bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a Human Neuronal Cell Model for Human Immunodeficiency Virus (HIV)-Infected Macrophage-Induced Neurotoxicity: Apoptosis Induced by HIV Type 1 Primary Isolates and Evidence for Involvement of the Bcl-2/Bcl-xL-Sensitive Intrinsic Apoptosis Pathway
Authors: Chen Wei , Sulcove Jerrold , Frank Ian , Jaffer Salman , Ozdener Hakan , Kolson Dennis L.
Published: October 2002

Neuronal apoptosis within the central nervous system (CNS) is a characteristic feature of AIDS dementia, and it represents a common mechanism of neuronal death induced by neurotoxins (e.g., glutamate) released from human immunodeficiency virus (HIV)-infected macrophages (HIV/macrophage-induced neurotoxicity). Neuronal apoptosis may result from activation of the intrinsic (mitochondrial/bcl-2regulated) or extrinsic (death receptor) pathways, although which pathway predominates in CNS HIV infection is unknown. Apoptosis initiated by the intrinsic pathway is typically blocked by antiapoptosis Bcl-2 family proteins, such as Bcl-2 and Bcl-xL, but whether these can block HIV/macrophage-induced neuronal apoptosis is unknown. To determine the potential role of the Bcl-2 family in HIV/macrophage-induced neuronal apoptosis, we developed a unique in vitro model, utilizing the NT2 neuronal cell line, primary astrocytes and macrophages, and primary CNS HIV type 1 (HIV-1) isolates. We validated our model by demonstrating that NT2.N neurons are protected against HIV-infected macrophages byN-methyl-d-aspartate (NMDA) glutamate receptor antagonists, similar to effects seen in primary neurons. We then established stable NT2.N neuronal lines that overexpress Bcl-2 or Bcl-xL (NT2.N/bcl-2 and NT2.N/bcl-xL, respectively) and determined their sensitivity to macrophages infected with primary R5, X4, and R5/X4 HIV-1 isolates. We found that NT2.N/bcl-2 and NT2.N/bcl-xL neurons were resistant to apoptosis induced by either R5, X4, or R5/X4 isolates and that resistance was abrogated by a Bcl-2 antagonist. Thus, the NMDA receptor/bcl-2-regulated apoptotic pathway contributes significantly to HIV/macrophage-induced neuronal apoptosis, and Bcl-2 family proteins protect neurons against the spectrum of primary HIV-1 isolates. Modulation ofbcl-2gene expression may therefore offer adjunctive neuroprotection against development of AIDS dementia.
Compartmentalization of Surface Envelope Glycoprotein of Human Immunodeficiency Virus Type 1 during Acute and Chronic Infection
Authors: Zhang Linqi , Rowe Leslie , He Tian , Chung Chris , Yu Jian , Yu Wenjie , Talal Andrew , Markowitz Marty , Ho David D.
Published: October 2002

Human immunodeficiency virus type 1 is characterized by extensive genetic heterogeneity. Having previously demonstrated that, in the peripheral blood, the initial viral population is more homogeneous than at subsequent stages of infection, we have extended our studies to tissue samples, allowing comparisons between viral populations in peripheral blood and tissues during both the acute and chronic stages of infection. We found that homogeneity in gp120 sequences during the acute infection phase is not just restricted to the peripheral blood but also extends to other tissue compartments. However, in chronically infected individuals, heterogeneous and distinct viral populations were found in different compartments. We therefore conclude that the dominant and homogeneous viral population observed during the acute infection phase is likely to infiltrate lymphoid tissues and form the genetic bases for subsequent diversification. It is therefore likely that the compartmentalization of viral sequences observed in chronically infected patients reflects a gradual diversification of a common dominant viral variant rather than the preferential migration of distinct viral populations to different tissue compartments at the beginning of infection.
Interaction with Decay-Accelerating Factor Facilitates Coxsackievirus B Infection of Polarized Epithelial Cells
Authors: Shieh Joseph T. C. , Bergelson Jeffrey M.
Published: October 2002

All coxsackie B (CB) viruses can initiate infection by attaching to the coxsackievirus and adenovirus receptor (CAR). Although some CB isolates also bind to decay-accelerating factor (DAF), the role of DAF interaction during infection remains uncertain. We recently observed that CAR in polarized epithelial cells is concentrated at tight junctions, where it is relatively inaccessible to virus. In the experiments reported here we found that, unlike CAR, DAF was present on the apical surface of polarized cells and that DAF-binding isolates of CB3 and CB5 infected polarized epithelial cells more efficiently than did isolates incapable of attaching to DAF. Virus attachment and subsequent infection of polarized cells by DAF-binding isolates were prevented in the presence of anti-DAF antibody. Serial passage on polarized cell monolayers selected for DAF-binding virus variants. Taken together, these results indicate that interaction with DAF on the apical surface of polarized epithelial cells facilitates infection by a subset of CB virus isolates. The results suggest a possible role for DAF in infection of epithelial cells at mucosal surfaces.
A Recombinant Rhesus Cytomegalovirus Expressing Enhanced Green Fluorescent Protein Retains the Wild-Type Phenotype and Pathogenicity in Fetal Macaques
Authors: Chang W. L. William , Tarantal Alice F. , Zhou Shan Shan , Borowsky Alexander D. , Barry Peter A.
Published: October 2002

