To examine recent trends and geographic variations in road-traffic deaths in China.
A longitudinal descriptive analysis of national and provincial data on road-traffic deaths, examining recent trends and geographic variations.
China, 1985–2005.
The Transportation and communications yearbook of China (1986–2006) and the National statistics yearbook of China (1996–2006).
The percentage change in death rates per 100 000 population was used to examine the trend. Epi Info was used to map the geographic distribution of road-traffic death rates and the increases in rates. Correlation coefficients were calculated between per capita gross regional product, road quality, and the number of motor vehicles in the 31 provinces, to help understand the geographic variations in road-traffic mortality at the provincial level in China.
The road-traffic death rate increased by 95%, from 3.9/100 000 persons in 1985 to 7.6/100 000 persons in 2005. High death rates and the greatest increases in death rates occurred in both developed provinces in the southeast and underdeveloped northern and western provinces. Xizang/Tibet, Qinghai, and Xinjiang, with the lowest population density, had the highest death rates per 100 vehicles.
China’s government should introduce and support measures to prevent road-traffic injuries. Developed and underdeveloped provinces in China should both be considered when road-traffic policy and interventions are developed.
Electronic stability control (ESC) systems were developed to reduce motor vehicle collisions (MVCs) caused by loss of control. Introduced in Europe in 1995 and in the USA in 1996, ESC is designed to improve vehicle lateral stability by electronically detecting and automatically assisting drivers in unfavorable situations.
To examine the relationship between vehicle rollover risk and presence of ESC using a large national database of MVCs.
A retrospective cohort study for the period 1995 through 2006 was carried out using data obtained from the National Automotive Sampling System General Estimates System. All passenger cars and sport utility vehicles (SUVs)/vans of model year 1996 and later were eligible. Vehicle ESC (unavailable, optional, standard) was determined on the basis of make, model, and model year. Risk ratios (RRs) and 95% CIs were calculated to compare rollover risk by vehicle ESC group.
For all crashes, vehicles equipped with standard ESC had decreased risk of rollover (RR = 0.62, 95% CI 0.50 to 0.77) compared with vehicles with ESC unavailable. The association was consistent for single-vehicle MVCs (RR = 0.61, 95% CI 0.46 to 0.82); passenger cars had decreased rollover risk (RR = 0.77, 95% CI 0.52 to 1.12), but SUVs/vans had a more dramatically decreased risk (RR = 0.40, 95% CI 0.26 to 0.61).
This study supports previous results showing ESC to be effective in reducing the risk of rollover. ESC is more effective in SUVs/vans for rollovers related to single-vehicle MVCs.
To determine the factors that influence appropriate restraint usage by child occupants across the age range for which any type of child restraint may be appropriate (0–10 years).
Randomized household telephone survey.
Statewide survey, New South Wales, Australia.
Parents or carers of children aged 0–10 years.
Parental reporting of appropriateness of child restraint.
Demographic information and data on age, size, restraint practices, parental knowledge of child occupant safety, and attitude to restraint use was collected using a structured interview. Data were analysed using logistic regression after cluster adjustment.
Inappropriate restraint use by children was widespread, particularly in children aged 2+ years. Overall, parental knowledge of appropriate ages for restraint transitions was associated with increased likelihood of appropriate restraint use. Lower levels of formal parental education, larger families, parental restraint non-use, and parent/child negotiability of restraint use were predictors of inappropriate restraint use. For particular child age subgroups, the parental knowledge that predicted appropriate restraint use was specific to that age group. Most parents felt that they knew enough to safely restrain their child, despite widespread inappropriate restraint use.
Parents are more likely to make appropriate restraint choices for their children if they possess restraint knowledge specific to their children’s age and size. Educational campaigns may be most effective when they provide information for specific ages and transition points. Strategies to overcome parents’ misplaced confidence that they know enough to restrain their children safely are also indicated.
To investigate the effectiveness of a paraprofessional home visitation program (HVP) to improve home safety and prevent injuries among children living in low-income settings.
