bluuebunny/crossref_metadata_2025 huggingface dataset:
Silent meniscal abnormalities in athletes: magnetic resonance imaging of asymptomatic competitive gymnasts.
Authors: Ludman C N , Hough D O , Cooper T G , Gottschalk A
Published: December 2008

BACKGROUND: Magnetic resonance imaging (MRI) produces exceptionally detailed images of the intra-articular structures of the knee. Recognising the range of MRI appearances within a normal population is therefore necessary in order to avoid attributing a greater significance to these than is clinically justified. OBJECTIVE: To compare MRI appearances in asymptomatic gymnasts with those in a less active population in order to identify findings that may be seen in the absence of significant pathology and thereby aid the clinical management of this athletic group. METHODS: MR images were obtained from 24 knees of asymptomatic competitive American collegiate gymnasts aged 18-22. The menisci were evaluated according to established grading criteria, and compared with a group of controls matched for age and sex. RESULTS: Grade 3 intrameniscal signal abnormalities are considered to be highly correlated with meniscal tears. When compared with control group, the experimental group of gymnasts had a significantly different distribution (p<0.001) of grade 3 intrameniscal signal changes, preferentially involving the lateral meniscus. The overall incidence of grade 3 changes (13%) in gymnasts was not, however, significantly different from the incidence in the controls. CONCLUSIONS: A knowledge of these MRI appearances is important when evaluating the lateral menisci within this group of athletes to prevent unnecessary treatment or intervention. This is particularly pertinent when the imaging findings do not closely correlate with the site of symptoms.
Prospective decrease in progesterone concentrations in female lightweight rowers during the competition season compared with the off season: a controlled study examining weight loss and intensive exercise.
Authors: Morris F L , Payne W R , Wark J D
Published: December 2008

The purpose of this study was to monitor ovarian hormone function response to intense exercise and body weight changes in female athletes. Ovarian hormone function was evaluated in 12 female lightweight rowers and 10 age-height-weight matched sedentary controls. Ovarian hormone function was assessed during consecutive competition season and off season, by measurement of peak and average alternative day overnight urinary oestrone glucuronide (E1G) and pregnanediol glucuronide (PdG) excretion. Competition season was associated with a 5.8 kg (9.3%) body weight loss in the lightweight rowers. Significantly lower competition season peak and average urinary excretion of PdG were found in the lightweight rowers compared with the controls. Lower competition season peak and average urinary excretion of E1G were also found in the lightweight rowers compared with the controls, but the difference did not reach significance. The number of rowing training hours was a significant determinant of peak PdG excretion in the rowers (R2 = 0.40; p<0.02). The seasonal suppression of PdG excretion was associated with degree of weight loss (R2 = 0.46; p<0.01). The competition related decrease in E1G and PdG excretion for the lightweight rowers was predominantly restored during the off season when exercise intensity and duration were decreased and body weight increased. These results showed a significant (p<0.05) reduction in progesterone metabolite excretion and a non-significant decrease in oestrone metabolite excretion associated with intensive competition season training loads and body weight reduction in female lightweight rowers.
Children's views of accident risks and prevention: a qualitative study
Authors: Green Judith , Hart Laura
Published: December 2008

Objectives—To examine children's accounts of injury risks and opportunities for prevention.

Setting—Schools, youth clubs, and a holiday activity scheme in the south east of England.

Methods—Sixteen focus groups were held with 7–11 year old children. Transcripts of the discussions were analysed using qualitative methods.

Results—Children were knowledgeable about injury risks and how to reduce them. They also saw injury prevention as primarily their own responsibility. However, they were also sophisticated in their criticisms of generalised prevention advice, and evaluated safety messages in the light of local environmental and social knowledge. Personal experience was more often reported as a reason for risk reduction than formal prevention advice. Risks for injury were not isolated from other risks faced.

Conclusions—Effective educational interventions aimed at changing children's risk behaviour should build more on children's own competence and knowledge of their local environment, and stress the need to manage risks rather than avoid dangers.
School based bicycle safety education and bicycle injuries in children: a case-control study
Authors: Carlin John B , Taylor Petra , Nolan Terry
Published: December 2008

Objectives—To evaluate possible benefits of a school based bicycle safety education program (“Bike Ed”) on the risk of bicycle injury in children.

Methods—A population based case-control study was undertaken in a region of Melbourne, Australia. Cases were children presenting at hospital emergency departments with injuries received while riding bicycles. Controls were recruited by calling randomly selected telephone numbers. Data were collected by personal interview.

Results—Analysis, based on 148 cases and 130 controls aged 9 to 14 years, showed no evidence of a protective effect and suggested a possible harmful effect of exposure to the bicycle safety course (odds ratio (OR) 1.64, 95% confidence interval (CI) 0.98 to 2.75). This association was not substantially altered by adjustment for sex, age, socioeconomic status, and exposure, measured as time or distance travelled. Subgroup analysis indicated that the association was strongest in boys (OR 2.0, 95% CI 1.1 to 3.8), younger children, children from families with lower parental education levels, and children lacking other family members who bicycle.

