Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

Coverage of motor vehicle crashes with injuries in U.S. newspapers, 1999-2002

Problem

The aims of the study were to evaluate information on motor-vehicle crashes with injuries provided in newspaper reports and to assess the frequency of thematic and episodic reporting of motor-vehicle crashes.

Method

The study used Fatal Analysis Reporting System (FARS) derived variables to code a nationally representative sample of U.S. newspaper reports of motor-vehicle crashes from 1999-2002. A total of 473 newspaper reports of motor-vehicle crashes with injuries were included. Information on the crash event, people involved, and vehicles was extracted. The reports were coded for episodic and thematic news framing.

Results

A majority of newspaper reports used episodic framing. The majority of reports included information on the type of crash, but characteristics about people and vehicles were rarely reported.

Discussion

Lack of information in newspapers makes them an incomplete source from which to influence public perceptions and attitudes.

Impact on industry

This provides an opportunity for news print media to improve public health content.

Impact on industry

Newspapers represent an important source of public information; they are, however, an incomplete source [Voight, B., Lapidus, G., Zavoski, R., & Banco, L. (1998). Injury reporting in Connecticut newspapers. Injury Prevention, 4, 292-294.; Baullinger, J., Quan, L., Bennett, E., Cummings, P., & Williams, K. (2001). Use of Washington state newspaper for submersion injury surveillance. Injury Prevention, 7, 339-342]. To increase the accuracy of information provided to the public through media sources, there is a need for increased communication between public health professionals and reporters.The results of this study raise concerns about the contents of motor-vehicle crash information provided in newspapers and suggest that newspapers do not provide information to allow public perception to be in accord with the importance of motor-vehicle crash injuries and health promoting actions to reduce risk of injury. More balanced and detailed information in newspapers would provide an opportunity for news print media to improve public health programs and public perception about the impact of motor-vehicle crashes on safety for all.     

Tracking the prevalence of rollover protective structures on U.S. farm tractors: 1993, 2001, and 2004

Problem

Between 1992 and 2005, 1412 workers on farms died from tractor overturns. A Rollover Protective Structure (ROPS) is a proven intervention to reduce overturn deaths. However, farm characteristics that are associated with the adoption of ROPS are not well understood.

Methods

ROPS prevalence statistics were derived from National Institute for Occupational Safety and Health (NIOSH) surveys that tracked ROPS use on farms. Data were from the years 1993, 2001, and 2004.

Results

In 1993, 38% of tractors were equipped with ROPS. This increased to 51% by 2004. ROPS prevalence rates were higher on farms in the Southern region of the United States, on farms where the operator was 25-34 years old, and on farms with $100,000 or more of farm sales. Low ROPS prevalence rates were associated with farm operators 65 years old or older and with farms with less than $10,000 of farm product sales.

Summary

The increase in ROPS prevalence between 1993 and 2004 has not been sufficient to decrease the rate of tractor overturn deaths on farms. Incentive programs targeting older farm operators and low-income farm operations are suggested to increase ROPS use on tractors.

Impact on Industry

The study provides farm characteristics associated with low ROPS prevalence rates. The results can be used to target farms for future ROPS promotion activities.     

Evaluation of a healthcare safety climate measurement tool

Problem

Psychometrically validated measurement tools are needed to evaluate an organization's safety climate. In 2000, Gershon and colleagues published a new healthcare safety climate measurement tool to determine its relationship to safe work behavior (Gershon, R., Karkashian, C., Grosch, J., Murphy, L., Escamilla-Cejudo, A., Flanagan, P., et al. (2000). Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. American Journal of Infection Control, 28, 211-21). The present study evaluated the psychometric properties of the Gershon tool when modified to address respiratory rather than bloodborne pathogen exposures.

Method

Medical practitioners, nurses, and nurse aides (n = 460) were surveyed using the modified Gershon tool. Data were analyzed by factor analysis and psychometric properties of the tool evaluated.

Results

Eight safety climate dimensions were extracted from 25 items (Cronbach's alpha range: 0.62 - 0.88). Factor extractions and psychometric properties were reasonably consistent with those of the Gershon tool.