The HVP was implemented in two low-income communities in South Africa. In each community, approximately 200 households were randomly selected for the trial. Eligible households were those with children aged <=10 years. Intervention households received four visits, one every two weeks, by trained paraprofessionals that focused on a specific injury topic and consisted of: information dissemination about specific injury prevention practices; home inspection accompanied by information about home hazards; and the supply of safety devices. The key outcomes to measure the presence of home hazards were scores for burns (safety practices, paraffin, and electrical), poisoning, and falls.
Significant reductions were found for injury risks related to burn safety practices. For injury risks related to electrical burns, paraffin burns, and poisoning, a decline was also noted although this was not statistically significant. No decline was noted for fall-related risks.
Subject to further replication and evaluation, home visits by paraprofessionals providing safety education, home inspection, and safety devices be considered for integration into a comprehensive child injury prevention strategy in low-income communities.
To validate self-reported possession and storage of a range of substances within the home.
30 families with children aged 12–35 months on health visitor caseloads in Nottingham, UK.
Self-reported possession and storage of potentially hazardous substances were validated by observations. Sensitivity, specificity, and predictive values were calculated for possession, storage, and exposure to substances.
Self-reported low exposure to substances had high sensitivities (87–100%) and positive predictive values (75–100%) for all substances, except toilet cleaner (positive predictive value 62%) and high negative predictive values for commonly owned household products. Specificity and negative predictive value could not be estimated reliably for medicines and less commonly owned household products, as few families stored these unsafely.
A measurement of exposure that combines self-reported possession and storage may be sufficiently accurate to identify families with safer poison prevention practices.
A variety of factors affect the safety and risk practices of school-age children, but rarely have multiple factors been considered simultaneously.
To examine children’s safety attitudes and cognitions more thoroughly and assess how these factors, along with children’s safety knowledge and injury experiences, relate to children’s safety practices.
Over several classroom sessions, boys and girls in two age groups (7–9, 10–12 years) completed a psychometrically sound questionnaire that indexes their behaviors, attitudes, cognitions, knowledge, and injury experiences.
Fewer safety practices were reported by older than younger children and boys than girls. Children’s attitudes, cognitions, knowledge, and injury experiences each correlated with safety practices, but only safety attitudes and injury experiences predicted practices in a multivariate model.
Exploring the relative influence of numerous factors on safety practices highlights the important role that attitudes play in predicting children’s safety practices. Implications of these results for injury prevention programming are discussed.
To investigate the association between personality disorders and nonfatal unintentional injuries in a representative sample of US adults.
Data on self-reported nonfatal unintentional injuries during the 12 months before the interview were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed; 43 093 adults >=18 years participated in the NESARC wave I survey in 2001–02. Personality disorders were determined using the NIAAA Alcohol Use Disorders and Associated Disabilities Interview Schedule-DSM-IV.
Individuals with at least one personality disorder had a significantly higher 12-month incidence of injuries than people without any personality disorder (p<0.001). After accounting for sociodemographic characteristics or other mental disorders, OR was 1.54 (95% CI 1.39 to 1.71) for individuals with one personality disorder and 1.80 (95% CI 1.58 to 2.05) for individuals with two or more personality disorders compared with people with no personality disorder.
Personality disorders were associated with a significantly increased risk of unintentional injuries. This information has important implications for the treatment of patients with these disorders.
To investigate potential risk factors for whiplash injury as a function of crash configuration and driver’s characteristics, and to provide information on over-reporting and under-reporting of whiplash.
A case–control study of drivers involved in two-car injury collisions. Cases were drivers who had a diagnosis of whiplash injury, with or without another injury. Controls were drivers without diagnosed whiplash injury.
Hospital registries linked to police crash databases for Barcelona (Spain) and the "Département du Rhône" (France).
Relative risks of whiplash and 95% confidence intervals were estimated using a modified Poisson regression.
