteran athletes was performed, as longitudinal studies in such cohorts are rare. METHODS: Routine echocardiography was repeated as was resting, exercise, and 24 hour electrocardiography. RESULTS: Nineteen returned for screening. Mean (SD) age was 67 (6.2) years (range 56-83). Two individuals had had permanent pacemakers implanted (one for symptomatic atrial fibrillation with complete heart block, the other for asystole lasting up to 15 seconds). Only two athletes had asystolic pauses in excess of two seconds compared with seven athletes in 1985. Of these seven, five had no asystole on follow up. Two of these five had reduced their average running distance by about 15-20 miles a week. One athlete sustained an acute myocardial infarction during a competitive race in 1988. Three athletes had undergone coronary arteriography during the 12 years of follow up but none had obstructive coronary artery disease. Ten of 19 (53%) had echo evidence of left ventricular hypertrophy in 1997 but only two (11%) had left ventricular dilatation. Ten athletes had ventricular couplets on follow up compared with only two in 1985. CONCLUSIONS: Although the benefits of moderate regular exercise are undisputed, high intensity lifelong endurance exercise may be associated with altered cardiac structure and function. These adaptations to more extreme forms of exercise merit caution in the interpretation of standard cardiac investigations in the older athletic population. On rare occasions, these changes may be deleterious.
Effect of stretching duration on active and passive range of motion in the lower extremity.
Authors: Roberts J M , Wilson K
Published: December 2008

OBJECTIVES: To investigate the effect of different durations of stretching (five or 15 seconds) on active and passive range of motion (ROM) in the lower extremity during a five week flexibility training programme. METHOD: Twenty four university sport club members (19 men, five women), with a mean (SD) age of 20.5 (1.35) years, were randomly assigned to one of three groups (two treatment and one control). The two treatment groups participated in a static active stretching programme three times a week for a five week period, holding each stretch for a duration of either five or 15 seconds. The total amount of time spent in a stretched position was controlled. The five second group performed each stretch nine times and the 15 second group three times resulting in a total stretching time of 45 seconds for both groups for each exercise. The control group did not stretch. Active and passive ROM were determined during left hip flexion, left knee flexion, and left knee extension before and after the training programme using an inclinometer. RESULTS: Two factor within subject analysis of variance indicated no significant difference in ROM before and after the training programme for the control group. However, significant improvements in active and passive ROM (p < 0.05) were shown in both treatment groups after the five week training programme. Two factor analysis of variance with repeated measures and post hoc analysis showed significant differences between the treatment groups and the control group for the improvements observed in active (p < 0.05) and passive (p < 0.05) ROM. The five and 15 second treatment groups did not differ from one another when ROM was assessed passively, but significant differences were apparent for active ROM, with the 15 second group showing significantly greater improvements (p < 0.05) than the five second group. CONCLUSION: These findings suggest that holding stretches for 15 seconds, as opposed to five seconds, may result in greater improvements in active ROM. However, sustaining a stretch may not significantly affect the improvements gained in passive ROM.
Medical cover at Scottish football matches: have the recommendations of the Gibson Report been met?
Authors: Kerr G W , Wilkie S C , McGuffie C A
Published: December 2008

OBJECTIVES: To determine if doctors providing medical care at Scottish football stadiums meet the standards recommended by the Gibson Report. METHODS: A postal questionnaire and telephone follow up of doctors involved with the 40 Scottish League teams. RESULTS: 47% of the doctors had not attended any relevant resuscitation courses and 72% had no training in major incident management. CONCLUSIONS: The recommendations of the Gibson Report with regard to medical cover at football stadiums have not been fully implemented in Scotland.
Frostbite at the gym: a case report of an ice pack burn.
Authors: O'Toole G , Rayatt S
Published: December 2008

The case is reported of a 59 year old woman who suffered a 1% total body surface area superficial partial thickness burn to her calf following the application of an ice pack. The cause, resulting injury, and subsequent management are discussed. It is possible that such injuries are common, but no similar reports were found in a literature search. Awareness of the risk of this type of injury is important for all those entrusted with advising patients on the treatment of minor soft tissue injuries.
Epidemiology of injury in elite and subelite female gymnasts: a comparison of retrospective and prospective findings.
Authors: Kolt G S , Kirkby R J
Published: December 2008

