Pless argues that the positions we put forward in our 2011 Commentary are ‘entirely wrong’ and challenges us to respond.
The proposed position that minor injury (ie, injury that has no serious or long-term consequences) should be regarded as more acceptable than serious injury has been stated in the previous commentaries. For example, Molcho and Pickett
(1) Estimate age, period and cohort effects for motorcyclist traffic casualties 1979–2008 in New Zealand and (2) forecast the incidence of New Zealand motorcycle traffic casualties for the period 2019–2023 assuming future age, cohort and period effects, and compare these with an estimate based on simple linear extrapolation.
Age-period-cohort (APC) modelling was used to estimate the individual effects of age, period and cohort after adjusting for the other two factors. Forecasting was produced for three period-effect scenarios.
After adjusting for cohort and period effects, 15–19-year-olds have substantially elevated risk. The period effect reduced in significance over time until the last period, 2004–2008, where the risk was higher than the preceding period. The 10-year cohorts born 1949–1958, 1954–1963, 1959–1968 and 1964–1973, had elevated risk. The forecasting, based on APC modelling, resulted in the lowest estimates of the future incidence being approximately one-third that of the highest estimate (6641).
Trends in motorcycle casualties have been influenced by significant independent age, period and cohort effects. These need to be considered in forecasting future casualties. The selection of the period effect has a significant impact on the estimates. Which period-effect scenario readers choose to accept depends on their views about a wide range of factors which might influence motorcycle use and crash risk over time.
The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use.
Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets.
5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2–3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal.
Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.
The aim of the present work was to assess the short-term effects of stimulant medication use on risk of injury among children diagnosed as having attention deficit hyperactivity disorder (ADHD).
The study group for this self-controlled case series study was children aged 1–18 years old diagnosed as having ADHD who experienced an incident medically-attended injury event and received at least one prescription for stimulant medication between 1993 and 2008 (n=328), identified from The Health Improvement Network primary care database from the UK. Conditional Poisson regression was used to estimate incident rate ratios (IRR) and 95% CIs for injury comparing periods of time exposed to stimulant medication to unexposed periods.
Among children with ADHD prescribed stimulant medication, the rate of medically-attended injury was decreased during periods of stimulant medication use as compared to unexposed periods (IRR 0.68, 95% CI 0.50 to 0.91). There was evidence of a protective association among males and among children aged 10–14 years. This effect did not change over time on treatment.
Stimulant medication use may decrease the risk of injury among children treated for ADHD, although unmeasured time varying confounding may be an alternative explanation. Injury risk may be considered during the decision-making process with regard to medication continuation among children with ADHD.
Childhood injuries are a major public health problem worldwide, injuries being the leading cause of death and disability from early childhood through adolescence.
To examine the 40-year nationwide trends in the number and incidence of fatal injuries among children aged 0–14 years in Finland, a country with a white European population of 5.3 million.
Data were obtained from the Official Cause-of-Death Statistics of Finland during 1971–2010. The main categories for unintentional injury deaths were road traffic injury, water traffic injury, falls, drowning and poisoning. For intentional injury deaths, the main categories were suicide and homicide.
In 1971, there were 109 fatal injuries involving girls and 207 involving boys, and in 2010, these numbers were 10 and 16. The corresponding incidence rates (per 100 000 children per year) were 20.1 and 2.3 (girls), and 36.7 and 3.5 (boys). The reduction in fatal injuries was mostly due to fewer unintentional injuries. The greatest decline occurred in the number of fatal motor vehicle injuries: from 57 (girls) and 92 (boys) in 1971 to 5 (girls) and 2 (boys) in 2010. Drownings followed a similar pattern. Violence-related deaths also showed a decreasing trend. In 1971, there were 14 intentional deaths in girls and 15 in boys, while in 2010 these numbers were 0 and 3, respectively.
This nationwide study confirms a decline in childhood injury deaths over the last four decades, with the greatest declines occurring in the number of fatal motor vehicle injuries, drownings and intentional injuries.