Impact on Industry

The Gershon safety climate tool appears to have sufficient reliability and validity for use by healthcare decision makers as an indicator of employee perceptions of safety in their institution.     

When workplace safety depends on behavior change: Topics for behavioral safety research

Introduction

Comprehensive interventions that address public-health concerns invariably include behavior-change strategies. In occupational safety and health, behavioral safety is an approach designed to improve safety performance directly through peer observations of safe behaviors, goal setting, performance feedback, and celebrations or incentives for reaching safety goals. Although the basic components of behavioral safety processes have been studied and widely documented, the current safety literature reveals several gaps in knowledge. These gaps are associated mostly with wide practice variations among the common process elements and uncertainty about the influence of organizational and other external factors.

Impact to Industry

A major objective of this paper was to highlight not only key topic areas that warrant further research, but also to propose a list of research questions that are tied to uncertainties about various intervention practices. If only a portion of these topic areas and research questions are addressed through systematic reviews, field interventions, surveys, and laboratory-based studies, then the knowledge gained will significantly improve the delivery and effectiveness of behavioral safety interventions and thus their impact on worker health and safety.     

Occupational fatalities due to electrocutions in the construction industry

Introduction

Occupational fatalities due to contact with electricity account for approximately 9% of all deaths in the construction industry and is the fourth leading cause of death in this industry.

Method

Differences in the proportions of electrocutions in the construction industry are significantly different from other industries based upon the age of the worker and the source of the electricity.

Results

This study found that, in the construction industry, the proportion of occupational fatalities due to contact with electric current is significantly higher for workers in the 16 to 19 years old age group. Contact with overhead power lines occurred more frequently with younger workers, while contact with electric wiring, transformers, and related equipment was found to occur more frequently with older workers. The proportion of fatalities due to this event was also found to account for a significantly greater proportion of fatalities in the construction industry overall.

Impact on industry

The proportions of electrocution fatalities in the construction industry were found to be significantly higher for younger workers when compared to all other industries. Focusing prevention measures toward younger workers who work near overhead power lines could have a significant impact upon death rates. For older workers, the focus should be on those who work on or near transformers, electrical wiring, and components. Across the construction industry, implementation of effective lockout-tagout programs, and verification of energy isolation, can prevent approximately 125 fatalities per year in the construction industry.     

A Strategic Project Appraisal framework for ecologically sustainable urban infrastructure

Actors in the built environment are progressively considering environmental and social issues alongside functional and economic aspects of development projects. Infrastructure projects represent major investment and construction initiatives with attendant environmental, economic and societal impacts across multiple scales. To date, while sustainability strategies and frameworks have focused on wider national aspirations and strategic objectives, they are noticeably weak in addressing micro-level integrated decision making in the built environment, particularly for infrastructure projects. The proposed approach of this paper is based on the principal that early intervention is the most cost-effective and efficient means of mitigating the environmental effects of development projects, particularly macro infrastructure developments. A strategic overview of the various project alternatives, taking account for stakeholder and expert input, could effectively reduce project impacts/risks at low cost to the project developers but provide significant benefit to wider communities, including communities of future stakeholders. This paper is the first exploratory step in developing a more systematic framework for evaluating strategic alternatives for major metropolitan infrastructure projects, based on key sustainability principles. The developed Strategic Project Appraisal (SPA) framework, grounded in the theory of Strategic Environmental Assessment (SEA), provides a means of practically appraising project impacts and alternatives in terms of quantified ecological limits; addresses the neglected topic of metropolitan infrastructure as a means of delivering sustainability outcomes in the urban context and more broadly, seeks to open a debate on the potential for SEA methodology to be more extensively applied to address sustainability challenges in the built environment. Practically applied and timed appropriately, the SPA framework can enable better decision-making and more efficient resource allocation ensuring low impact infrastructure development.     