OBJECTIVES: An 18 month prospective injury survey was conducted on 64 Australian elite and subelite female gymnasts. The aims were to determine the rate of injury, anatomical location, and types of injury incurred by female competitive gymnasts, and to compare the findings with data collected retrospectively from the same sample of gymnasts. METHODS: The gymnasts recorded (weekly) in an injury record booklet the number of hours trained and information on any injuries suffered over that week. RESULTS: The sample reported 349 injuries, a rate of 5.45 per person (6.29 for the elite and 4.95 for subelite gymnasts) over the 18 month survey. Injuries to the ankle and foot (31.2%) were the most commonly reported, followed by the lower back (14.9%). The most prevalent type of injury were sprains (29.7%), followed by strains (23.2%), and growth plate injuries (12.3%). The elite gymnasts reported that, for each injury, they missed fewer training sessions (p = 0.01), but modified more sessions (p = 0.0001) than their subelite counterparts. Further, the elite gymnasts spent 21.0% of the year training at less than full capacity because of injury. Although a significantly higher number of injuries were recorded in the prospective study (p = 0.0004), no differences were found between the distribution of injury by anatomical location or type between the two methods of data collection. CONCLUSIONS: The findings have important implications in terms of training procedures and periodic screening of gymnasts.
Injuries to polo riders: a prospective evaluation.
Authors: Costa-Paz M , Aponte-Tinao L , Muscolo D L
Published: December 2008

OBJECTIVE: To assess prospectively the incidence, nature, and severity of injuries to polo riders competing in the 1996 Argentine High Polo season. METHODS: Assessment, documentation, and provision of care for all injuries sustained during the 1996 season by one of the authors. Riders were also surveyed retrospectively for their previous polo injuries. RESULTS: 34 riders took part in the study. Nine injuries were sustained prospectively and 55 injuries were reviewed retrospectively (64 total). The injuries were categorised as minor (10), moderate (13), and major (41). Twenty five (39%) injuries occurred in the arms, 20 (31%) in the legs, 12 (19%) in the head, 3 (5%) in the back, and 4 (6%) in the face. A fracture occurred in 25 (39%) injuries as most resulted from a fall from the horse. Additionally, facial lacerations occurred prospectively in five riders but did not result in missed play. An overall injury rate of 7.8/1000 player-game hours was calculated. CONCLUSIONS: Although many sports have injury rates much greater than 8/1000 player-game hours, the severity of most injuries occurring in polo was classified as major, with fractures and facial lacerations common. The use of a helmet with a face protector is recommended to decrease injury to players. A doctor experienced in the management of serious trauma should be present at all polo matches.
Reliability of ratings of perceived exertion during progressive treadmill exercise.
Authors: Lamb K L , Eston R G , Corns D
Published: December 2008

OBJECTIVE: To assess the test-retest reliability (repeatability) of Borg's 6-20 rating of perceived exertion (RPE) scale using a more appropriate statistical technique than has been employed in previous investigations. The RPE scale is used widely in exercise science and sports medicine to monitor and/or prescribe levels of exercise intensity. The "95% limits of agreement" technique has recently been advocated as a better means of assessing within-subject (trial to trial) agreement than traditional indicators such as Pearson and intraclass correlation coefficients. METHODS: Sixteen male athletes (mean (SD) age 23.6 (5.1) years) completed two identical multistage (incremental) treadmill running protocols over a period of two to five days. RPEs were requested and recorded during the final 15 seconds of each three minute stage. All subjects successfully completed at least four stages in each trial, allowing the reliability of RPE responses to be examined at each stage. RESULTS: The 95% limits of agreement (bias +/- 1.96 x SDdiff) were found to widen as exercise intensity increased: 0.88 (2.02) RPE units (stage 1), 0.25 (2.53) RPE units (stage 2), -0.13 (2.86) RPE units (stage 3), and -0.13 (2.94) RPE units (stage 4). Pearson correlations (0.81, 0.72, 0.65, and 0.60) and intraclass correlations (0.82, 0.80, 0.77, and 0.75) decreased as exercise intensity increased. CONCLUSIONS: These findings question the test-retest reliability of the RPE scale when used to monitor subjective estimates of exercise intensity in progressive (or graded) exercise tests.
Hip and ankle range of motion and hip muscle strength in young female ballet dancers and controls.
Authors: Bennell K , Khan K M , Matthews B , De Gruyter M , Cook E , Holzer K , Wark J D
Published: December 2008