To facilitate identification of rhesus cytomegalovirus (RhCMV)-infected cells, a recombinant virus expressing enhanced green fluorescent protein (EGFP), designated RhCMV-EGFP, was constructed. An expression cassette for EGFP under the control of the simian virus 40 (SV40) early promoter was inserted into the intergenic region between unique short 1 (US1) and US2 of the RhCMV genome by homologous recombination. RhCMV-EGFP exhibited comparable growth kinetics to that of wild-type virus in rhesus fibroblast cultures and retained its pathogenicity in monkey fetuses. Typical neurologic syndromes caused by CMV infection were observed in all fetuses experimentally inoculated with RhCMV-EGFP, as evidenced by sonographic and gross examinations. Systemic RhCMV infections were established in all fetuses, as viral antigen was detected in multiple organs and virus was isolated from fetal blood samples. The engineered viral genome was stable following rapid serial passages in vitro and multiple rounds of replication in vivo. Infected cells could be readily distinguished by green fluorescence both in tissue cultures and in the fetuses. In addition, EGFP expression was detected in various cell types that were permissive to RhCMV infection, consistent with a broad tissue tropism of the SV40 promoter. These results demonstrate that RhCMV can be successfully engineered without loss of wild-type replication and pathogenic potential. Further, the spectrum of cortical anomalies and the distribution of infected cells in the brain tissues indicated that RhCMV may have preferentially targeted immature neuronal cells. The pattern of RhCMV infection in the central nervous system may offer an explanation for the severe developmental outcomes associated with congenital human CMV infection early in gestation.
Facile Preparation of Chloro-Cage-Substituted 11-Vertex 1-(η6-Arene)-isonido-1,2,4-ruthenacarboranes from [RuCl2(PPh3)3] and nido-5,6-C2B8H12 in Arene Solvents
Authors: Konoplev Vitalii E. , Pisareva Irina V. , Lemenovskii Dmitrii A. , Petrovskii Pavel V. , Tok Oleg L. , Dolgushin Fedor M. , Chizhevsky Igor T.
Published: October 2002

A series of arene-ruthenium 11-vertex complexes 3-Cl-1-(η6-arene)-isonido-1,2,4-RuC2B8H9 (4a-4h) and 6-Cl-1-(η6-arene)-isonido-1,2,4-RuC2B8H9 (5a, 5b, 5f, 5g) (arene = p-xylene (a), mesitylene (b), p-cymene (c), benzene (d), toluene (e), hexamethylbenzene (f), 1,2,4,5-tetramethylbenzene (g), 1,2,4-trimethylbenzene (h)) have been obtained as isomeric mixtures 4a, 4b, 4f, 4g and 5a, 5b, 5f, 5g or, predominantly, as single isomers 4c-4e, 4h by the treatment of nido-5,6-C2B8H12 (1) with [RuCl2(PPh3)3] (2), either in the corresponding arene solvents at 80-85 °C (in the case of 4a-4e and 5a, 5b) or in the arene/1,2-dichloroethane solution under reflux (in the case of 4f-4h and 5f, 5g) in the presence of N,N,N',N'-tetramethylnaphthalene-1,8-diamine. The compounds prepared were characterized by combination of analytical, IR and multinuclear NMR data, including a crystallographic study of 4b. A possible pathway for the formation of isomeric complexes 4 and 5 is discussed.
Sports medicine training in Turkey
Authors: Yaman H
Published: October 2002

Sports medicine training in Turkey is reviewed. The current level of training is outlined and a curriculum needs assessment made. The main problems in athletic health care are discussed and solutions suggested. Changes in education, financing, and policy are recommended.
Circadian effects on the acute responses of salivary cortisol and IgA in well trained swimmers
Authors: Dimitriou L , Sharp N C C , Doherty M
Published: October 2002

Objective: To examine whether time of day significantly affects salivary cortisol and IgA levels before and after submaximal swimming.

Methods: Fourteen male competitive swimmers (mean (SD) age 18 (3.2) years) volunteered to participate in the study. In a fully randomised, cross over design, each subject performed 5 × 400 m front crawl at 85 (1.2)% of their seasonal best time (277 (16) seconds), with one minute rest between each 400 m, at 0600 and 1800 hours on two separate days. Timed, unstimulated saliva samples were collected before and after exercise. Saliva samples were analysed for cortisol and IgA by radioimmunoassay and single radial immunodiffusion respectively.

Results: Significant time of day effects (am and pm respectively) were observed in IgA concentration (0.396 (0.179)v0.322 (0.105) mg/ml, p<0.05), IgA secretory rate (0.109 (0.081)v0.144 (0.083) mg/min, p<0.01), and saliva flow rate (0.31 (0.23)v0.46 (0.22) ml/min, p<0.001) before exercise (all values mean (SD)). Differences in cortisol levels before exercise (1.09 (0.56)v0.67 (0.94) μg/dl) approached significance (p = 0.059). The exercise protocol did not significantly affect IgA concentration and secretory rate (p>0.05) but, in comparison with values before exercise, caused significant alterations in cortisol (p<0.01) and saliva flow rate (p<0.01). There was no significant interaction effect of time of day by exercise on any salivary variables measured (p>0.05). However, most of the values of the salivary variables before exercise were significantly inversely related to their exercise induced response (p<0.05).