Conclusions—It is concluded that this educational intervention does not reduce the risk of bicycle injury in children and may possibly produce harmful effects in some children, perhaps due to inadvertent encouragement of risk taking or of bicycling with inadequate supervision.
Comparison of community based smoke detector distribution methods in an urban community
Authors: Douglas Malinda Reddish , Mallonee Sue , Istre Gregory R
Published: December 2008

Objectives—Various methods of soliciting participation for a large smoke detector giveaway program were tested to determine the most effective method of distributing smoke detectors to a high risk urban population.

Setting—The target area was a 24 square mile (62 km2) section on the south side of Oklahoma City where 16% (73 301) of the city's population resided in 16% (34 845) of the dwellings (excluding apartments). Of the 66 persons in Oklahoma City who were injured in residential fires from September 1987 to April 1990, 45% (30) were in the target area. Of the target area injuries, 47% resulted from fires started by children playing with fire (fireplay).

Methods—The number of homes without detectors was estimated by telephone survey. Four different methods of soliciting participants were used, including notifying residents by mail; placing flyers on the doors of every habitable residence; and displaying flyers at public places (grocery stores, convenience stores, restaurants, etc). Each of these methods alerted residents that free smoke detectors were available at specific fire stations. The fourth method was distributing detectors door-to-door (canvassing).

Results—The canvassing method resulted in significantly more smoke detectors being distributed to homes without detectors (107%) than any of the three other methods (18%) (p< 0.00001). The canvassing method distributed detectors to 31% of the total target homes, compared with 5% with the other methods (p < 0.00001). Canvassing also resulted in the lowest estimated cost per detector distributed ($1.96) (all other methods, $3.95), and in the largest number distributed per volunteer hour (5.9v3.1 detectors per hour by other methods).

Conclusions—Distributing smoke detectors directly to homes (canvassing) was the most effective and cost efficient method to reach high risk urban residents.
Injury surveillance in accident and emergency departments: to sample or not to sample?
Authors: Morrison A , Stone D H
Published: December 2008

Objectives—To establish whether injury surveillance based on sampling strategies is as valid as total patient surveillance.

Methods—Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) data for 1996 were retrospectively analysed using five sampling frames. Proportions for key variables were calculated for each sample, then compared with the proportions for the total population of patients.

Results—Two of the five sampling frames produced statistically significant differences from the total population, which can be explained by seasonal variations. However, no significant differences were observed between the remaining three samples and the total population.

Conclusions—A well planned and executed sampling strategy can generate as valid data as total patient surveillance, obviating the need for data collection on every patient presenting with an injury or poisoning. In practice, however, systematic sampling can be difficult to implement and sustain, counterbalancing the economic advantages.
Case series and exposure series: the role of studies without controls in providing information about the etiology of injury or disease
Authors: Cummings Peter , Weiss Noel S
Published: December 2008

Descriptions of exposure histories in persons with the same injury or illness (“case series”), and descriptions of outcomes in persons with the same exposure (“exposure series”), have the potential to contribute knowledge relevant to disease etiology in some special situations. The case series can be thought of as a primitive form of case-control study—one in which the controls are only implied. Similarly, the exposure series is a rudimentary type of cohort study. By keeping these analogies in mind, those who author or read studies without controls can assess the design or results for selection bias, confounding, or information bias. While studies without controls cannot supplant true case-control or cohort studies, they are relatively cheap and easy to perform, and there are circumstances in which they provide valuable information. Attention to design is needed to strengthen the results they provide.
Road injuries in school age children: relation to environmental factors amenable to interventions
Authors: von Kries Rüdiger , Kohne Claudia , Böhm Olaf , von Voss Hubertus
Published: December 2008

Objectives—To assess the impact of potentially modifiable environmental factors on the risk for pedestrian and cyclist injuries among school age children.

Setting—Population of school age children in Düsseldorf (population 570 000) in the west of Germany. All pedestrian and cyclist injuries involving children between 6 and 14 years brought to the attention of the police between January 1993 and March 1995 were eligible.

Methods—A case-control design was used, with controls matched by age and sex. Criteria for inclusion of cases were: residence in Düsseldorf, and injury within 500 meters from home. A random sample of 174 cases was selected. For each an age-sex matched child, resident in Düsseldorf, was randomly selected from a list of all school age children. The environment within a radius of 500 meters around the homes of cases and controls was analysed by blinded on site investigators. These used a standardized questionnaire to assess the number of streets with speed limits of 30 kph, the number of pedestrian crossings with traffic lights per street with speed limits of 50 kph or above, and the number of playgrounds for children.