OBJECTIVES: To compare the hip and ankle range of motion and hip muscle strength in 8-11 year old novice female ballet dancers and controls. METHODS: Subjects were 77 dancers and 49 controls (mean (SD) age 9.6 (0.8) and 9.6 (0.7) years respectively). Supine right active hip external rotation (ER) and internal rotation (IR) were measured using an inclinometer. A turnout protractor was used to assess standing active turnout range. The measure of ER achieved from below the hip during turnout (non-hip ER) was calculated by subtracting hip ER range from turnout range, and hip ER:IR was derived by dividing ER range by IR range. Range of right weight bearing ankle dorsiflexion was measured in a standing lunge using two methods: the distance from the foot to the wall (in centimetres) and the angle of the shank to the vertical via an inclinometer (in degrees). Right calf muscle range was measured in weight bearing using an inclinometer. A manual muscle tester was used to assess right isometric hip flexor, internal rotator, external rotator, abductor, and adductor strength. RESULTS: Dancers had less ER (p<0.05) and IR (p<0.01) range than controls but greater ER:IR (p<0.01). Although there was no difference in turnout between groups, the dancers had greater non-hip ER. Dancers had greater range of ankle dorsiflexion than controls, measured in both centimetres (p<0.01) and degrees (p<0.05), but similar calf muscle range. After controlling for body weight, controls had stronger hip muscles than dancers except for hip abductor strength which was similar. Regression analyses disclosed a moderate relation between turnout and hip ER (r = 0.40). There were no significant correlations between range of motion and training years and weekly training hours. CONCLUSIONS: Longitudinal follow up will assist in determining whether or not hip and ankle range in young dancers is genetically fixed and unable to be improved with further balletic training.
Prediction of peak oxygen uptake in chronic fatigue syndrome.
Authors: Mullis R , Campbell I T , Wearden A J , Morriss R K , Pearson D J
Published: December 2008

OBJECTIVES: To establish a simple, valid, and acceptable method of predicting peak oxygen uptake (VO2peak) in patients with chronic fatigue syndrome (CFS), which could provide a basis for subsequent exercise prescription at an appropriate intensity as part of a clinical rehabilitation programme. METHODS: A total of 130 patients who met UK research criteria for CFS were taken from consecutive referrals for chronic fatigue to the University Department of Medicine at Withington Hospital, Manchester. VO2peak was determined using an incremental graded exercise test to exhaustion. Respiratory gas exchange, work rate, and heart rate were monitored throughout. RESULTS: In all patients, VO2peak was found to correlate strongly and significantly with peak work rate (WRpeak) during testing (r2 = 0.88, p<0.001). In patients who exercised for longer than two minutes (n = 119), regression analysis established the relation as Vo2peak = 13.1 x WRPpeak + 284, where VO2 is given in ml/min and WR in W. The mean error between the measured VO2peak and the predicted value was 10.7%. The relation between increase in work rate and oxygen uptake across the group was highly significant (r2 = 0.87, p<0.001), and given as VO2increase = 12.0 x WRincrease, this value being similar to that expected for healthy individuals. Almost all (97%) subjects reported no exacerbation of symptoms after maximal exercise testing. CONCLUSIONS: Using a simple to administer maximal exercise test on a cycle ergometer, it is possible to predict accurately the VO2peak of a patient with CFS from peak work rate alone. This value can then be used as an aid to setting appropriate exercise intensity for a rehabilitation programme. The increase in VO2 per unit increase in workload was consistent with that expected in healthy individuals, suggesting that the physiological response of the patients measured here was not abnormal. Contrary to the belief of many patients, maximal exercise testing to the point of subjective exhaustion proved to be harmless, with no subjects suffering any lasting deterioration in their condition after assessment.
General practitioners' training for, interest in, and knowledge of sports medicine and its organisations.
Authors: Buckler D G
Published: December 2008

OBJECTIVES: To assess the training and interest of a group of general practitioners in the area of sport and exercise medicine, and the organisations representing the specialty. DESIGN: A postal questionnaire using a Likert scale in a previously piloted set of questions. SUBJECTS: 275 general practitioners registered with the Northampton Regional Health Authority. MAIN OUTCOME MEASUREMENTS: Responses to questions designed to assess training and interest in sport and exercise medicine. RESULTS: A response rate of 87.6% was achieved. It was found that 72.7% of the responding general practitioners felt inadequately trained to practice sport and exercise medicine. Some 76.0% would welcome more training and 36.4% felt that their undergraduate orthopaedic training was of no use in primary care. Many (63.6%) of the general practitioners believed that the current NHS cannot sustain sport and exercise medicine, and there was uncertainty as to whether it is currently a recognised specialty, although 60.4% felt that it should be. General practitioners listed lack of facilities (53.1%), lack of training (42.9%), and lack of time (38.2%) as the main problems in practicing sport and exercise medicine in primary care within the current NHS. CONCLUSIONS: General practitioners feel undertrained in sport and exercise medicine at both undergraduate and post-graduate level; they have a perceived need for more training and show an interest in the subject. There is scope for improving the value of undergraduate orthopaedic training. General practitioners wish to see sport and exercise medicine recognised as an NHS specialty but fear that this is not sustainable under current conditions. There is confusion among general practitioners about the current sport and exercise medicine organisations.
Eccentric and concentric isokinetic moment characteristics in the quadriceps and hamstrings of the chronic isolated posterior cruciate ligament injured knee.
Authors: MacLean C L , Taunton J E , Clement D B , Regan W
Published: December 2008