Conclusion: These results suggest a significant circadian variation in the variables measured before exercise, without showing a significant effect on their acute responses to exercise.
Citrulline/malate promotes aerobic energy production in human exercising muscle
Authors: Bendahan D , Mattei J P , Ghattas B , Confort-Gouny S , Le Guern M E , Cozzone P J
Published: October 2002

Background: Previous studies have shown an antiasthenic effect of citrulline/malate (CM) but the mechanism of action at the muscular level remains unknown.

Objective: To investigate the effects of CM supplementation on muscle energetics.

Methods: Eighteen men complaining of fatigue but with no documented disease were included in the study. A rest-exercise (finger flexions)-recovery protocol was performed twice before (D−7 and D0), three times during (D3, D8, D15), and once after (D22) 15 days of oral supplementation with 6 g/day CM. Metabolism of the flexor digitorum superficialis was analysed by31P magnetic resonance spectroscopy at 4.7 T.

Results: Metabolic variables measured twice before CM ingestion showed no differences, indicating good reproducibility of measurements and no learning effect from repeating the exercise protocol. CM ingestion resulted in a significant reduction in the sensation of fatigue, a 34% increase in the rate of oxidative ATP production during exercise, and a 20% increase in the rate of phosphocreatine recovery after exercise, indicating a larger contribution of oxidative ATP synthesis to energy production. Considering subjects individually and variables characterising aerobic function, extrema were measured after either eight or 15 days of treatment, indicating chronological heterogeneity of treatment induced changes. One way analysis of variance confirmed improved aerobic function, which may be the result of an enhanced malate supply activating ATP production from the tricarboxylic acid cycle through anaplerotic reactions.

Conclusion: The changes in muscle metabolism produced by CM treatment indicate that CM may promote aerobic energy production.
An international comparison of childhood injuries in Hong Kong
Authors: Chan Charles C , Cheng J C Y , Wong T W , Chow C B , Luis Ben P K , Cheung W L , Chan Kevin
Published: October 2002

Objectives—This study describes 7813 childhood injuries in Shatin, Hong Kong. Supplementary analyses include developmental specificity of external causes and comparison with international childhood injury data.

Methods—Children aged 0–15 attending the accident and emergency (A&E) department of the Prince of Wales Hospital in Hong Kong were recruited for the study. Attendance records of participants from the A&E department were analyzed. Details concerning the injury, including theInternational Classification of Diseases, ninth revision, external cause of injury (E code), nature of injury (N code), abbreviated injury scale, and injury severity scale constitute core measurements, along with participants' age, gender, and respective A&E procedural data.

Results—Males (65.7%) and fall related injuries (44.2%) predominate, while contusion (34.6%) is the prevailing nature of injury. Two age external cause dimensions are derived from a correspondence analysis. Children 0–1 years old are associated with falls, poisoning, scalds, and machinery related injury. Adolescents aged 12–15 are associated with motor related injury, animal related injury, and cuts/piercings. In comparison with international data, unintentional child injuries in Hong Kong comprised more falls but fewer poisonings and burns.

Conclusion—A large proportion of falls, along with low proportion of poisonings and burns, are characteristics of childhood injury profile in Hong Kong. From the results of age external cause correspondence analysis, prevention strategies for different external cause should be developmentally specific.
International comparisons of child injuries and prevention programs: recommendations for an improved prevention program in Germany
Authors: Ellsäβer G , Berfenstam R
Published: October 2002

Objectives—To compare child injury mortality in Germany with that of four neighboring countries, and to examine injury prevention models in these countries with a view to improving prevention programs in Germany.

Methods—Based on official cause of death certificates, child injury mortality rates in Germany are compared with those of Austria, the Netherlands, Sweden, and Switzerland. The main structures and funding of injury prevention programs in these countries are described.

Results—In all five countries, mortality is highest among children aged 1–4 years for home and leisure accidents and drownings. Transport accidents are the main cause of death in the 5–14 age group. Mortality in both age groups has fallen significantly since 1980, most markedly in Sweden and the Netherlands.

Conclusion—Drawing on the injury mortality data and experience of the comparison countries, the following recommendations are proposed to further reduce home and leisure injuries among children in Germany: (1) establish a soundly funded, central institution responsible for child injury surveillance, research, and the coordination of injury prevention activities, (2) improve product control legislation, and (3) disseminate specific safety information to target groups and the general public.
Parental attitudes regarding interviews about injuries to their children
Authors: Scheidt Peter C , Brenner Ruth A , Rossi Maryann W , Clyman Robert , Boyle Kerrie E
Published: October 2002

Background—Questions about the circumstances of injuries, especially to infants and young children, might be perceived by parents as threatening or intrusive. Some institutional research review committees express concerns that interviews about childhood injuries may be offensive to parents. The perceived value and potential risk of questions about a young child's injury could affect the quality of responses.