环境风险预警评估方法研究

有毒有害物质发生突发性事故时将造成环境危害，使人体健康受到影响，严重时机毁人亡。本文通过对有毒有害污染源分析，事故频率分析，后果分析，风险预警估算及防范措施与应急计划的分析从环境风险与人体健康的角度上论述了在有毒有害物质作业场所预警技术问题。     

Denitrification and phenol degradation in a contaminated aquifer

A natural groundwater system modified by pollutant phenols and agricultural nitrate has been modelled in the laboratory by a series of sacrificial microcosm experiments. Samples of aquifer sediment and groundwater from the margin of the phenol plume were used to inoculate anaerobic microcosms enriched in nitrate and pollutant phenols. Rapid degradation of phenol and p-cresol was observed over a 35-day period leading to the generation of inorganic carbon and a number of transient intermediates. O-cresol proved to be recalcitrant on the experimental time-scale. A mass balance calculation shows that, during degradation, carbon was conserved in the aqueous phase. Groundwater-sediment interactions were monitored using carbon stable isotope data. A mass balance for solution TIC indicates thatp-cresol degradation stimulated the dissolution of sedimentary carbonate phases due to the formation of carbonic acid. Compound-specific carbon isotope analysis (GC-IRMS) was used to search for 13C enrichment in residual p-cresol. A slight enrichment trend (epsilon = -2.5/1000) was tentatively identified. The potential of this fractionation effect for obtaining in situ degradation rates is discussed. Results from the microcosm experiments help to explain the observed distribution of nitrate and phenols within the polluted aquifer.     

Processes controlling the distribution and natural attenuation of dissolved phenolic compounds in a deep sandstone aquifer

Processes controlling the distribution and natural attenuation (NA) of phenol, cresols and xylenols released from a former coal-tar distillation plant in a deep Triassic sandstone aquifer are evaluated from vertical profiles along the plume centerline at 130 and 350 m from the site. Up to four groups of contaminants (phenols, mineral acids, NaOH, NaCl) form discrete and overlapping plumes in the aquifer. Their distribution reflects changing source history with releases of contaminants from different locations. Organic contaminant distribution in the aquifer is determined more by site source history than degradation. Contaminant degradation at total organic carbon (TOC) concentrations up to 6500 mg l(-1) (7500 mg l(-1) total phenolics) is occurring by aerobic respiration NO3-reduction, Mn(IV)-/Fe(III)-reduction, SO4-reduction, methanogenesis and fermentation, with the accumulation of inorganic carbon, organic metabolites (4-hydroxybenzaldehyde, 4-hydroxybenzoic acid), acetate, Mn(II), Fe(II), S(-II), CH4 and H2 in the plume. Aerobic and NO3-reducing processes are restricted to a 2-m-thick plume fringe but Mn(IV)-/Fe(II)-reduction, SO4-reduction, methanogenesis and fermentation occur concomitantly in the plume. Dissolved H2 concentrations in the plume vary from 0.7 to 110 nM and acetate concentrations reach 200 mg l(-1). The occurrence of a mixed redox system and concomitant terminal electron accepting processes (TEAPs) could be explained with a partial equilibrium model based on the potential in situ free energy (deltaGr) yield for oxidation of H2 by specific TEAPs. Respiratory processes rather than fermentation are rate limiting in determining the distribution of H2 and TEAPs and H2 dynamics in this system. Most (min. 90%) contaminant degradation has occurred by aerobic and NO3-reducing processes at the plume fringe. This potential is determined by the supply of aqueous O2 and NO3 from uncontaminated groundwater, as controlled by transverse mixing, which is limited in this aquifer by low dispersion. Consumption to date of mineral oxides and SO4 is, respectively, <0.15% and 0.4% of the available aquifer capacity, and degradation using these oxidants is <10%. Fermentation is a significant process in contaminant turnover, accounting for 21% of degradation products present in the plume, and indicating that microbial respiration rates are slow in comparison with fermentation. Under present conditions, the potential for degradation in the plume is very low due to inhibitory effects of the contaminant matrix. Degradation products correspond to <22% mass loss over the life of the plume, providing a first-order plume scale half-life >140 years. The phenolic compounds are biodegradable under the range of redox conditions in the aquifer and the aquifer is not oxidant limited, but the plume is likely to be long-lived and to expand. Degradation is likely to increase only after contaminant concentrations are reduced and aqueous oxidant inputs are increased by dispersion of the plume. The results imply that transport processes may exert a greater control on the natural attenuation of this plume than aquifer oxidant availability.