OBJECTIVE: Functional strength deficits associated with chronic isolated posterior cruciate ligament (PCL) insufficiency have received limited attention in the literature. The purpose of this study was to determine the eccentric and concentric isokinetic moment characteristics of the quadriceps and hamstrings in a sample of patients with isolated PCL injury. METHODS: Eccentric and concentric mean average and average peak moments were measured for 17 patients with a history of conservatively treated isolated PCL injury using an isokinetic dynamometer. Quadriceps and hamstring isokinetic moments were recorded from 10 degree to 90 degree of knee flexion. Strength ratios were calculated and compared with those reported in the literature for healthy subjects. RESULTS: The hamstrings of the involved side (eccentric/concentric (E/C) ratio = 1.06) were significantly weaker (p<0.05) eccentrically than those of the contralateral side (E/C ratio = 1.29). All hamstrings/quadriceps (H/Q) ratios were less than the universally accepted value of 0.60 and the eccentric H/Q ratio for the injured extremity was significantly lower than the non-injured (p<0.05). In a bilateral comparison, the injured/non-injured (I/N) ratio was less than 1.00 for concentric quadriceps, eccentric quadriceps, and hamstring isokinetic moments. Calculation of the E/C ratio showed that, for the quadriceps, it was 1.08 on the injured side and 1.07 on the non-injured extremity. CONCLUSIONS: Eccentric strengthening should be an integral part of functionally rehabilitating the quadriceps and hamstrings of athletes who suffer from the complications associated with chronic isolated PCL insufficiency.
Common extensor tendon rupture following corticosteroid injection for lateral tendinosis of the elbow.
Authors: Smith A G , Kosygan K , Williams H , Newman R J
Published: December 2008

Corticosteroid injections are commonly administered to athletes to relieve symptoms of lateral elbow tendinosis. This report presents a case of almost total rupture of the common extensor origin in a 45 year old female squash player secondary to such a procedure.
Five year results of rotator cuff repair.
Authors: Habernek H , Schmid L , Frauenschuh E
Published: December 2008

In thirty nine patients with either an acute rotator cuff rupture or a chronic impingement syndrome plus a cuff tear, a standard acromioplasty was performed along with a cuff repair using a bone detaching approach. Postoperative active motion was allowed in all but three. Follow up examination was performed two and five years after the operation. Continuous improvement in function, range of movement, and strength was observed, while pain increased slightly. The size of the tear and delay in treatment were determining factors in the outcome.
Demographic risk factors for injury among Hispanic and non-Hispanic white children: an ecologic analysis
Authors: Anderson Craig L , Agran Phyllis F , Winn Diane G , Tran Cecile
Published: December 2008

Objectives—To determine the effects of neighborhood levels of poverty, household crowding, and acculturation on the rate of injury to Hispanic and non-Hispanic white children.

Setting—Orange County, California.

Methods—An ecologic study design was used with census block groups as the unit of analysis. Measures of neighborhood poverty, household crowding, and acculturation were specific to each ethnic group. Poisson regression was used to calculate mutually adjusted incidence rate ratios (IRRs) corresponding to a 20% difference in census variables.

Results—Among non-Hispanic white children, injury rates were more closely associated with neighborhood levels of household crowding (adjusted IRR 2.36, 95% confidence interval (CI) 1.22 to 4.57) than with neighborhood poverty (adjusted IRR 1.06, 95% CI 0.89 to 1.26). For Hispanic children, the strongest risk factors were the proportion of Hispanic adults who spoke only some English (compared with the proportion who spoke little or no English, adjusted IRR 1.26, 95% CI 1.04 to 1.53) and the proportion who were US residents for <5 years (adjusted IRR 1.20, 95% CI 1.001 to 1.43). Neighborhood levels of household crowding were not related to injury among Hispanic children (adjusted IRR 0.98, 95% CI 0.89 to 1.08), but surprisingly, neighborhood poverty was associated with lower injury rates (adjusted IRR 0.89, 95% CI 0.81 to 0.97).

Conclusions—Cultural and geographic transitions, as well as socioeconomic differences, appear to contribute to differences in childhood injury rates between ethnic groups.
A case-control study of risk factors for playground injuries among children in Kingston and area
Authors: Mowat David L , Wang Feng , Pickett William , Brison Robert J
Published: December 2008

Objective—To determine the risk for injury associated with environmental hazards in public playgrounds.

Setting—One hundred and seventeen playgrounds operated by municipalities or school boards in and around Kingston, Ontario, Canada.

Methods—A regional surveillance database was used to identify children presenting to emergency departments who were injured on public playgrounds; each case was individually matched (by sex, age, and month of occurrence) with two controls—one non-playground injury control, and one child seen for non-injury emergency medical care. Exposure data were obtained from an audit of playgrounds conducted using Canadian and US safety guidelines. Exposure variables included the nature of playground hazards, number of hazards, frequency of play, and total family income. No difference in odds ratios (ORs) were found using the two sets of controls, which were therefore combined for subsequent analysis.