Objectives—To assess parents' perceptions of threat and value of interviews about injury to their young children.

Setting—District of Columbia, 1 October 1995 to 30 September 1996.

Methods—Trained research assistants telephoned the parents of children seen in an emergency department or admitted to the hospital after an injury. To be eligible for inclusion the child must have been <3 years of age and a resident of the District of Columbia at the time of the event. After collection of sociodemographic information and circumstances of injury, the respondents were asked if the interview caused them to feel angry, offended or threatened, and if participation in the study was considered worthwhile.

Results—Seventy eight per cent of eligible families were contacted. Among those contacted, 93% completed the interview. Eighty two per cent of respondents were mothers and 11% fathers. Ninety per cent (95% confidence interval (CI) 88.4 to 91.6) of the respondents reported that the interview did not make them feel angry, offended, or threatened. Only 13 (1%; 95% CI 0.5 to 1.5) reported being very angry and 7.1% (95% CI 5.8 to 8.5) reported being a little angry. The majority of participants (61.2%, 95% CI 58.6 to 63.8) felt that participation in the study was definitely worthwhile and only 5.5 % (95% CI 4.3 to 6.7) felt that it was not at all worthwhile. Parents of children with intentional injuries were more likely to report feelings of anger than parents of children with unintentional injuries (24%v8 %; p=0.02). The per cent of respondents reporting any anger was greater when the interview was conducted within 14 days of the hospital visit compared with later interviews (11%v7 %; p=0.02).

Conclusions—In similar populations most parents of young, injured children are neither upset nor threatened by interviews that probe for details about how their children become injured. In general, collecting data aimed to prevent injuries is perceived as worthwhile, and parents readily cooperate with providing this information. Investigators and review committees should consider that interviews about infant and young child injuries are of no or minimal risk.
Equestrian injuries: a five year review of hospital admissions in British Columbia, Canada
Authors: Sorli Janet M
Published: October 2002

Aim—To determine the demographics of hospital admissions and mortality associated with equestrian activities in the 33 000 riders in British Columbia (BC).

Method—Analysis of admission data from the Ministry of Health for the years 1991–96, review of information obtained from the Office of the Chief Coroner, and comparison of data from Canadian Hospitals Injury Reporting and Prevention Program.

Results—The mean number of admissions per year was 390. Head injury was the most common cause of admission to hospital (20%) in BC. Females most often required admission (62%). Teenagers and children have a higher incidence of head injuries than the general population. The injury rate was 0.49/1000 hours of riding. There were three deaths per year, 1/10 000 riders; 60% were caused by head injury and females predominated.

Conclusion—Head injuries and other serious injuries occur with equestrian activities and it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including helmets, especially for children.
Socioeconomic differences in childhood injury: a population based epidemiologic study in Ontario, Canada
Authors: Faelker Taron , Pickett William , Brison Robert J
Published: October 2002

Objective—To determine whether risks for childhood injury vary according to socioeconomic gradients.

Design—Population based, retrospective study. The percentage of individuals living below the poverty line (described ecologically using census data) was the primary measure of socioeconomic status.

Setting—Catchment area of a tertiary medical centre that provides emergency services to all area residents. Area residents aged 0–19 years during 1996 were included.

Observations—Injuries that occurred during 1996 were identified by an emergency department based surveillance system. The study population was divided into socioeconomic grades based upon percentages of area residents living below the poverty line. Multiple Poisson regression analyses were used to quantify associations and assess the statistical significance of trends.

Results—5894 childhood injuries were identified among 35 380 eligible children; 985 children with missing socioeconomic data were excluded. A consistent relation between poverty and injury was evident. Children in the highest grade (indicating higher poverty levels) experienced injury rates that were 1.67 (95% confidence interval 1.48 to 1.89) higher than those in the lowest grade (adjusted relative risk for grades 1-V: 1.00,1.10,1.22,1.42, 1.67; ptrend<0.001). These patterns were observed within age/sex strata; for home, recreational, and fall injuries; and for injuries of minor and moderate severities.

Conclusions—Socioeconomic differences in childhood injury parallel mortality and morbidity gradients identified in adult populations. This study confirms that this health gradient is observable in a population of children using emergency department data. Given the population based nature of this study, these findings are likely to be reflected in other settings. The results suggest the need for targeted injury prevention efforts among children from economically disadvantaged populations, although the exact requirements of the optimal prevention approach remain elusive.
Effect of an older sibling and birth interval on the risk of childhood injury
Authors: Nathens Avery B , Neff Margaret J , Goss Christopher H , Maier Ronald V , Rivara Frederick P
Published: October 2002

Objective—Certain family structures have been identified as putting children at high risk for injury. To further define children at highest risk, we set out to explore the effect of an older sibling and birth interval on the risk of injury related hospital admission or death.

