The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming.
Retrospective chart review conducted on all children 0-17 years admitted to the Children's Hospital of Eastern Ontario (CHEO) between April 1, 1996, and March 31, 2000, following acute trauma. Each record was reviewed and assigned an ISS using the AIS 1990 revision. All cases with an ISS > 11 were included in the study.
There were 2610 trauma cases admitted to CHEO over the study period. Of these, 237 (9.1%) had severe trauma (ISS > 11). Sixty-two percent were male. Twenty-nine percent were between the ages of 10 and 14 years, 27% between 5 and 9 years, 16% between 15 and 17 years, 15% between 1 and 4 years, and 13% less than 1 year old. The most common mechanisms of injury were due to motor vehicle traffic (39%), falls (24%), child abuse (8%), and sports (5%). Of those resulting from motor vehicle traffic, 53 (57%) were occupants, 22 (24%) were pedestrians, and 18 (19%) were cyclists. When combining traffic and nontraffic mechanisms, 26 (11% of all severe trauma cases) occurred as a result of cycling incidents. The most severe injury in 65% of patients was to the head and neck body region.
Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.
BACKGROUND AND PURPOSE: Osteoporosis and stroke share several risk factors, including age, smoking, low physical activity, and hypertension. Thus, low bone mineral density (BMD) and high stroke risk may be related. We examined the relationship between BMD and acute stroke in noninstitutionalized men and women aged >/=60 years. METHODS: Sixty-three stroke patients (33 women and 30 men) and 188 control subjects from the general population were included. BMD was measured by using dual-energy x-ray absorptiometry at both proximal femurs. The measurements of the stroke patients were performed 6 days after the onset of stroke. RESULTS: The BMD at the femoral neck in the female stroke patients was 8% lower than in the control subjects (P:=0.007). In men, no difference in BMD between the stroke patients and their controls was found. Women with BMD values in the lowest quartile had a higher risk of stroke than women with BMD values in the highest quartile (OR 4.8), and the probability value for linear trend over the quartiles was statistically significant (P:=0.003). The OR for stroke increased 1.9 per SD (0.13 g/cm(2)) reduction in BMD, and the association between low BMD and stroke in women remained significant when the analysis was adjusted for potential confounders. CONCLUSIONS: Female, but not male, stroke patients have lower BMD than population controls. Low BMD may predict stroke in women.
Comment In: Stroke. 2001 Dec 1;32(12):2956-711740005
This study analyzed the database of Canadian Accident Injury Reporting and Evaluation (CAIRE) for the injuries reported from January 1986 to March 1996 in seven provinces at children's or general hospitals in Canada. In order to describe the characteristics of injuries, we compared the different categories of injuries by sex and by age groups, identified patterns of injuries, and detected the products causing injury to Canadian people. The results showed that there were 130,489 injury cases in Canada during the 10 years from 1986 to 1996. The 10-19 year age group had 57,582 cases, representing 44.13% of total injuries, and making it the group with the highest occurrence of injuries. The male injury rate (69.75%) was significantly higher than the female rate (30.25%) (P = 0.0001). Six areas were identified as priorities for intervention: 1) injuries occurring on playgrounds among children and youth; 2) sports and playground apparatus injuries and injuries sustained in transit among young people; 3) the top five causes of injuries; 4) diagnosis and treatment of injuries; 5) consumer products and safety; and 6) nature and physical sites of injuries. Further work is needed in: evaluating injury causes, comparing the results with reports from other countries and the necessary approaches and prevention measures to reduce and control injury occurrences to improve the quality of consumer products, and to protect the health of the population in Canada.
The starting lists for the alpine disciplines during the 1994 Olympic Winter Games in Lillehammer totalled 555 racers, but only 354 of them (64%) completed the different races. The race completion rate was 43% in the slalom, 51% in the giant slalom, 75% in the super giant slalom and 91% in the downhill. In combined downhill/slalom the race completion rate was 60%, but 96% in the downhill and 68% in the slalom part of the combination, respectively. Only three injuries were recorded, all in females. Including the training competitions a total of 1541 runs through the different alpine courses was recorded during the games. This means an injury rate of 1.9 injuries per 1000 runs. For downhill the injury rate was only 1.1 per 1000 runs. If the injury rate is related to the number of skiers who did not finish the race because of falls or skiing errors, the rate was 21.1 injuries per 1000 falls (skiing errors) for all alpine races. In conclusion, the race completion rate was twice as high in downhill as in slalom, and the injury rate was low.