Results—Multivariate analysis showed strong associations between injuries and the use of inappropriate surface materials under and around equipment (OR 21.0, 95% confidence interval (CI) 3.4 to 128.1), appropriate materials with insufficient depth (OR 18.2, 95% CI 3.3 to 99.9), and inadequate handrails or guardrails (OR 6.7, 95% CI 2.6 to 17.5).

Conclusion—This study confirms the validity of guidelines for playground safety relating to the type and depth of surface materials and the provision of handrails and guardrails. Compliance with these guidelines is an important means of preventing injury in childhood.
All terrain vehicle ownership, use, and self reported safety behaviours in rural children
Authors: Warda Lynne , Klassen Terry P , Buchan Norma , Zierler Amy
Published: December 2008

Objectives—To describe all terrain vehicle (ATV) ownership, access, use, and safety behaviours in rural Manitoba children.

Methods—Questionnaire administered to a convenience sample of grade 6 students attending an agricultural fair.

Results—162 grade 6 children participated. The mean age was 11.4 years, and 46% were male. 125 students (77%) reported having access to ATVs, including 69 four wheeled, 24 three wheeled, and four both three and four wheeled ATVs. ATV experience was reported in 95 students, significantly more often in males and among those with a family owned ATV, with no difference between children living on a farm and in a town. Use of helmets and protective clothing was inadequate (10–40%), and dangerous riding habits common, with males and children living on a farm reporting significantly fewer desirable behaviours.

Conclusions—ATVs are commonly used by children in rural Manitoba, with inadequate protective gear and dangerous riding habits. Mandatory rider training, consumer and dealer education, and legislation enforcement could improve ATV safety in this population.
Rates of, and the factors affecting, cycle helmet use among secondary schoolchildren in East Sussex and Kent
Authors: Cryer P Colin , Cole Jeremy , Davidson Leslie L , Rahman Mohammed , Ching Vivian , Goodall Janet B
Published: December 2008

Objectives—To assess the level of cycle helmet wearing among young people in two counties in the South East of England in 1994, and to identify the factors associated with helmet wearing.

Design—Cross sectional survey in a convenience sample.

Setting—Secondary schools in East Sussex and Kent.

Subjects—Students in year 7 (aged 10–12 years) and year 11 (aged 14–16 years).

Main outcome measures—Self reported “always wears a helmet”.

Results—Among those who ride a bicycle, 32% of boys and 29% of girls aged 10–12 years, and 14% of boys and 10% of girls aged 14–16, reported that they always wear helmets. The variables that were most consistently associated with helmet wearing (that is significantly associated with helmet wearing in at least five of the six age, sex, and county subgroups) were: “parental encouragement to wear a helmet”, “closest friend wears a helmet”, “belief that laws that make children wear helmets are good”, and “sometimes rides off-road”.

Conclusions—The self reported rates of always wearing a cycle helmet in East Sussex and Kent are consistent with overseas findings for populations who had not been exposed to intensive helmet promotion. The evidence suggests that parental encouragement has a favourable effect on rates of cycle helmet use among secondary schoolchildren, which is separate from and additional to peer influences. When designing a helmet promotion programme, therefore, it will have added impact if both parents and children are addressed.
Evaluation of a bicycle skills training program for young children: a randomized controlled trial
Authors: Macarthur Colin , Parkin Patricia C , Sidky Malak , Wallace Will
Published: December 2008

Objective—To evaluate the effectiveness of a skills training program in improving safe cycling behavior, knowledge, and attitudes in young children.

Methods—Grade 4 children from six elementary schools in East York (a borough of Metropolitan Toronto) participated. The intervention—playground based instruction on bicycle handling skills by certified instructors—was randomly allocated to three schools. Altogether 141 children participated: 73 in the intervention group and 68 in the control group, with follow up evaluations available on 117 (83%). The primary outcome was safe cycling behavior (straight line riding, coming to a complete stop, and shoulder checking before a left turn). A self report questionnaire collected data on knowledge and attitudes. Baseline assessments were made in June, with follow up evaluations in September, 1995.

Results—The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively, were: straight line riding (90%v88%; p=0.782), coming to a complete stop (90%v76%; p=0.225), and shoulder checking (0%v2%; p=1.000). Over time (from baseline to follow up) children in both groups were more likely to maintain straight line riding, less likely to ride on the sidewalk, and less likely to consider that a car had more right to the road.

Conclusions—This brief skills training program was not effective in improving safe cycling behavior, knowledge, or attitudes among grade 4 children.
Fractures among children: incidence and impact on daily activities
Authors: Kopjar Branko , Wickizer Thomas M
Published: December 2008

Objectives—The study's objective was to examine incidence of fractures and associated activity restriction among children aged 0–12 years.