Methods—Data were analyzed using a case-control design. Cases and controls were identified by linking longitudinal birth data from Washington state (1989–96) to death certificate records and hospital discharge data obtained from the Washington State Comprehensive Hospital Abstract Reporting System and frequency matched in a 1:2 ratio on year of birth. Cases consisted of singleton children 6 years of age or younger who were hospitalized or died as a result of injury during the years 1989–96. Multivariate logistic regression was used to identify and adjust for confounding variables.

Results—There were 3145 cases and 8371 controls. The adjusted odds ratio for injury in children with an older sibling was 1.50 (95% confidence interval 1.37 to 1.65). The effect was greatest in children under 2 years of age, and in those with a birth interval of less than two years. As the number of older siblings increased, so did the risk of injury, with the highest risk in children with three or more older siblings.

Conclusion—These data suggest that the presence of an older sibling is associated with an increased risk of injury. The risk is highest in those with very short birth intervals. Potential mechanisms for this increased risk may relate to inadequate parental supervision. Pediatricians and other care providers need to be alert to these identifiable risk factors and then direct preventive strategies, such as home visits and educational programs, toward these families.
Urban residential fire and flame injuries: a population based study
Authors: DiGuiseppi C , Edwards P , Godward C , Roberts I , Wade A
Published: October 2002

Background—Fires are a leading cause of death, but non-fatal injuries from residential fires have not been well characterised.

Methods—To identify residential fire injuries that resulted in an emergency department visit, hospitalisation, or death, computerised databases from emergency departments, hospitals, ambulance and helicopter services, the fire department, and the health department, and paper records from the local coroner and fire stations were screened in a deprived urban area between June 1996 and May 1997.

Result—There were 131 fire related injuries, primarily smoke inhalation (76%), an incidence of 36 (95% confidence interval (CI) 30 to 42)/100 000 person years. Forty one patients (32%) were hospitalised (11 (95% CI 8 to 15)/100 000 person years) and three people (2%) died (0.8 (95% CI 0.2 to 2.4)/100 000 person years). Injury rates were highest in those 0–4 (68 (95% CI 39 to 112)/100 000 person years) and ≥85 years (90 (95% CI 29 to 213)/100 000 person years). Rates did not vary by sex. Leading causes of injury were unintentional house fires (63%), assault (8%), clothing and nightwear ignition (6%), and controlled fires (for example, gas burners) (4%). Cooking (31%) and smoker's materials (18%) were leading fire sources.

Conclusions—Because of the varied causes of fire and flame injuries, it is likely that diverse interventions, targeted to those at highest risk, that is, the elderly, young children, and the poor, may be required to address this important public health problem.
Injury death excesses in smokers: a 1990–95 United States national cohort study
Authors: Leistikow B N , Martin D C , Samuels S J
Published: October 2002

Objectives—Assess injury death relative risks (RR), dose-response, and attributable fractions for current cigarette smokers (smokers) in a recent representative sample of the United States population without and with adjustment for (a) demographic and (b) additional behavioral risk factors.

Setting—United States.

Methods—National Health Interview Survey (NHIS) adult (ages 18+ years) interviewees from 1990 or 1991 were followed through 1995. Referents had never smoked a total of 100 cigarettes. Relative risks were estimated with Stata software's Cox proportional hazard regressions, using NHIS final weights and primary sampling units. The resulting RR and published data were used to estimate population smoking attributable fractions of injury deaths in the United States.

Results—The crude, age-race-gender adjusted, and fully (demographic plus educational attainment, marital status, alcohol use level, and seat belt use) adjusted RRs for injury death in smokers were 1.86 (95% confidence interval (CI) 1.30 to 2.66), 1.60 (CI 1.12 to 2.29), and 1.42 (CI 0.99 to 2.05) respectively. Those RRs correspond to United States injury death smoking attributable fractions of 18%, 13%, and 9%, respectively. Those smoker/injury death RRs each showed a significant dose response relationship (p<0.030). Smokers' unadjusted unintentional injury, motor vehicle crash, and suicide RRs were 1.87 (CI 1.22 to 2.86), 2.14 (CI 1.12 to 4.11), and 2.17 (CI 1.02 to 4.62), respectively.

Conclusions—Smokers in the United States have significant dose-response excesses of injury death, independent of age, race, gender, alcohol use, seat belt use, education, and marital status. This supports earlier studies suggesting that smoking may be a leading contributor to injuries and injury may be a leading burden from smoking, both nationally and globally.
Proposed explanations for excess injury among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers: Figure 1
Authors: Bell N S , Amoroso P J , Wegman D H , Senier L
Published: October 2002

Introduction—Death rates among US veterans of the Persian Gulf War were lower than rates among non-deployed veterans and the US population at large, with the exception of injury deaths; returning veterans were at significantly greater risk of injury mortality. Similar patterns of excess injury mortality were documented among US and Australian veterans returning from Vietnam. In spite of these consistent findings little has been done to explain these associations and in particular to determine whether or not, and how, war related exposures influence injury risk among veterans returning home after deployments.