Results—Complete information was available for 170 cases and 168 controls. There were significantly more streets with a speed limit of 30 kph around the homes of controls (p=0.0003; mean 9.5; 95% confidence interval (CI) 8.8 to 10.1) than cases (mean 7.8; 95% CI 7.3 to 8.3). For every five streets with a speed limit of 30 kph injury risk was reduced by nearly 50% (odds ratio 0.57; 95% CI 0.43 to 0.76). There were also significantly more pedestrian crossings with traffic lights on streets with a speed limit 50 kph or above around the homes of controls (p=0.0004; mean 2.7; 95% CI 2.4 to 2.9) compared with cases (mean 2.1; 95% CI 1.9 to 2.3). Finally there were significantly more playgrounds around the houses of controls (p=0.04; mean 1.9; 95% CI 1.7 to 2.2) compared with the houses of cases (mean 1.7; 95% CI 1.4 to 2.0).

Conclusions—Significant associations with injury risk were identified for some prespecified modifiable environmental factors.
Trends in injury mortality among adolescents in Taiwan, 1965–94
Authors: Lu Tsung-Hsueh , Lee Meng-Chih , Chou Ming-Chih
Published: December 2008

Objectives—To describe trends in injury mortality among adolescents in Taiwan for prioritising preventive interventions.

Methods—Adolescent injury mortality data for Taiwan were derived from official publications of vital statistics from 1965 to 1994 to determine trends by sex and cause of death. Simple linear regression was used to test the trends.

Results—The number of deaths due to injury among adolescents aged 10–19 years in Taiwan increased from 983 in 1965 to 1783 in 1994, an 81% increase. The injury mortality rate increased 42%, from 32.2 per 100 000 in 1965 to 45.6 per 100 000 in 1994. The proportion of injury deaths also increased, from 45.3% in 1965 to 72.8% in 1994. The trends in mortality from motor vehicle injury (MVI) among four demographic groups were all significantly positive (p<0.001). The proportion of deaths due to MVI among injury was 14% in 1965 and increased to 63% in 1994.

Conclusions—The increase in injury mortality rates among adolescents over the past three decades appears to be due largely to the increase in MVI mortality rates with males aged 15–19 years accounting for most of this increase. Priorities for adolescents in Taiwan are MVI (especially motorcyclists) and drownings.
Evaluation of interventions to prevent injuries: an overview
Authors: Dannenberg Andrew L , Fowler Carolyn J
Published: December 2008

Overview of issues involved in evaluating the effectiveness of injury interventions is presented. An intervention should be evaluated to show it prevents injuries in the target population, to identify unintended consequences, to correct problems that limit effectiveness, to justify current and future resources from funding agencies, and to guide its replication elsewhere. Problems in conducting evaluations include obtaining sufficient resources, coping with rare events, establishing reliability and validity of measurement instruments, separating effects of multiple simultaneous events, and adjusting for the time lag between an intervention and its effects.

When feasible, changes in injury rates (documented by medical records) should be used. These are more convincing for demonstrating intervention effectiveness than changes in observed or reported behaviors or in knowledge and attitudes (documented by surveys). Quasiexperimental evaluation designs are often useful, such as measuring injury rates before and after an intervention in a time series design, or intervening in one of two comparable communities in a non-equivalent control group design. Evaluations using true experimental designs, in which individuals or groups are randomized to receive or not receive an intervention, are highly desirable but are often difficult due to logistical or ethical considerations. An evaluation component should be integral to the introduction of any new injury intervention.
Where children sit in motor vehicles: a comparison of selected European and American cities
Authors: Segui-Gomez Maria , Glass Roberta , Graham John D
Published: December 2008

Objectives—To ascertain whether there are differences in child seating location between selected cities in the US and continental Europe, and if differences exist, to ascertain what factors predict them.

Setting—Boston and New Orleans, which have no laws regarding child seating location, and Paris, Frankfurt, and Brussels, which for approximately 20 years have had laws requiring children under the ages of 10 or 12 to sit in the rear.

Methods—Observations were made in the first quarter of 1997 at several locations in or near each city. The vehicle seating capacity, total number of occupants, the seating location of adults and children, and driver shoulder belt use were recorded for each vehicle with at least one child. The predictors of a vehicle having a child in the front were estimated using logistic regression.

Results—Data on 5501 children riding in 3778 vehicles were collected. Adjusting for differences in vehicle seating capacity, occupant mix, and driver shoulder belt use, vehicles in the European cities are significantly less likely to have a child in the front seat than vehicles in the American cities.

Conclusions—Cities with no history of laws prohibiting children from sitting in the front, vehicles with low seating capacity, vehicles with no adult (other than the driver) or many child passengers, and unbelted drivers were associated with a higher likelihood of children riding in the front seat. It is feasible for a society to insist, through custom and/or law, that children sit in the back seat.
Harstad injury prevention study: prevention of burns in young children by community based intervention
Authors: Ytterstad Børge , Smith Gordon S , Coggan Carolyn A
Published: December 2008

Objective—To describe the long term effectiveness of a community based program targeting prevention of burns in young children.

Design—Quasiexperimental.