A study was conducted to verify if there is an association between occupational noise exposure, noise-induced hearing loss and driving safety expanding on previous findings by Picard, et al. (2008) that the two factors did increase accident risk in the workplace.
This study was made possible when driving records of all Quebec drivers were made available by the Societe de l'assurance automobile du Quebec (SAAQ is the state monopoly responsible for the provision of motor vehicle insurance and the compensation of victims of traffic accidents). These records were linked with personal records maintained by the Quebec National Institute of Public Health as part of its mission to prevent noise induced hearing loss in the workplace. Individualized information on occupational noise exposure and hearing sensitivity was available for 46,030 male workers employed in noisy industries who also held a valid driver's permit. The observation period is of five years duration, starting with the most recent audiometric examination. The associations between occupational noise exposure levels, hearing status, and personal driving record were examined by log-binomial regression on data adjusted for age and duration of exposure. Daily noise exposures and bilateral average hearing threshold levels at 3, 4, and 6 kHz were used as independent variables while the dependent variables were 1) the number of motor vehicle accidents experienced by participants during the study period and 2) participants' records of registered traffic violations of the highway safety code. The findings are reported as prevalence ratios (PRs) with their 95% confidence intervals (CIs). Attributable numbers of events were computed with the relevant PRs, lesser-noise, exposed workers and those with normal hearing levels making the group of reference.
Adjusting for age confirmed that experienced workers had fewer traffic accidents. The data show that occupational noise exposure and hearing loss have the same effect on driving safety record than that reported on the risk of accident in noisy industrial settings. Specifically, the risk of traffic accident (PR = 1.07 (CI 95% [1.01; 1.15]) is significantly associated with the daily occupational noise exposures >or= 100 dBA. For participants having a bilateral average hearing loss ranging from 16 to 30 dB, the PR of traffic accident is 1.06 (CI 95% [1.01; 1.11]) and reaches 1.31 (CI 95% [1.2; 1.42]) when the hearing loss exceeds of 50 dB. A reduction in the number of speeding violations occurred among workers occupationally exposed to noise levels >or= 90 dBA and those with noise-induced hearing loss >or=16 dB. By contrast, the same individuals had an increase in other violations of the Highway safety code. This suggests that noise-exposed workers might be less vigilant to other traffic hazards.
Daily occupational noise exposures >or= 100 dBA and noise-induced hearing losses-even when just barely noticeable-may interfere with the safe operation of motor vehicles.
STUDY OBJECTIVE: To do a complete survey of hospital-treated fractures in the aged (65+ years old) and to report the characteristics and distribution of all fractures occurring within this defined population. DESIGN: Prospective injury recording study. SETTING: The Norwegian municipality of Harstad (population 23,000) during eight years from 1 July 1985. PARTICIPANTS: The person years of the study estimated from yearly census data, were 22,970. MEASUREMENTS AND MAIN RESULTS: The variables were selected and coded according to the Nordic system and the data were collected as part of a national injury surveillance system. Of 753 recorded fractures, nine out of ten were caused by falls. 50.6% of fractures occurred in private homes, 24.4% in traffic areas (traffic accidents excluded), 13.3% in nursing homes. Adjusting for exposure, fracture rates (per 1000 person years) were 70.0 in nursing homes, 17.7 in private homes, and 8.5 in traffic areas in winter (traffic accidents excluded). The fracture risk in traffic areas increased fivefold in months with snow. CONCLUSION: Nine out of ten fractures in the aged were caused by falls. Although the fracture risk for the elderly living in a nursing home was four times as high as those living in private homes, the volume of fractures occurring in private homes and traffic areas make them a prime target for interventions. Continuous prospective hospital recording of fractures in a community of aged is feasible and provides a tool for targeting interventions and evaluating the outcome of a community fall-fracture prevention programme.