Design—Injuries were prospectively recorded over the four year period from 1992–95 in a cohort of children aged 0–12 years, representing 193 540 children years. Information about length and extent of activity restriction was collected from parents by a mailed questionnaire for a subsample of 192 children with a fracture.

Results—A total of 2477 fractures occurred in the study population (128 per 10 000 children annually). The incidence increased linearly with age, by 14 cases per 10 000 children year for each year of age. Boys and girls showed similar patterns of fracture occurrence. There was a significant difference in length of activity restrictions for different types of fractures. The mean and 95% confidence interval (CI) of activity restricted days for leg fractures were 26 (95% CI 7 to 45) days, for arm fractures, 14 (95% CI 8 to 20) days, and for other fractures, 5 (95% CI 1 to 8) days. Arm fractures represented 66% of the cases and 62% of the activity restricted days; leg fractures 19% of cases and 33% of all activity restricted days; and other fractures 16% of the cases but only 5% of the activity restricted days in this population.

Conclusion—The incidence of fractures increases in childhood. Different types of fractures among children cause different amounts of activity restriction.
Characteristics of a gun exchange program, and an assessment of potential benefits
Authors: Romero Michael P , Wintemute Garen J , Vernick Jon S
Published: December 2008

Objectives—To describe a gun exchange program and assess potential benefits for participants and host communities.

Methods—Mail survey of participants in a Sacramento, California gun exchange program, August 1993; the response rate was 79%. Comparative data were obtained from nationwide polls of gun owners.

Results—Most (62%) respondents were men; 40% were more than 55 years old; none was less than 25. Concern that children might find and use the gun was the most frequently cited reason for participating (46% of respondents). Of 141 firearms exchanged, 72% were handguns; 23% of respondents indicated that the guns they turned in were not in working order. Of respondents who owned a gun at the time of the program (rather than those who owned no guns and turned in a gun owned by someone else), 41% owned no guns after participating; the prevalence of handgun ownership declined from 79% to 32%. Those who continued to own guns were as likely as gun owners nationwide to keep a gun loaded in the house (odds ratio (OR) 0.9, 95% confidence interval (CI) 0.4 to 1.7) or to carry a gun with them (OR 1.5, 95% CI 0.6 to 3.8).

Conclusions—Gun exchange programs may reduce risk for firearm violence among some participants, but a number of factors limit their overall benefits to host communities.
Tap water scald burns in children
Authors: Feldman Kenneth W , Schaller Robert T , Feldman Janen A , McMillon Mollie
Published: December 2008

Tap water scald burns account for 7% to 17% of all childhood scald burns that require hospitalization. Often the burns are severe and disabling. Toddlers and preschool children are the most frequent victims. In 45% of the injuries, the unsupervised victim or a peer turned on the tap water; in 28% the cause was abuse. Eighty per cent of the homes tested had unsafe bathtub water temperatures of 54°C (130°F) or greater, exposing the occupants to the risk of full thickness scalds with 30 second exposure to hot water. Such burns may be prevented passively by limiting household water temperatures to less than 52°C (125°F). New water heaters could be preset at this temperature and families could be taught to turn down the temperature on existing units.
Motor vehicle related injuries among American Indian and Alaskan Native youth, 1981–92: analysis of a national hospital discharge database
Authors: Quinlan Kyran P , Wallace L J David , Furner Sylvia E , Brewer Robert D , Bolen Julie , Schieber Richard A
Published: December 2008

Objective—To describe national trends in hospitalizations for motor vehicle related injuries among children and youth (0–24 years) of the United States Indian Health Service (IHS) from 1981–92.

Design—Descriptive epidemiologic study of the E coded national hospital discharge database of the IHS.

Results—From 1981 to 1992, the age standardized annual incidence of motor vehicle related injury hospitalizations (per 100 000 population) among American Indian and Alaskan Native (AI/AN) youth decreased more than 65% from 269 to 93. Substantial declines in hospitalization rates for all age and sex groups, all IHS areas, and most injury types were seen over this time. Injuries to vehicle occupants accounted for 78% of all motor vehicle related injury hospitalizations. The annual incidence of hospitalization (per 100 000 population) ranged from 291 in the Billings (Wyoming/Montana) and Aberdeen (the Dakotas) areas to 38 in the Portland area (Pacific Northwest).