Setting—The Norwegian city of Harstad (main intervention), six surrounding municipalities (intervention diffusion), and Trondheim (reference).

Participants—Children under age 5 years in the three study populations.

Methods—Outpatient and inpatient hospital data were coded according to the Nordic system, and collected as part of a national injury surveillance system. Burn data collection started in May 1985. The first 19.5 months of the study provided baseline data, while the last 10 years involved community based intervention, using a mix of passive and active interventions.

Results—The mean burn injury rate decreased by 51.5% after the implementation of the intervention in Harstad (p<0.05) and by 40.1% in the six municipalities (not significant). Rates in the reference city, Trondheim, increased 18.1% (not significant). In Harstad and the six surrounding municipalities there was a considerable reduction in hospital admissions, operations, and bed days. Interventions with passive strategies were more effective, stove and tap water burns being eliminated in the last four years, while active strategies were less effective.

Conclusions—A program targeting burns in children can be effective and sustainable. Local injury data provided the stimulus for community action.
Seating positions and children's risk of dying in motor vehicle crashes
Authors: Braver Elisa R , Whitfield Randy , Ferguson Susan A
Published: December 2008

Objectives—To determine the effects of seating position, combined with restraint use and airbag status, on children's risk of dying in crashes.

Methods—Using 1988–95 data from the United States Fatality Analysis Reporting System, risk of death was compared among front and rear seated passengers aged 12 and younger who were involved in fatal crashes for different categories of restraint use and in vehicles with and without passenger airbags.

Results—Restrained children in rear seats had the lowest risk of dying in fatal crashes. Among children seated in the rear, risk of death was reduced 35% in vehicles without any airbags, 31% in vehicles equipped only with driver airbags, and 46% in vehicles with passenger airbags. Both restrained and unrestrained children aged 0–12 were at lower risk of dying in rear seats. Rear seats also afforded additional protection to children aged 5–12 restrained only with lap belts compared with lap/shoulder belted children in front seats. Children were about 10–20% less likely to die in rear center than in rear outboard positions.

Conclusions—Parents and others who transport children should be strongly encouraged to place infants and children in rear seats whether or not vehicles have airbags. Existing laws requiring restraint use by children should be strengthened and actively enforced.
Family, social, and cultural factors in pedestrian injuries among Hispanic children
Authors: Agran Phyllis F , Winn Diane G , Anderson Craig L , Del Valle Celeste
Published: December 2008

Objectives—In an earlier population based surveillance study of pediatric injuries, the rate of Hispanic children injured as pedestrians was 63/100 000 compared with 17/100 000 for non-Hispanic white children. The present study was designed to examine the effect of family, social, and cultural factors on the rate of pedestrian injury in a population of Hispanic children in the southwestern US.

Methods—A case-control study of pedestrian injuries among Hispanic children. The sample consisted of 98 children 0–14 years of age hospitalized as a result of a pedestrian injury and 144 randomly selected neighborhood controls matched to the case by city, age, gender, and ethnicity. Cases were compared with controls using conditional logistic regression; in the study design the odds ratio (OR) estimates the incidence rate ratio.

Results—The following family and cultural variables were associated with an increased risk of injury: household crowding (OR=2.8, 95% confidence interval (CI) 1.1 to 7.1 for 1.01–1.5 persons per room, compared with ≤ 1.0 persons per room), one or more family moves within the past year (OR 2.2, 95% CI 1.2 to 4.1), poverty (OR 1.9, 95% CI 1.1 to 3.3), and inability of mother (OR 3.6, 95% CI 1.3 to 10) or father (OR 5.6, 95% CI 1.5 to 20) to read well. However, children in single parent households and children whose parents did not drive a car, had less education, or were of rural origin, did not have an increased rate of injury.

Conclusions—These results have implications for childhood pedestrian prevention efforts for low income, non-English speaking Hispanic populations, and perhaps for other immigrant and high risk groups. Prevention programs and materials need to be not only culturally sensitive but also designed for those with limited reading skills. In addition, environmental interventions that provide more pedestrian friendly neighborhoods must be considered.
Costs of occupational injuries to teenagers, United States
Authors: Miller Ted R , Waehrer Geetha M
Published: December 2008

Objectives—This paper estimates the incidence and costs of teenage occupational injuries by severity in the United States.

Methods—Existing estimates of occupational injury costs are adapted for the teenage population. Incidence estimates are constructed using data from the US 1993 Annual Survey of Occupational Injury and Illness and the 1993 Census of Fatal Occupational Injuries combined with incidence data from the National Health Interview Survey.

Results—In 1993, an estimated 371 000 teenagers were injured in the workplace, accounting for 4.2% of all occupational injuries. These injuries cost $5 billion, approximately 3% of the total of injury costs involving teenagers.