Hypothesized pathways—Several potential pathways are proposed through which injury might be related to deployment. First, increases in injury mortality may be a consequence of depression, post-traumatic stress disorder, and symptoms of other psychiatric conditions developed after the war. Second, physical and psychological traumas experienced during the war may result in the postwar adoption of “coping” behaviors that also increase injury risk (for example, heavy drinking). Third, greater injury risk may be the indirect consequence of increased experiences of ill defined diseases and symptoms reported by many returning veterans. Fourth, veterans may experience poorer survivability for a given injury event resulting in greater mortality but not morbidity. Finally, the process that selects certain individuals for deployment may lead to a spurious association between deployment status and injury mortality by preferentially selecting individuals who are risk takers and/or exposed to greater hazards.

Conclusions—More research and attention from policymakers is needed to clarify the link between deployment and postwar increased risk of injury.
Sports activities related to injuries? A survey among 9–19 year olds in Switzerland
Authors: Michaud P-A , Renaud A , Narring F
Published: October 2002

Background—Most data on sports injuries are gathered in clinical settings so that their epidemiology in the general population is not well known.

Objective—To explore the link between sports injuries with the type and the amount of sports activity and biological factors.

Methods—In 1996, 3609 in-school adolescents 10–19 years (1847 girls and 1762 boys) participated in a regional survey. This included anthropometric measurements and a self administered questionnaire.

Results—Altogether 28.2% of girls and 35.9% of boys reported one or more sports injuries during the previous year and 2.1% of girls and 6.5% of boys reported at least one hospitalization due to a sports injury. Using the mean rate of injuries as reference level, some sports are highly related to injury occurrence: body building (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5 to 1.9), skateboarding and rollerskating (RR 1.6, 1.4 to 1.8), athletics (RR 1.5, 1.3 to 1.7), snowboarding (RR 1.5, 1.4 to 1.6), basketball (RR 1.3, 1.2 to 1.4), soccer (RR 1.3, 1.2 to 1.4), and ice hockey (RR 1.2, 1.1 to 1.3). Using a logistic regression, several variables associated with a higher risk of injury were identified: the amount of physical activity, high risk sports, and Tanner pubertal stages.

Conclusion—The risk of sports injury increases not so much with age but with exposure to specific sports and with pubertal development.
Injury patterns in rural and urban Uganda
Authors: Kobusingye O , Guwatudde D , Lett R
Published: October 2002

Objectives—To describe and contrast injury patterns in rural and urban Uganda.

Settings—One rural and one urban community in Uganda.

Methods—Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire.

Results—In the rural setting, 1673 households, with 7427 persons, were surveyed. Injuries had an annual mortality rate of 92/100 000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2322 households, with 10 982 people, were surveyed. Injuries had an annual mortality rate of 217/100 000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1000/year. Leading causes of death were drowning in the rural setting, and road traffic in the city.

Conclusion—Injuries are a substantial burden in Uganda, with much higher rates than those in most Western countries. The urban population is at a higher risk than the rural population, and the patterns of injury differ. Interventions to control injuries should be a priority in Uganda.
A population based study of unintentional firearm fatalities
Authors: Cherry D , Runyan C , Butts J
Published: October 2002

Objectives—To describe the circumstances of fatal unintentional firearm injuries in a statewide population in a region of the United States with high firearm fatality rates and to compare to similar data from an earlier period in the same state.

Methods—Analyses of North Carolina medical examiner database (1985–94) and review of medical examiner case reports (1990–94) and comparison to similar data from 1979–82.

Results—A total of 390 unintentional shooting deaths occurred (0.59/100 000 population) between 1985–94 with the highest rate in the ages 15–24. Between 1990–94, handguns were responsible for 59% of these deaths compared to 40% in the 1979–82 period. Younger victims were more likely to be shot by family or friends, though, 53% of all deaths were self inflicted. In 45 cases, the person firing the weapon was reported to believe that the gun was unloaded or had the safety device activated.

Conclusions—This study demonstrates changes in patterns of unintentional firearm fatalities in North Carolina in two decades, particularly the increase in incidence of events involving handguns. The results highlight the need for additional attention to efforts governing access to firearms, particularly handguns; technological advances in designing safer guns, and additional emphasis on safe storage policies and practices.
Hypothermia deaths in Jefferson County, Alabama
Authors: Taylor A J , McGwin G , Davis G G , Brissie R M , Holley T D , Rue L W
Published: October 2002

Introduction—Some reported characteristics associated with hypothermia mortality include older age, alcohol consumption, male sex, and black race. The purpose of this paper is to present the epidemiology of hypothermia deaths in Jefferson County, Alabama.

Methods—Autopsy reports maintained by the county coroner's office were abstracted for all cases with primary or underlying causes of death listed as “hypothermia” or “exposure to cold” between January 1983 and July 1999.

Results—Sixty three hypothermia deaths occurred in Jefferson County during the study period. The mean age among cases was 68 years, 63.9% were male and 70% were of black race. Rates of hypothermia death were highest among black males, followed by black females, particularly blacks aged 80 years or older. Deaths occurring indoors were more common among older persons and outdoor deaths more common among younger persons. Thirty per cent of decedents tested positive for alcohol, 75% of whom were found outdoors. Nine decedents tested positive for drugs or medications. Approximately 90% of decedents were identified as having one or more chronic medical conditions. Excluding alcoholics, 52% of decedents had one or more chronic medical conditions.