Of the 8720 drivers involved in car-to-car crashes recorded in the French database, 12.2% were diagnosed with whiplash; the corresponding figure in the Spanish database was 12.0% of 7558 drivers. Female drivers and drivers in rear-impact collisions were most likely to have a whiplash diagnosis, although the absolute number of whiplash cases was greater in front and side impacts. Wearing a seatbelt, being in a heavier car, and age greater than 65 years were associated with a lower risk of whiplash injury. Drivers with other injuries were also more often diagnosed as having a whiplash injury, except the most severely injured.
Devices aimed at reducing the occurrence of whiplash injuries, such as dynamic headrest systems, should be adapted to the characteristics of at-risk occupants, especially women, and should address the mechanics of front and side impacts in addition to rear impacts.
Most intimate partner homicides (IPHs) follow a long history of violence and occur while the victim is ending the relationship. Restraining orders are a common legal recourse by which to seek protection from an abusive partner. This study expands on prior research by examining the restraining order history of IPH victims by characteristics of the victim, assailant, and homicide.
State-wide databases containing information about restraining orders and homicides were linked, and bivariate and multivariate statistics were then calculated to identify differences between IPH victims who had and had not been issued a restraining order.
About 11% of 231 women killed by male intimates had been issued a restraining order. About one-fifth of the female IPH victims who had a restraining order were killed within 2 days of the order being issued; about one-third were killed within a month. Nearly half of those with a restraining order had been protected by multiple orders. Victims killed in a shared residence (versus elsewhere) had lower odds of having a restraining order, whereas victims from rural (versus urban) counties, married (versus dating) victims, and Latino (versus non-Latino) victim–offender dyads had higher odds of having a restraining order. The type of weapon used was not associated with whether the victim had been under the protection of a restraining order.
Most female IPH victims did not have a restraining order when they were killed. Further research is needed to determine whether restraining orders protect against IPH and, if they do, on how to increase their utilization.
Pedestrian injuries are a leading cause of death and disability. Transport policy decisions have a major impact on the risk of pedestrian injury, but the effects cannot usually be quantified in controlled studies. However, mathematical modeling can help to establish the injury consequences of transport policy decisions.
A stochastic mathematical model was developed to estimate the effect of alternative transport scenarios on pedestrian injury risk. The model is based on a mechanistic description of pedestrian injury causation and comprises four sub-models: vehicle dynamics, pedestrian dynamics, collision incidence, and injury severity.
The model was used to estimate the yearly pedestrian injury rate for a baseline scenario, corresponding to current traffic conditions in London, UK, and three alternative scenarios, comprising reductions in vehicle speed, traffic volume, and vehicle mass. The model simulated a baseline injury rate of 88 per 100 000. Compared with baseline, a 15% reduction in mean speed resulted in a 21% reduction in injury rate and a 75% reduction in fatality rate. A 15% reduction in traffic volume resulted in a 14% reduction in injury rate and a 25% reduction in fatality rate. Reducing vehicle mass by 15% did not reduce the number of injuries, but a 25% reduction resulted in less severe injuries.
The model simulated well the rates and severity of pedestrian injury corresponding to the baseline scenario and made predictions for different transport policy scenarios. However, it is offered primarily as a generic decision support tool for the assessment of alternative policies by transport authorities.
To assess the use of the International Classification of Diseases Australian Modification (ICD-10-AM) activity sub-codes for identifying sports/leisure injury hospitalizations and the impact of missing codes on population incidence estimates.
Injury-related hospital separations in New South Wales, Australia, for the period 2003–04 were examined with sports/leisure cases identified by the ICD-10-AM activity codes.
Over 30% of all injury hospitalizations had either a missing or unspecified activity code. Among cases with valid activity codes, 13.9% of all injury hospitalizations were associated with sports/leisure. When adjusted for underreporting associated with undefined or missing activity codes, sports/leisure injuries accounted for up to 20% of injury hospitalizations.
Defining sports/leisure injury cases on the basis of activity codes is likely to lead to an underestimate of their contribution to the overall injury burden. Improvements need to be made to the completeness of activity coding of hospitalization data.