Conclusions—National motor vehicle related injury hospitalization rates of AI/AN children and youth decreased significantly from 1981–92. This may be due to a reduction in the incidence of severe motor vehicle related trauma, changing patterns of medical practice, and changes in the use of services. Additional measures, such as passage and enforcement of tribal laws requiring the use of occupant restraints and stronger laws to prevent alcohol impaired driving, might further reduce the incidence of serious motor vehicle related injuries in this high risk population.
Bicycle helmet promotion among low income preschool children
Authors: Britt John , Silver Ilene , Rivara Frederick P
Published: December 2008

Objective—To evaluate the effectiveness of a multifaceted bicycle helmet promotion program for low income children attending preschool enrichment programs throughout Washington State.

Study sample—Preschool Head Start programs that conducted routine home visits among their enrolled families at least five times during the school year were eligible. Eighteen sites and 880 children met this criterion and were able and willing to carry out evaluation activities. Two hundred children were from control sites where no helmet promotion activities were carried out.

Intervention—Classroom activities with children, education of parents during school meetings and home visits, fitting and distribution of helmets, a bicycle skills and safety “rodeo” event, and requiring children to wear helmets while riding on school grounds.

Evaluation methods—Regularly scheduled home visits were used to observe helmet use of enrolled preschool children before and after the promotion program. Home visitors requested parental permission for enrolled children to ride, and then noted whether the child wore a helmet.

Results—Helmet use in the intervention group more than doubled, from 43% to 89%, while use in the control group increased from 42% to 60% (p<0.05 for intervention group changesvcontrol group changes).

Conclusions—This multifaceted helmet promotion program successfully increased helmet use. Similar home visit protocols may be useful to evaluate the impact of other injury intervention programs.
Did changes in minimum age drinking laws affect adolescent drowning (1970–90)?
Authors: Howland Jonathan , Birckmayer Johanna , Hemenway David , Cote Jennifer
Published: December 2008

Objective—To test the hypothesis that changes in the minimum legal drinking age (MLDA) laws would affect drowning among adolescents, the effects of changes in state MLDA laws on drowning were examined for the targeted (18–20 years) and two adjacent (15–17 years and 21–23 years) age groups, over a period of 21 years (1970–90).

Methods—Poisson maximum likelihood regression was used to estimate the effects of both lowering and increasing the MLDA. The dependent variable in these analyses was the number of drownings per state per year for the age groups observed. At first only state and year effects were controlled for and then any other variable potentially associated with the incidence of drowning was included. The other control variables included proportion of population living near border states with lower MLDA laws, urbanicity, unemployment, divorce, education, poverty, beer tax, and proxy measures for MLDA law enforcement.

Results—No significant association between drowning and MLDA was found for any of the age groups studied.

Conclusion—It is concluded that MLDA laws are not an important public policy strategy for affecting drowning rates among adolescents and young adults.
Measuring community/environmental interventions: the Child Pedestrian Injury Prevention Project
Authors: Stevenson Mark , Iredell Helena , Howat Peter , Cross Donna , Hall Margaret
Published: December 2008

Objectives—To assess the effectiveness of community/environmental interventions undertaken as part of the Child Pedestrian Injury Prevention Project (CPIPP).

Setting—Three communities (local government areas) in the Perth metropolitan area, Western Australia.

Methods—A quasiexperimental community intervention trial was undertaken over three years (1995–97). Three communities were assigned to either: a community/environmental road safety intervention and a school based road/pedestrian safety education program (intervention group 1); a school based road/pedestrian safety education program only (intervention group 2); or to no road safety intervention (comparison group). Quantification of the various road safety community/environmental activities undertaken in each community during the trial was measured, and a cumulative community activity index developed. Estimates of the volume and speed of vehicular traffic were monitored over a two year period.

Results—Greater road safety activity was observed in intervention group 1 compared with the other groups. A significant reduction in the volume of traffic on local access roads was also observed over the period of the trial in intervention group 1, but not in the remaining groups.

Conclusions—The findings indicate that the various community/environmental interventions initiated in collaboration with CPIPP in intervention group 1 contributed, in part, to the observed reduction in the volume of traffic. A combination of community/environmental interventions and education are likely to reduce the rate of childhood pedestrian injury.
Unintentional poisoning hospitalisations among young children in Victoria
Authors: Hoy Julie L , Day Lesley M , Tibballs James , Ozanne-Smith Joan
Published: December 2008

Objectives—To describe the epidemiology of unintentional childhood poisoning hospitalisation in Victoria, Australia, in order to monitor trends and identify areas for research and prevention.

Methods—For children under 5 years, all Victorian public hospital admissions, July 1987 to June 1995, due to unintentional poisoning by drugs, medicines, and other substances were analysed. Similar cases were also extracted from the database of the Royal Children's Hospital intensive care unit, Melbourne for the years 1979–91. Log linear regression modelling was used for trend analyses.

Results—The annual average childhood unintentional poisoning rate was 210.7 per 100 000. Annual rates for males consistently exceeded those for females. The most common agents were those acting on the respiratory system and on smooth and skeletal muscles (muscle relaxants, cough and cold medicines, antiasthmatics), aromatic analgesics (paracetamol), and systemic agents (including antihistamines).