The city of Winnipeg was the first among several jurisdictions in Manitoba, Canada, to introduce breed specific legislation (BSL) by banning pit-bull type dogs in 1990. The objective of the present work was to study the effectiveness of BSL in Manitoba.
Temporal differences in incidence of dog-bite injury hospitalisations (DBIH) within and across Manitoba jurisdictions with and without BSL were compared. Incidence was calculated as the number of unique cases of DBIH divided by the total person-years at risk and expressed as the number per 100 000 person-years. Year of implementation determined the pre-BSL and post-BSL period for jurisdictions with BSL; for jurisdictions without BSL to date, the entire study period (1984–2006) was considered as the preimplementation period. The annual number of DBIH, adjusted for total population at risk, was modelled in a negative binomial regression analysis with repeated measures. Year, jurisdiction and BSL implementation were independent variables. An interaction term between jurisdiction and BSL was introduced.
A total of 16 urban and rural jurisdictions with pit-bull bans were identified. At the provincial level, there was a significant reduction in DBIH rates from the pre-BSL to post-BSL period (3.47 (95% CI 3.17 to 3.77) per 100 000 person-years to 2.84 (95% CI 2.53 to 3.15); p=0.005). In regression restricted to two urban jurisdictions, DBIH rate in Winnipeg relative to Brandon (a city without BSL) was significantly (p<0.001) lower after BSL (rate ratio (RR)=1.10 in people of all ages and 0.92 in those aged <20 years) than before (RR=1.29 and 1.28, respectively).
BSL may have resulted in a reduction of DBIH in Winnipeg, and appeared more effective in protecting those aged <20 years.
It is globally reported that young children are at a higher risk of burns but little is known about the individual risk factors. This study was undertaken in 2008 to investigate factors associated with burn injuries in children aged 0–5 years.
This was a case-control study with cases recruited prospectively from children attending hospital for a new burn injury and controls recruited from children admitted for other conditions.
A total of 248 cases and 248 controls were recruited. Cases included scalds (79%), contact burns (17%) and flame injuries (4%). Burns were most commonly caused by tea utensils (42%) and kerosene stoves (36%). Multivariable analyses found that a poor living standard (OR 5.4, 95% CI 2.6 to 11.7), having a child with a higher activity score (OR 5.3, 95% CI 3.4 to 8.5), having a history of burns in other family members (OR 2.8, 95% CI 1.5 to 5.2) and a higher number of home hazards (OR for a one unit increase in hazards score 1.32, 95% CI 1.02 to 1.70) were all associated with a significant increase in the odds of a burn injury. The presence of a second carer (OR 0.42, 95% CI 0.2 to 0.7) and having disability (OR 0.14, 95% CI 0.03 to 0.6) were protective factors.
This information about risk factors for burn injuries can be used to target preventive interventions towards families at the greatest risk of injury.
To estimate the overall and age-specific associations between obesity and extremity musculoskeletal injuries and pain in children.
This cross-sectional study used information from electronic medical records of 913 178 patients aged 2–19 years enrolled in an integrated health plan in the period 2007–2009. Children were classified as underweight, normal weight, overweight, or moderately/extremely obese and, using multivariable logistic regression methods, the associations between weight class and diagnosis of upper or lower extremity fractures, sprains, dislocations and pain were calculated.
Overweight (OR 1.18, 95% CI 1.15 to 1.20), moderately obese (OR 1.24, 95% CI 1.20 to 1.27) and extremely obese (OR 1.34, 95% CI 1.30 to 1.39) children had statistically significantly higher odds of lower extremity injuries/pain compared to normal weight, adjusted for sex, age, race/ethnicity and insurance status. Age-stratified analyses yielded similar results. No consistent association was observed between body mass index and injuries/pain of the upper extremities.
Greater body mass index is associated with increased odds of lower extremity injuries and pain issues. Because the benefits of physical activity may still outweigh the risk of injury, attention should be paid to injury prevention strategies for these children at greater risk for lower extremity injuries.