Conclusions—Hypothermia in Jefferson County, Alabama is a cause of death primarily affecting two distinct groups of individuals, elderly persons who develop hypothermia inside a dwelling and middle aged males who develop hypothermia out of doors and have consumed alcohol.
A geographic analysis of motor vehicle collisions with child pedestrians in Long Beach, California: comparing intersection and midblock incident locations
Authors: Lightstone A S , Dhillon P K , Peek-Asa C , Kraus J F
Published: October 2002

Objectives—The purpose of this study was to use geographic information system (GIS) software to locate areas of high risk for child pedestrian-motor vehicle collisions in the city of Long Beach and to compare risk factors between midblock and intersection collisions.

Methods—Children 0–14 years of age involved in a motor vehicle versus pedestrian collision that occurred on public roadways in Long Beach, CA, between 1 January 1992 and 30 June 1995, were identified retrospectively from police reports. The GIS software program, ArcView, was used for spatial analysis and distance calculations. χ2Tests were used to compare the distribution of the characteristics between intersection and midblock collisions.

Results—The average annual incident and fatality rate was 183.3/100 000 children/year and 2.4/100 000 children/year, respectively. Children less than 5 years of age were significantly more likely to be hit at a midblock location while those aged 5–9 and 10–14 were more often hit at an intersection. Intersection collisions were more likely to occur on major arterials and local streets, and the driver to be the primary party at fault (p<0.001). While intersection incidents tended to occur further from the child's home (64.4%) the majority of midblock incidents (61.5%) occurred within 0.1 miles of the child's residence. For both midblock and intersection locations, pedestrian collisions tended to occur more frequently in those census tracts with a larger number of families per census tract—a measure of household crowding and density.

Conclusions—Future studies taking into consideration traffic volume and vehicle speed would be useful to focus prevention efforts such as environmental modifications, improving police enforcement, and educational efforts targeted at parents of younger children. As GIS illustrative spatial relationships continue to improve, relationships between pedestrian collision sites and other city landmarks can advance the study of pedestrian incidents.
Drowsiness, counter-measures to drowsiness, and the risk of a motor vehicle crash
Authors: Cummings P , Koepsell T D , Moffat J M , Rivara F P
Published: October 2002

Objectives—Knowledge of how different indicators of drowsiness affect crash risk might be useful to drivers. This study sought to estimate how drowsiness related factors, and factors that might counteract drowsiness, are related to the risk of a crash.

Methods—Drivers on major highways in a rural Washington county were studied using a matched case-control design. Control (n=199) drivers were matched to drivers in crashes (n=200) on driving location, travel direction, hour, and day of the week.

Results—Crash risk was greater among drivers who felt they were falling asleep (adjusted relative risk (aRR) 14.2, 95% confidence interval (CI) 1.4 to 147) and those who drove longer distances (aRR 2.2 for each additional 100 miles, 95% CI 1.4 to 3.3). Risk was also greater among drivers who had slept nine or fewer hours in the previous 48 hours, compared with those who had slept 12 hours. Crash risk was less for drivers who used a highway rest stop (aRR 0.5, 95% CI 0.3 to 1.0), drank coffee within the last two hours (aRR 0.5, 95% CI 0.3 to 0.9), or played a radio while driving (aRR 0.6, 95% CI .4 to 1.0).

Conclusion—Drivers may be able to decrease their risk of crashing if they: (1) stop driving if they feel they are falling asleep; (2) use highway rest stops; (3) drink coffee; (4) turn on a radio; (5) get at least nine hours sleep in the 48 hours before a trip; and (6) avoid driving long distances by sharing the driving or interrupting the trip.
Mandatory helmet legislation and children's exposure to cycling
Authors: Macpherson A K , Parkin P C , To T M
Published: October 2002

Background—Mandatory helmet legislation for cyclists is the subject of much debate. Opponents of helmet legislation suggest that making riders wear helmets will reduce ridership, thus having a negative overall impact on health. Mandatory bicycle helmet legislation for children was introduced in Ontario, Canada in October 1995. The objective of our study was to examine trends in children's cycling rates before and after helmet legislation in one health district.

Setting—Child cyclists were observed at 111 preselected sites (schools, parks, residential streets, and major intersections) in the late spring and summer of 1993–97 and in 1999, in a defined urban community.

Participants—Trained observers counted the number of child cyclists. The number of children observed in each area was divided by the number of observation hours, resulting in the calculation of cyclists per hour.

Main outcome measure—A general linear model, using Tukey's method, compared the mean number of cyclists per hour for each year, and for each type of site.

Results—Although the number of child cyclists per hour was significantly different in different years, these differences could not be attributed to legislation. In 1996, the year after legislation came into effect, average cycling levels were higher (6.84 cyclists per hour) than in 1995, the year before legislation (4.33 cyclists per hour).

Conclusion—Contrary to the findings in Australia, the introduction of helmet legislation did not have a significant negative impact on child cycling in this community.
Cost effectiveness analysis of a smoke alarm giveaway program in Oklahoma City, Oklahoma
Authors: Haddix A C , Mallonee S , Waxweiler R , Douglas M R
Published: October 2002

Objective—To estimate the cost effectiveness of the Lifesavers Residential Fire and Injury Prevention Program (LRFIPP), a smoke alarm giveaway program.