Conclusions—Teenagers appear to account for a larger share of the total number of occupational injuries relative to their presence in the employed workforce, but a lower share of the costs of such injuries.
Evaluation of a poison prevention lesson for kindergarten and third grade students
Authors: Liller Karen D , Craig Janice , Crane Nancy , McDermott Robert J
Published: December 2008

Objectives—The purpose of this study was to evaluate the MORE HEALTH poison prevention lesson that is given to kindergarten and third grade students in Hillsborough County, Florida. The lesson reaches approximately 6000 students per year.

Methods—The evaluation was based on a post-test only control group design. Three schools were chosen as evaluation sites and three served as control settings. Students were administered a previously tested, age appropriate questionnaire that addressed the goals of the poison lessons. In addition, a survey was developed for intervention school parents to determine their poison prevention practices.

Results—One hundred ninety four intervention schoolchildren and 184 control schoolchildren completed the study. Children in the intervention schools consistently answered more questions correctly than those in the control schools. The parent survey showed that the majority have homes that are safe from poisons, although fewer than 50% said they had syrup of ipecac in their homes.

Conclusions—These results show that key concepts related to poison prevention can be communicated effectively to primary school students and parents report having homes safe from many poisons.
Childhood deaths from unintentional injuries in rural areas of Iran
Authors: Soori Hamid , Naghavi Mohsen
Published: December 2008

Objectives—To determine the incidence of children's fatal unintentional injuries in rural areas of Iran.

Setting—Thirteen provinces of Iran, with a total population of 11.3 million for 1993–94.

Methods—A descriptive epidemiological study, which obtained information about all deaths using a questionnaire from 6267 Health Houses (rural health centres) for one year, 1993–94. Subjects were residents who died from unintentional injuries.

Results—Crude mortality rate was 4.33 per 1000. The number of childhood deaths from unintentional injuries was 1832 (16.6% of all deaths), more among males than females (43.7v31.2 per 100 000). Those under 1 had the highest rate, 114.7 per 100 000. The top three causes of deaths were traffic accidents (37.5%), drowning (17.9%), and burns and scalds (12.1%).

Conclusions—During the past decade there has been a marked decline in deaths from infectious diseases in Iran. However, at present, a high proportion of childhood deaths in rural areas are from unintentional injuries. Because all age groups and both sexes are victims of unintentional injuries, and most injuries are preventable, they must be considered as a priority health problem in Iran.
New Zealand children's involvement in home activities that carry a burn or scald risk
Authors: Harré Niki , Field Jeff , Polzer-Debruyne Andrea
Published: December 2008

Objectives—The self reported involvement of elementary schoolchildren from Auckland, New Zealand was measured for home activities that carry a burn or scald risk.

Method—A survey was conducted with 421 children aged 7–13 years. The survey asked children whether they carried out specific home activities involving hot water, fire, or appliances that carry a burn risk. It also measured their knowledge of the three basic fire safety messages taught to New Zealand schoolchildren by the fire service.

Results—The results showed that although involvement levels increased with age, the majority of even the youngest children reported carrying out a number of the risky activities, such as preparing hot drinks, running their own baths, or using a microwave without help. No gender differences were found in the number of risky activities engaged in. Significant ethnic differences were found, with higher risk involvement by indigenous Maori and children of Pacific Island descent than children of European or Asian descent. Each of the three fire safety messages were correctly identified by between 79%–91% of the children.

Conclusions—Investigation of children's involvement in household activities that carry an injury risk may help in the design of prevention strategies, including school based education. Prevention efforts need to acknowledge the ages at which children begin to undertake specific household tasks, including those that involve care for younger siblings, and be attuned to the needs of different ethnic groups.
Injury reporting in Connecticut newspapers: Table 1
Authors: Voight Bonnie , Lapidus Garry , Zavoski Robert , Banco Leonard
Published: December 2008

Objectives—To describe how newspapers report injury events and how often they contain information about injury prevention measures.

Methods—A commercial service provided all newspaper clippings reporting unintentional injury events between July and September 1995 from 17 daily and 55 weekly newspapers published in Connecticut, USA. Each clipping was reviewed to determine the presence or absence of 35 content variables.

Results—There were 962 articles and excluding 35 editorials, 927 reported injury events and 17% pertained to persons under 21 years. Of the 60% that described motor vehicle collisions only 3% mentioned driver alcohol use, 9% seat belt use, and fewer than 1% airbag use. In the 17 motorcycle and 44 bicycle stories, 29% and 20% respectively, mentioned helmet use. In the 16 articles about house fires only 13% mentioned smoke detector use. There were no significant differences in injury reporting by circulation size.

Conclusions—Newspapers are an important source of public information but are woefully deficient in providing information on injury prevention.
Babywalkers: prevalence of use and relationship with other safety practices
Authors: Kendrick Denise , Marsh Patricia
Published: December 2008

Objective—To examine the prevalence of walker use, and to compare sociodemographic factors, perceptions of the risk of injury and of household hazards, and safety practices in families by walker use.

Setting—36 primary care practices across Nottingham, UK.