Further investigation is justified for cardiac agents, some respiratory agents, and asthma medications.

Conclusions—Childhood poisoning hospitalisation rates have not decreased in Victoria over recent years. A focused, agent specific approach, as well as a series of generic measures for the prevention of poisoning to children under 5 is advocated. The ongoing surveillance, collection and analysis of data, in addition to research on specific poisoning agents are essential components of any prevention strategy.
Child and adolescent injury and death from urban firearm assaults: association with age, race, and poverty
Authors: Powell Elizabeth C , Tanz Robert R
Published: December 2008

Objective—To describe rates and trends in the incidence of non-fatal and fatal firearm assault among children (16 years old or younger) over an 11 year period in Chicago, Illinois and to identify the socioeconomic characteristics of community areas where assaults are common.

Methods—The Chicago Police Department (CPD) records from 1986 through 1996 were reviewed for children assaulted with a firearm. United States census data for 1990 for Chicago were used to calculate incidence rates; census data were also used for community area (defined by census tract) socioeconomic descriptions.

Results—The CPD recorded 11 163 pediatric firearm assaults during the study period: 10 571 non-fatal and 592 (5%) fatal. From 1986 through 1996 non-fatal assaults more than doubled, with the highest rates in 1994; fatal assaults tripled, with rates peaking in 1993–94. Significant increases in non-fatal firearm assaults occurred among black and Hispanic males and females. In 1994, compared with white males, the relative risk of non-fatal assault was 7.0 (95% confidence interval (CI) 5.3 to 9.1) for black males and 3.3 (95% CI 2.5 to 4.4) for Hispanic males; the relative risk was 1.5 (95% CI 1.1 to 2.1) for black females. A handgun was the firearm used in most assaults (88% of non-fatal and 84% of fatal).

Within community areas, the correlation between non-fatal and fatal assault incidence was strong (r=0.80, p<0.001). The proportion of families with income below the 1989 poverty level ($12 674) and the per cent black race in the community area together accounted for 70% of the variance in assault rates.

Conclusions—From 1986 to 1994 there were significant increases in both non-fatal and fatal firearm assaults, usually by handguns; thereafter, rates declined. Urban children who were victims of non-fatal firearm assault appear to come from the same population as those who suffer fatal assaults. Black and Hispanic youth living in poverty were at particular risk.
What pediatricians can do to further youth violence prevention—a qualitative study
Authors: Barkin Shari , Ryan Gery , Gelberg Lillian
Published: December 2008

Objective—Youth violence is a public health problem world wide. However, the United States has the worst rate of youth violence among industralized countries. This study was conducted to learn what pediatricians, community leaders, and parents think the doctor's role is in youth violence prevention during the well-child examination for children.

Methods—Interviews were conducted with pediatricians, community leaders, and parents living or working in Los Angeles, California.

Results—All three groups interviewed believed that the physician should incorporate violence prevention counseling as part of the well-child examination. The mechanism of action differed for the three groups. Almost half of pediatricians' statements focused on their role as prevention counselor, with respect to such issues as appropriate discipline and gun safety. One third of community leaders' statements, however, related to physician referral to existing community resources. More than half of parents' statements referred to the pediatrician as someone who can directly educate their child about making positive choices.

Conclusions—Although pediatricians cannot solve the problem of youth violence alone, findings from this study suggest that they should address this issue with their patients and should work in tandem with existing community resources to further a solution to this growing epidemic.
Reduced fatalities related to rear seat shoulder belts
Authors: Robertson Leon S
Published: December 2008

Objective—To determine the effect on fatality rates in crashes of installation of shoulder belts in automobile back seats.

Methods—During 1988–96, fatalities to rear outboard seat occupants of passenger cars, classified by age of occupant and vehicle curb weight were matched to data on model year in which shoulder belts became standard equipment. The same data were obtained from the same years on back seat occupants in crashes from the Crashworthiness Data System. Weighted regression was performed on death rates per occupants in crashes by belt equipment, occupant age, and vehicle weight for all occupants and occupants who claimed to be restrained.

Results—The risk of death is significantly lower in vehicles equipped with shoulder belts, midsized to larger cars, and among children. Claimed child restraint use is higher in cars with shoulder belts and claimed use of shoulder belts is higher among adolescents and young adults but lower among those 35 and older. However, older occupants have lower death rates in shoulder belt equipped cars.

Conclusions—Shoulder belts substantially reduce risk of death relative to lap belts at prevalent use rates in each age group. Belt effectiveness when used cannot be estimated precisely because of invalid claimed use, but the lowered rates among vehicles with shoulder belts indicates that effectiveness given prevalent use is far more efficacious than lap belts without shoulder belts.