To describe the provision of safety training to Canadian employees, specifically those in their first year of employment with a new employer.
Three repeated national Canadian cross-sectional surveys.
59 159 respondents from Statistics Canada's Workplace and Employee Surveys (1999, 2001 and 2003), 5671 who were in their first year of employment.
Receiving occupational health and safety training, orientation training or office or non-office equipment training in either a classroom or on-the-job in the previous 12 months.
Only 12% of women and 16% of men reported receiving safety training in the previous 12 months. Employees in their first 12 months of employment were more likely to receive safety training than employees with >5 years of job tenure. However, still only one in five new employees had received any safety training while with their current employer. In a fully adjusted regression model, employees who had access to family and support programs, women in medium-sized workplaces and in manufacturing, and men in large workplaces and in part-time employment all had an increased probability of receiving safety training. No increased likelihood of safety training was found in younger workers or those in jobs with higher physical demands, both of which are associated with increased injury risk.
From our results, it would appear that only one in five Canadian employees in their first year of a new job received safety training. Further, the provision of safety training does not appear to be more prevalent among workers or in occupations with increased risk of injuries.
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Associations between a 10-year community-based osteoporosis and fall prevention program and fracture incidence amongst middle-aged and elderly residents in an intervention community are studied, and comparisons are made with a control community. A health-education program was provided to all residents in the intervention community, which addressed dietary intake, physical activity, smoking habits and environmental risk factors for osteoporosis and falls. Both communities are small, semi-rural and situated in Ostergotland County in southern Sweden. The analysis is based on incidences of forearm fractures in the population 40 years of age or older, and hip fractures in the population 50 years of age or older. Data for three 5-year periods (pre-, early and late intervention) are accumulated and compared. In the intervention community, forearm fracture incidence decreased in women. There are also tendencies towards decreasing forearm fracture incidence in men, and towards decreasing trochanteric hip fracture incidences in women and in men in the late intervention period. No such changes in fracture incidences are found in the control community. Cervical hip fracture incidence did not change in the intervention and the control communities. Although the reported numbers of fractures are small (a total of 451 forearm and 357 hip fractures), the numbers are based on total community populations and thus represent a true difference. The decrease in forearm fracture incidence among women, and the tendency towards decreasing trochanteric hip fractures, in contrast to the absence of change in cervical hip fractures, might be mainly due to a more rapid effect of fall preventive measures than an increase in bone strength in the population. For the younger age groups an expected time lag between intervention and effect might invalidate the short follow-up period for outcome measurements. Thus, the effect of the 10-year intervention program on fracture incidence should be followed during an extended post-intervention period.
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.
AIM: To investigate whether social and socio-economic characteristics of the population within a parish influence childhood injury. METHODS: The study encompasses all children aged 0-15 y living in Stockholm County over the 3-y period 1999-2001 (about 360,000 children per year), grouped into parish of residence (138 parishes). The effect of parish attributes on injury rate were analysed based on three indices (deprivation, socio-economic status and social integration) derived by a factor analysis of 11 characteristics of the parishes' population, each index being split into three levels. Childhood injury resulting in at least one night of hospitalization during the period 1999-2001 was considered (n = 5540) by index, and rate ratios were calculated for 12 injury causes using parishes forming the best level of the index as the reference group. RESULTS: Higher levels of deprivation negatively influenced pedestrian injury rates, had a protective effect on other traffic-related injuries, and negatively affected some other types of unintentional injuries. Higher concentrations of people with low socio-economic status did not impact on the risk of traffic and fall injuries, but increased that of burns/scalds and cases of poisoning. Parishes with lower levels of social integration had significantly higher rates of bicycle- and moped-related injuries, and also of self-inflicted ones. CONCLUSION: Compositional characteristics of the population in a residential area affect injury to varying degrees and direction according to type of injury. The underlying mechanisms are likely to be specific to injury type.