Method—Postal questionnaire to all parents of children aged 3–12 months registered at each practice (n=2152) to assess safety practices, perceptions of risk of injury, and of the risk associated with household hazards and sociodemographic factors. Data were analysed using χ2tests for categorical data, Mann-Whitney U tests for ordinal data, and logistic regression analysis.

Results—The response rate was 74%. Fifty per cent of parents used babywalkers. Receipt of means tested benefits (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.02 to 1.99), non-owner occupation (OR 1.46, 95% CI 1.04 to 2.04), residence in a deprived area (OR 1.42, 95% CI 1.06 to 1.91), and unemployment (OR 0.64, 95% CI 0.41 to 0.99) were independently associated with use of walkers. Families using babywalkers were less likely to use stair gates (χ2= 4.36, 1df, p=0.037), fireguards (χ2= 6.80, 1df, p=0.009), and had a higher total number of unsafe practices (Mann-Whitney U test , Z = −2.90, p=0.004). Perceptions of risk of injury and of the risk associated with household hazards however, did not differ by walker use.

Conclusions—Babywalker use is common across all social groups and is associated with other unsafe practices such as not using stair gates or fireguards. Health professionals should support campaigns to limit the sale of babywalkers, but, in addition, they should ascertain each family's reasons for walker use and try to find acceptable alternatives. They should also make the family aware of the importance of properly fitted stair gates and fireguards and help the family to obtain and use such items of safety equipment.
How members of the public interpret the wordaccident
Authors: Girasek D C
Published: December 2008

Objective—To explore what the wordaccidentmeans to the lay public. This interpretation is of interest because it has been raised by injury control professionals as one justification for discouraging use of that word.

Methods—A national telephone survey of 943 adults in the United States was conducted. Respondents were selected at random from households whose phone numbers were generated using random digit dialing techniques. Bivariate and multivariate analyses were performed to determine if respondent characteristics predicted their interpretations of the wordaccident.

Results—Eighty three per cent of respondents associated preventability with the wordaccident, and only 26% felt that accidents were controlled by fate. However, 71% thought that accidents could not be predicted, and 4% felt that accidents were done on purpose. Age, education, income, and race emerged as independent predictors of variousaccidentinterpretations.

Conclusions—Only in the case of “unpredictability” does the public's interpretation of the wordaccidentmatch many experts' expectations. The concept of “unintentionality” is what seems to be communicated most strongly by use of the wordaccident. Persistent attempts on the part of injury control professionals to eliminate this word from social discourse may result in unintended consequences, which are discussed.
Barriers to pediatric injury prevention counseling
Authors: Cohen Lisa R , Runyan Carol W
Published: December 2008

Objectives—Physicians cite numerous barriers to incorporating injury prevention counseling into routine care. Health behavior models suggest that beliefs about barriers are associated with physician characteristics. This study explores associations between physician characteristics and physician perceptions of barriers.

Methods—Self administered structured questionnaires were sent to all five North Carolina (United States) pediatric residency programs. A total of 160 (72%) physicians training in pediatrics or medicine-pediatrics in these programs replied. Associations between perceived barriers and knowledge, gender, training, experience, and correlation between perceived barriers and other physician beliefs about injury prevention counseling, were measured.

Results—Although most residents believed that talking to parents about injury prevention during routine visits was important, they felt they lacked time, did not think to ask parents about injury prevention, or had more important things to do. The more importance residents placed on asking parents about hazards, the less the extent to which barriers were perceived (r= 0.32). Barriers were perceived to a greater extent by residents who thought their preceptors did not expect them to counsel about injury prevention (r= 0.28), lacked confidence that their counseling helped parents (r= 0.32), or felt uncomfortable counseling parents about injury prevention (r= 0.18). Knowledge, residency year, training, and previous experience with injury were not related to perceived barriers.

Conclusions—Residency programs should teach the importance of injury prevention; provide opportunities for residents to become comfortable talking with parents about this; and train residents in the appropriate use of counseling as one strategy for addressing injury prevention.
A new paradigm of injury intentionality
Authors: Cheng Tina L , Wright Joseph L , Fields Cheryl B , Brenner Ruth A , Schwarz Donald , O'Donnell Regina , Scheidt Peter C
Published: December 2008

Objective—To improve understanding of processes leading to injury and assess more specifically the degree of intentionality.

Methods—A new paradigm was developed that characterizes the act of inflicting injury (self, other, not inflicted) and the motive. Motives are determined for the act of injury and for the outcome. To test this, 986 cases of adolescent injuries in seven hospitals were reviewed. Three investigators independently classified all cases using the new paradigm and three used standard definitions of intent. Inter-rater reliability was measured.

Results—Of injuries inflicted by others, 61% were intentional using the standard classification. In the new paradigm 67% were intended acts and 59% involved intentional motive for outcome. Altogether 87% of sports injuries were coded as unintentional acts compared with 96% using standard methods. Using standard classification there was 93% agreement between paired raters, with an average κ of 0.86. In the new paradigm questions on intentionality of act, outcome, and infliction of act, the agreement was 89%, 91%, 88%, with a κ of 0.79, 0.80, 0.76, respectively.