Setting—In 1990, the LRFIPP distributed over 10 000 smoke alarms in an area of Oklahoma City at high risk for residential fire injuries. The program also included fire prevention education and battery replacement components.

Methods—A cost effectiveness analysis was conducted from the societal and health care systems perspectives. The study compared program costs with the total costs of medical treatment and productivity losses averted over a five year period. Fatal and non-fatal residential fire related injuries prevented were estimated from surveillance data. Medical costs were obtained from chart reviews of patients with fire related injuries that occurred during the pre-intervention period.

Results—During the five years post-intervention, it is estimated that the LRFIPP prevented 20 fatal and 24 non-fatal injuries. From the societal perspective, the total discounted cost of the program was $531 000. Total discounted net savings exceeded $15 million. From the health care system perspective, the total discounted net savings were almost $1 million and would have a net saving even if program effectiveness was reduced by 64%.

Conclusions—The program was effective in reducing fatal and non-fatal residential fire related injuries and was cost saving. Similar programs in other high risk areas would be good investments even if program effectiveness was lower than that achieved by the LRFIPP.
Non-fatal animal related injuries to youth occurring on farms in the United States, 1998
Authors: Hendricks K J , Adekoya N
Published: October 2002

Objective—To provide data on the magnitude and patterns of animal related on-farm injuries to youth in the United States.

Data source—A survey of 26 000 farm households conducted for the National Institute for Occupational Safety and Health by the United States Department of Agriculture in 1998.

Subjects—Youth younger than 20 years of age.

Results—There were an estimated 6438 animal related on-farm injuries to youth in 1998. 70% occurred to farm residents; 69% were work related. Males accounted for 64% and approximately 41% occurred to those younger than 10; 37% involved horses and 31% cattle. Most horse related injuries occurred to females and a majority of the cattle related injuries were to males. Additionally, most of the cattle related injuries were work related, while horse related injuries were mainly non-work.

Conclusions—One out of every five youth injuries occurring on farms in the United States is animal related. These animal related injuries were due to both work and non-work related exposures. The large number of horse and cattle related injuries highlights a need for intervention strategies based on the injury circumstances common to these animals.
Citywide trauma experience in Kampala, Uganda: a call for intervention
Authors: Kobusingye O C , Guwatudde D , Owor G , Lett R R
Published: October 2002

Objectives:To describe injuries and their emergency care at five city hospitals.

Setting:Data were collected between January and December 1998 from casualty departments of the five largest hospitals of Kampala city, Uganda, with bed capacity ranging from 60 to 1200.

Methods:Registry forms were completed on trauma patients. All patients with injuries were eligible. Outcome at two weeks was determined for admitted patients.

Results:Of the 4359 injury patients, 73% were males. Their mean age was 24.2 years, range 0.1–89, and a 5–95 centile of 5–50 years. Patients with injuries were 7% of all patients seen. Traffic crashes caused 50% of injuries, and were the leading cause for patients ≥10 years. Fifty eight per cent of injuries occurred on the road, 29% at home, and 4% in a public building. Falls, assaults, and burns were the main causes in homes. Fourteen per cent of injuries were intentional. Injuries were severe in 24% as determined with the Kampala trauma score. One third of patients were admitted; two thirds arrived at the hospital within 30 minutes of injury, and 92% were attended within 20 minutes of arrival.

Conclusions:Injuries in Kampala are an important public health problem, predominantly in young adult males, mostly due to traffic. The majority of injuries are unintentional. Hospital response is rapid, but the majority of injuries are minor. Without pre-hospital care, it is likely that patients with serious injuries die before they access care. Preventive measures and a pre-hospital emergency service are urgently needed.
Missing the target: a comparison of buyback and fatality related guns
Authors: Kuhn E M , Nie C L , O'Brien M E , Withers R L , Wintemute G J , Hargarten S W
Published: October 2002

Objectives:To determine whether the firearms recovered in buyback programs in a large urban community are the types most closely associated with firearm fatalities in the same geographic area.

Methods:The type, caliber, and manufacturer of 941 handguns recovered in Milwaukee County 1994–96 buyback programs were compared with 369 homicide related and 125 suicide related handguns used in Milwaukee during 1994–97.

Results:Buyback handguns differed substantially from those used in homicide and suicide. One third of buyback handguns were semiautomatic pistols versus two thirds of homicide related handguns (p<0.001) and 40% of suicide related handguns (p=NS). Over 75% of buyback handguns were small caliber compared with 24% of homicide and 32% of suicide handguns (p<0.001). The top two manufacturers of buyback handguns represented 30% of these guns but only 5% of fatality related handguns (p<0.001). Companies currently out of business manufactured 15% of buyback handguns versus 7% of fatality related handguns (p<0.001).

Conclusions:Handguns recovered in buyback programs are not the types most commonly linked to firearm homicides and suicides. Although buyback programs may increase awareness of firearm violence, limited resources for firearm injury prevention may be better spent in other ways.