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  1. I B Pless, Editor

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    Usually a book review provides an in-depth examination of the material under consideration. This addition to the book review section is different. What I am offering lies somewhere between notices of books and reports I have received and a brief commentary on their contents. Thus, apologies are owed to the authors for judgments that are necessarily superficial. On balance it seemed better, however, to bring these to the attention of our readers and allow them to judge for themselves than have them linger, perhaps indefinitely, on my shelves while awaiting a formal review.

    The first is a collection of four paperback books all by Heward Grafftey. Two have a coauthor, Richard McInenley. Grafftey is a lawyer, a former Member of Parliament in Canada, and was Minister of Science and Technology during a previous government. Since leaving office, he has become chairman of an organization called Safety Sense Enterprises, Inc. Grafftey is a vocal advocate for safety, operating, for better or worse, outside of the scientific mainstream. All four books are written primarily for laypersons. The titles are self explanatory: How to Live Safely & Prevent Death & Injury (1996); Safety Sense in the Home (with McInenley) (1990); Safety Sense on the Road (also with McInenley) (1988), and Safety Sense at Play (1991). A quasigovernmental organization, Central Housing and Mortgage, provided assistance in the production of the books.

    Each is organized under appropriate subheadings, for example, Safety Sense in the Home, covers the kitchen, living and dining areas, sleeping areas and bathrooms, and in each section, separate sections cover the topic, usually in one page, by reviewing the risk factors and contributing factors, then offering a commentary and a list of safety sense bullets. As a result, the books are miniencyclopedias. On the positive side, I found few serious errors in any of the sections I checked. On the negative side, the sources used are mostly Canadian, some are outdated, and no scientific publications are cited. In fact, although the sources are all listed in the back of each book, none of the individual sections are connected to the citations. Hence, much has to be accepted on faith and it is difficult to determine where information came from. In spite of these shortcomings, this remarkable collection has much to recommend it, though I find it difficult to imagine who the most appropriate audience might be.

    Child Safe: A Practical Guide for Preventing Childhood Injuries, by Mark A Brandenburg, MD, is a similar collection of good advice in paperback format. The author is a practising emergency physician at the Trauma Emergency Center in Tulsa Oklahoma. Unlike the Grafftey collection, this book has an excellent index. It too is comprehensive and clearly aimed at parents. It is organized along quite different lines, however. The first part addresses non-age related injuries (automobiles, child abuse, day care centers, dog bites, etc—the topics then appearing in alphabetical order). The second part, also alphabetical within sections, covers age related injuries (infants, toddlers and preschoolers, and school age children). The third part lists product recalls and resources. One nice feature is the frequent use of anecdotes. Although clearly more based on scientific material, none of the references are given. For parents, especially American parents, this book, which has been officially endorsed by the American Academy of Emergency Medicine, is a valuable resource, though, to be fair, there are many others that cover the same territory equally well.

    Women's Injury in the Home in Victoria, by Erin Cassell and Joan Ozanne-Smith, is report number 158 of the Monash University Accident Research Centre. I regularly receive these reports and am invariably impressed by them. This is no exception. Directed more at fellow researchers and policy makers, this report, running to over 200 pages, is based on the exemplary collection of data sources in Victoria: the Coroner's Database, the Victorian Inpatient Minimum Database, the Victorian Injury Surveillance System, and the Extended Latrobe Valley Injury Surveillance project, which is a regional collection of data based on visits to general practitioners. The results are far from surprising, highlighting the overriding importance of falls, suicide, and self harm, as well as cutting and piercing injuries. Although the detailed descriptions of the injuries is, perhaps, exhaustive, they are more than compensated by excellent discussion and recommendation sections that conclude each topic. The more than 50 tables provide all the data one could hope for (and more) and although in some instances the findings may not apply in other countries, for the most part the findings are likely to be generalizable.

    Another favourite arrival is the Annual Report of the Injury Prevention Research Centre (IPRC) of the Department of Community Health, University of Auckland, New Zealand. Although I receive many such reports, these are always rewarding because of the “structured abstracts” that describe each of the main projects undertaken during 1999. Enough details are given about the methods and results to others to follow these examples. Especially important are those involving evaluation, for example, the Waitakere Community Intervention Project and Kidsafe Week.

    Tomorrow's Roads—Safer for Everyone, is from the Department of the Environment, Transport and the Regions in the UK. It is subtitled “The Government's road safety strategy and casualty reduction targets for 2010”. Although I suspect most such departments world wide have similar reports, this is the most recent to cross my desk and I must say I was impressed and encouraged. In the foreword, three ministers express their satisfaction with “the long, successful period in which the number of serious casualties have gone down and down . . .”, concluding, “Great Britain has be the best road safety record in Europe apart from Sweden”. Importantly, they go on to say, “Nevertheless, no one can be satisfied when just under 10 people are killed and 110 people are seriously injured every day on the roads. That is unacceptable and it is not inevitable”. They also acknowledge the dismal picture for child pedestrians and conclude, “This demands and will get specific action”. The goals set are a reduction of deaths and serious injuries by 40%—and by 50% for children. The report actually begins with a section entitled “Safer for children” and provides a detailed action plan. Also included are sections addressing safer drivers—training and testing, and drink, drugs, and drowsiness, as well as sections addressing safer infrastructure, safer speeds, safer vehicles, safer motorcycling, and safety for pedestrians, cyclists, and horse riders. All are commendable, but would in my view be disappointing if the final section, “Better enforcement”, were omitted. Two personal comments: I disagree with the conclusion (6.15) that “The 70 mph and 30 mph limits are well established and well understood and there is no case for a blanket change on safety or environmental grounds”. I agree however that “the definitions of dangerous and careless driving are not quite right” (10.17) and I am fully supportive of the move to increase the maximum penalty to £5000. There is much more in this plan that is laudatory, but I was left with a nagging concern that too many of the truly tough measures needed that are under consideration may never see the light of day.

    Injuries in the US Armed Forces—Surveillance, Research and Prevention, by B H Jones and P J Amoroso, a supplement to the American Journal of Preventive Medicine (April 2000) is a remarkable document in several respects. This compilation of papers draws on the astoundingly comprehensive set of injury data collected by the US military. The papers are preceded by an introduction by David Sleet describing the history and circumstances of the data collection and the implications of the findings; another by James Peake describing the “hidden epidemic”; and a third by Mark Rosenberg entitled “There's safety in numbers”, the point of which escaped me. The concluding commentary by Lincoln, Smith, and Baker describes the use of existing military administrative and health databases for injury surveillance and research—the heart of the matter. There follows in part I a series of papers on deaths, disabilities, hospitalizations, etc, and in part II, another set on risk taking behaviors, and such topics as cigarette smoking and exercise related injuries, knee and sports injuries, and much more. I said at the beginning that the document was “remarkable” in several respects: the most remarkable is that it is entirely devoid of any reference to injuries occurring in combat. In this sense it has a fairytale, Alice in Wonderland aspect to it. It is almost appears as if the devastating injuries that occur in wartime are out-of-bounds; that they are not part and parcel of what armed forces bring upon themselves and others, including, on tragic occasion, civilians.

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