Conclusions—This paradigm defines a spectrum of injury intent, enhances understanding of the causal sequence of injury, and has important implications for research and prevention.
“First Aid for Scalds” campaign: reaching Sydney's Chinese, Vietnamese, and Arabic speaking communities
Authors: King Lesley , Thomas Margaret , Gatenby Kristen , Georgiou Angela , Hua Myna
Published: December 2008

Objectives—As a serious yet preventable problem, scald injuries in children have been a priority for prevention in Australia and other developed countries. Not only can the occurrence of scalds be prevented, but immediate first aid treatment offers an effective method for secondary prevention, reducing the severity of scalds. Despite the success of scald prevention initiatives, local evidence suggested that first aid knowledge was lacking in some minority ethnic groups. To redress this gap, the “First Aid for Scalds” campaign for those from a non-English speaking background was specifically targeted to three ethnic groups (Vietnamese, Chinese, and Arabic), with the aim of increasing the proportions of parents and caregivers who had correct knowledge of first aid treatment for scalds. The primary strategy was a media campaign, including advertisements on ethnic radio and in ethnic newspapers.

Methods—The evaluation design included formative research and impact evaluation. The impact evaluation study involved random population based telephone surveys with each of the three language groups, before and after the campaign, to assess the reach and effectiveness of the campaign.

Results—After the campaign, there were significant increases in the proportion of people who knew the correct first aid treatment for scalds. There were substantial variations in campaign recall and knowledge between each of the three language groups. The largest improvement was found in the Vietnamese group.

Conclusion—The association between campaign recall and increase in correct knowledge, and the absence of any similar interventions during the campaign period, give credence to the conclusion that the changes observed were a result of the campaign. The results demonstrate the value of community based injury prevention campaigns specifically targeting linguistically diverse communities.
Evaluation of a drowning prevention campaign in King County, Washington
Authors: Bennett Elizabeth , Cummings Peter , Quan Linda , Lewis Frances Marcus
Published: December 2008

Objectives—A three year drowning prevention campaign focused on increasing the use of life vests among children 1–14 years old. An evaluation was conducted to determine campaign awareness, change in ownership and use of life vests by children, and predictors of life vest use.

Setting—King County, Washington.

Methods—Four telephone surveys were conducted with parents before, during, and after the campaign.

Results—The campaign was recalled by 50% of families surveyed. From before to after the campaign, reported life vest use by children on docks, beaches, or at pools increased from 20% to 29% (p<0.01) and life vest ownership for children increased from 69% to 75% (p=0.06). Among parents aware of the campaign, reported child life vest use increased from 20% to 34% (p<0.001) and ownership increased from 69% to 80% (p<0.01). Among families unaware of the campaign, neither life vest use nor ownership changed significantly. Children were more often reported to wear life vests if a parent knew of the campaign, was confident fitting the vest, was younger than 40 years, felt the child could not swim well, and owned a life vest for the child.

Conclusions—A community-wide drowning prevention campaign resulted in a significant, although modest, increase in reported life vest use and ownership among children.
Injury hospitalizations among American Indian youth in Washington
Authors: Johnson Shannon J , Sullivan Marianne , Grossman David C
Published: December 2008

Objective—To determine the rate and causes of hospitalizations for injury among American Indian and Alaska Native (AI/AN) youth in the state of Washington, and to compare this with the rate of hospitalizations for injury among youth of all races.

Methods—Subjects were aged 0–19 years and were admitted to civilian hospitals for care of an injury (International Classification of DiseasesN codes 800–995) in Washington between 1990 and 1994. Deaths occurring in the pre-hospital setting and emergency department are not included. Using several fields of identifying information, the Washington state hospital discharge database was linked with the Indian Health Service (IHS) patient registration database to identify AI/AN youth. Denominator data included the total age specific IHS user population for American Indians and US Census derived population estimates. Incidence ratios (IRs) were calculated to compare rates of hospitalization between AI/AN youth and all youth in Washington.

Results—A total of 694 and 29 048 hospitalizations for injury were identified for AI/AN youth and all races, respectively. The rate of hospitalization for injuries among AI/AN youth was 507 discharges per 100 000 youth (IR = 1.30; 95% confidence interval (CI) 1.20 to 1.40. The leading mechanism of injury was motor vehicles (IR 1.73, CI 1.49 to 2.01), followed by falls (IR 0.95, CI 0.79 to 1.15), and poisoning (IR 1.20, CI 0.80 to 1.78). The disparity was greater for intentional injuries (IR 1.71, CI 1.44 to 2.04). The highest IR for all unintentional injuries was for injuries from fire (IR 2.35, CI 1.42 to 3.87). AI/AN children aged 15–19 had the greatest disparity for rates of injury hospitalization (IR 1.4, CI 1.25 to 1.56).