Vacant lots are often overgrown with unwanted vegetation and filled with trash, making them attractive places to hide illegal guns, conduct illegal activities such as drug sales and prostitution, and engage in violent crime. There is some evidence that greening vacant lots is associated with reductions in violent crime.
We performed a randomised controlled trial of vacant lot greening to test the impact of this intervention on police reported crime and residents' perceptions of safety and disorder. Greening consisted of cleaning the lots, planting grass and trees, and building a wooden fence around the perimeter. We randomly allocated two vacant lot clusters to the greening intervention or to the control status (no intervention). Administrative data were used to determine crime rates, and local resident interviews at baseline (n=29) and at follow-up (n=21) were used to assess perceptions of safety and disorder.
Unadjusted difference-in-differences estimates showed a non-significant decrease in the number of total crimes and gun assaults around greened vacant lots compared with control. People around the intervention vacant lots reported feeling significantly safer after greening compared with those living around control vacant lots (p<0.01).
In this study, greening was associated with reductions in certain gun crimes and improvements in residents' perceptions of safety. A larger randomised controlled trial is needed to further investigate the link between vacant lot greening and violence reduction.
Mediation of potentially violent conflicts is a key component of CeaseFire, an effective gun violence-prevention programme.
To describe conflicts mediated by outreach workers (OW) in Baltimore's CeaseFire replication, examine neighbourhood variation, and measure associations between conflict risk factors and successful nonviolent resolution.
A cross-sectional study was conducted using records for 158 conflicts mediated between 2007 and 2009. Involvement of youth, gangs, retaliation, weapons and other risk factors were described. Principal component analysis (PCA) was used for data-reduction purposes before the relationship between conflict risk components and mediation success was assessed with multivariate logistic regression.
Most conflicts involved 2–3 individuals. Youth, persons with a history of violence, gang members and weapons were commonly present. OWs reported immediate, nonviolent resolution for 65% of mediated conflicts; an additional 23% were at least temporarily resolved without violence. PCA identified four dimensions of conflict risk: the risk-level of individuals involved; whether the incident was related to retaliation; the number of people involved; and shooting likelihood. However, these factors were not related to the OW's ability to resolve the conflict. Neighbourhoods with programme-associated reductions in homicides mediated more gang-related conflicts; neighbourhoods without programme-related homicide reductions encountered more retaliatory conflicts and more weapons.
The 2007 National Roadside Survey found that the prevalence of drugs in weekend nighttime drivers in the USA was 16.4%—higher than 12.3% who tested positive for alcohol—bringing attention to the large potential for drugged driving.
I recently became aware of an impressive body of work that is less often cited than it should be when debating the effects of bicycle helmet legislation. As well as providing strong support for the effectiveness of helmets, it also helps counter the argument that ridership is reduced by legislation. Those opposed to helmet laws constantly refer to Robinson (some of whose work was published in this Journal). However, overlooked are a series of apparently flawless studies by Jake Olivier, a statistician, and his colleagues in New South Wales, Australia. I urge readers interested in this issue to at least read those listed below. In a nutshell, Olivier reminds us that in 1994, Marshall and White found no evidence of a significant change in ridership before and after the law, regardless of age. He also notes that the Australian ride-to-work survey before and...]]>
While the USA does not have the highest rate of firearm deaths in the world, it does have the highest rate among Organisation for Economic Cooperation and Development and high-income countries. The latest mass shooting in Newtown Connecticut stirred the country and the world in ways not seen before. Nevertheless, the hope for federal action on meaningful gun legislation has dimmed. How can this toll of gun deaths be reduced?
The answers are certainly complex and we need to know more. We believe that research on prevention of firearm violence is an important and necessary part of the solution. Yes, we do know that background checks have had an effect on inappropriate procurement of guns, although private gun sales currently require no background check. Laws mandating a minimum age for gun ownership reduce gun deaths. And we know that requiring the safe storage of guns can save lives....]]>