Conclusion—AI/AN youth in Washington had a higher hospitalization rate for injury compared with all youth in the state. Disparities were greatest for injuries related to motor vehicles and assaults. When linked, hospital discharge data can be used for surveillance of AI/AN hospitalizations.
Children's fractures: a population based study
Authors: Lyons Ronan A , Delahunty Annie M , Kraus Debbie , Heaven Martin , McCabe Mike , Allen Howard , Nash Pam
Published: December 2008

Objective—To measure the incidence of childhood fractures in a defined population.

Setting—Accident and emergency (A&E) departments covering the Swansea and Neath Port Talbot areas of South Wales in 1996.

Methods—Linkage of data from A&E departments with population data to produce fracture incidence rates by anatomical site and cause in children aged 0–14 years.

Results—During 1996, 2463 new fractures occurred in 2399 residents yielding a fracture rate of 36.1/1000 children. Fractures were more common in boys than girls and increased with age in both groups. Sports and leisure activities accounted for 36% of fractures, assaults for 3.5%, and road traffic accidents 1.4%. Fractures of the radius/ulna were most frequent (36%).

Conclusions—The fracture rate in South Wales children is twice the rate reported in previous studies. Further research is required to elucidate the reasons behind this high rate. Many fractures could be prevented by the use of safer surfaces in school playgrounds, and wrist protection in in-line skaters and possibly in soccer players.
Graduated licensing comes to the United States
Authors: Williams Allan F
Published: December 2008

Objective—To describe the young driver problem and the emergence of graduated licensing as a way to address it.

Methods—Literature review and commentary.

Results—Twenty four states in the United States adopted versions of graduated licensing in 1996–98; initial results show positive effects.

Conclusions—A major public health movement is under way that can be expected to produce significant reductions in crashes and injuries involving young drivers.
Comparing pediatric intentional injury surveillance data with data from publicly available sources: consequences for a public health response to violence
Authors: Stone David A , Kharasch Sigmund J , Perron Catherine , Wilson Kim , Jacklin Beth , Sege Robert D
Published: December 2008

Objective—A hospital based intentional injury surveillance system for youth (aged 3–18) was compared with other publicly available sources of information on youth violence. The comparison addressed whether locally conducted surveillance provides data that are sufficiently more complete, detailed, and timely that clinicians and public health practitioners interested in youth violence prevention would find surveillance worth conducting.

Setting—The Boston Emergency Department Surveillance (BEDS) project was conducted at Boston Medical Center and the Children's Hospital, Boston.

Method—MEDLINE and other databases were searched for data sources that report separate data for youth and data on intentional injury. Sources that met these criteria (one national and three local) were then compared with BEDS data. Comparisons were made in the following categories: age, gender, victim-offender relationship, injury circumstance, geographic location, weapon rates, and violent injury rates.

Results—Of 14 sources dealing with violence, only four met inclusion criteria. Each source provided useful breakdowns for age and gender; however, only the BEDS data were able to demonstrate that 32.6% of intentional injuries occurred among youth aged 12 and under. Comparison data sources provided less detail regarding the victim-offender relationship, injury circumstance, and weapon use. Comparison of violent injury rates showed the difficulties for practitioners estimating intentional injury from sources based on arrest data, crime victim data, or weapon related injury.

Conclusions—Comparison suggests that surveillance is more complete, detailed, and timely than publicly available sources of data. Clinicians and public health practitioners should consider developing similar systems.
House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury
Authors: Warda Lynne , Tenenbein Milton , Moffatt Michael E K
Published: December 2008

Objective—To summarize house fire injury risk factor data, using relative risk estimation as a uniform method of comparison.

Methods—Residential fire risk factor studies were identified as follows: MEDLINE (1983 to March 1997) was searched using the keywords fire*/burn*, with etiology/cause*, prevention, epidemiology, and smoke detector* or alarm*. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by the above keywords, as well as safety, skills, education, and training. Other sources included: references of retrieved publications, review articles, and injury prevention books;Injury Preventionjournal hand search; government documents; and internet sources. When not provided by the authors, relative risk (RR), odds ratio, and standardized mortality ratios were calculated, to enhance comparison between studies.

Results—Fifteen relevant articles were retrieved, including two case-control studies. Non-modifiable risk factors included young age (RR 1.8–7.5), old age (RR 2.6–3.6), male gender (RR 1.4–2.9), non-white race (RR 1.3–15.0), low income (RR 3.4), disability (RR 2.5–6.5), and late night/early morning occurrence (RR 4.1). Modifiable risk factors included place of residence (RR 2.1–4.2), type of residence (RR 1.7–10.5), smoking (RR 1.5 to 7.7), and alcohol use (RR 0.7–7.5). Mobile homes and homes with fewer safety features, such as a smoke detector or a telephone, presented a higher risk of fatal injury.

Conclusions—Risk factor data should be used to assist in the development, targeting, and evaluation of preventive strategies. Development of a series of quantitative systematic reviews could synthesize existing data in areas such as house fire injury prevention.