Children's behavioral traits and risk of injury: Analyses from a case-control study of agricultural households

Problem

Children on family agricultural operations have high risk of injury. The association between children's behavioral traits and their risk of injury is not well understood.

Method

Data from the Regional Rural Injury Study-II were used to assess behavioral risk factors for injury to children ages six to < 20 years. A total of 379 injury events (cases) and 1,562 randomly selected controls were identified. Adjusted odds ratios (OR) and 95% confidence intervals (CI), calculated using logistic regression, were used to estimate injury risk in reference to behavioral traits.

Results

Injury risks were greater for children with high levels of depressive symptoms (OR = 1.9, CI = 1.0-3.7) and aggression (OR = 1.6, CI = 0.9-2.7), and low levels of careful/cautious behavior (OR = 1.8, CI = 1.1-2.9). Children with low levels of self-regulation had reduced risks (OR = 0.4, CI = 0.2-0.8).

Discussion

Results suggest that children's behaviors affect their risk of agricultural injury. Additional research could elucidate mechanisms and inform interventions.

Impact on industry

The development of multifaceted, sustainable approaches for prevention is necessary for this unique population. These findings suggest a need for interventions that incorporate specific behavior-related risk factors in the context of family farms and ranches.     

Occupant injury severity from lateral collisions: A literature review

Problem

Side impacts are a serious automotive injury problem; they represent about 30% of all fatalities for passenger vehicle occupants. This literature review focuses on occupant injuries resulting from real lateral collisions. It emphasizes the interaction between injury patterns and crash factors, taking into account type of injuries and their severity. It highlights what is known on the subject and suggests further studies.

Method

We reviewed papers identified by searches in two electronic databases for the 1996-2009 publication period, and in specific journals and conference proceedings.

Results

Studies on the Primary Direction of Force (PDOF) have revealed that fatal crashes occur most frequently when the PDOF is at 3 or 9 o'clock. The risk of serious injury is two to three times higher for the near-side occupant than for the far-side occupant. Head injuries predominate in oblique impacts and thoracic injuries in perpendicular ones. A few results are also reported on side airbag protection.

Conclusions

This literature review presents an overall picture of the injuries caused by lateral collisions, though each of the papers or articles examined focuses mostly on some particular aspect of the problem. The incidence of specific injuries depends on the data source used. Very few population-based analyses of lateral collision injuries were found.

Impact on industry

New studies are needed to evaluate new protective devices (e.g., lateral airbags, inflatable curtains). Without interfering with their care duties, Emergency Medical Technicians could be systematically trained to observe the collision's specific characteristics and to report all their relevant observations to the emergency physicians to increase the likelihood of prompt diagnosis and proper care.     

Household youth on minority operated farms in the United States, 2000: exposures to and injuries from work, horses, ATVs and tractors

INTRODUCTION: It is likely that youth living on minority operated farms (<3% of U.S. farms) face hazards similar to the general farm population; however, since minority youth are not well represented by general farm surveys, this information hasn't been confirmed. METHOD: Nonfatal injury and exposure data were obtained from the 2000 Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS). RESULTS: On racial minority farms, there were an estimated 28,600 household youth. Of these, about 41% worked, 26% rode a horse, 23% drove an ATV, and 23% operated a tractor. On Hispanic farms, there were an estimated 17,998 household youth. Of these, 44% worked, 30% rode a horse, 27% drove an ATV, and 25% operated a tractor. CONCLUSIONS: These results show the value of conducting a survey of minorities to identify high risk groups and target issues that may be unique to the minority farm population.     

The unrecognized danger of a new transportation mechanism of injury--pedicabs

Objective

Pedicabs are a new and controversial transportation innovation for tourists in congested areas in several U.S. cities. Scant literature on this trauma mechanism exists. The purpose of this study is to identify the incidence, demographics, morbidity, mortality, and potential for injury prevention of pedicab incidents amongst major trauma admissions at an urban, academic Level I Trauma Center.

Patients & Methods

Researchers conducted a retrospective review of the Trauma Registry from 2000 to 2009. All patients identified as being injured in a pedicab incident were reviewed. Demographics, diagnoses, toxicology, treatments, and injury severity scale (ISS) were collected. Outcomes included mortality, ICU, and hospital length of stay (LOS), discharge disposition, and hospital charges. A photographic survey of 50 local pedicabs was examined for the presence and use of safety equipment.

Results

During the period of January 2000 to July 2009 there were 15 major trauma victims from identified pedicab incidents. Falling from the pedicab was the mechanism of injury in 14 of 15 cases. There were two fatalities in victims following severe traumatic brain injury. Traumatic brain injury, skull fracture, or loss of consciousness was seen in 11/15 victims. Ethanol ingestion was detected in blood tests of 10 of the 14 adult victims. Median charges of hospitalization due to a pedicab related injury was US$29,956 ± 77,482. A photographic survey of 50 local pedicabs reveals very limited use of safety belts by passengers despite existing city ordinances.

Conclusions

Major trauma victims of pedicab incidents in the United States suffer significant injuries and death. Most cases occurred in passengers falling from the pedicab at night after alcohol ingestion. There is an opportunity for implementation of strategies toward improved injury prevention with this new form of transport.     

Work-related deaths in Washington State, 1998-2002

INTRODUCTION: In Washington State, 87 workers are killed each year, on average, while in work status. To understand these incidents and to assist in focusing on and development of potential prevention measures, they must be well characterized. METHODS: Work-related fatalities between the years 1998 and 2002 are described by the demographics of the victims, types of incidents, the victims' occupations, and industries and location in which they worked. RESULTS: Motor vehicle- and machinery-related incidents accounted for nearly 33% and 14% of the incidents, respectively. Agriculture, forestry, fishing, hunting, and mining (n=87), and construction (n=83) had the most fatalities. Fatality rates per 100,000 workers for these industries were 25.7 and 8.7, respectively, compared to the state-wide average of 3.1 fatalities/100,000 workers. DISCUSSION: These data indicate numerous areas for prevention of work-related traumatic injuries and fatalities.     

The crash severity impacts of fixed roadside objects

INTRODUCTION: This study analyzes the in-service performance of roadside hardware on the entire urban State Route system in Washington State by developing multivariate statistical models of injury severity in fixed-object crashes using discrete outcome theory. The objective is to provide deeper insight into significant factors that affect crash severities involving fixed roadside objects, through improved statistical efficiency along with disaggregate and multivariate analysis. METHOD: The developed models are multivariate nested logit models of injury severity and they are estimated with statistical efficiency using the method of full information maximum likelihood. RESULTS: The results show that leading ends of guardrails and bridge rails, along with large wooden poles (e.g. trees and utility poles) increase the probability of fatal injury. The face of guardrails is associated with a reduction in the probability of evident injury, and concrete barriers are shown to be associated with a higher probability of lower severities. Other variables included driver characteristics, which showed expected results, validating the model. For example, driving over the speed limit and driving under the influence of alcohol increase the probability of fatal accidents. Drivers that do not use seatbelts are associated with an increase in the probability of more severe injuries, even when an airbag is activated. IMPACT ON INDUSTRY: The presented models show the contribution of guardrail leading ends toward fatal injuries. It is therefore important to use well-designed leading ends and to upgrade badly performing leading ends on guardrails and bridges. The models also indicate the importance of protecting vehicles from crashes with rigid poles and tree stumps, as these are linked with greater severities and fatalities.     

Protective Effect of Different Types of Bicycle Helmets

The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross-table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21–0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41–1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58–1.41) among users of hard shell helmets, and 1.87 (CI = 1.03–3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling.     

工伤保险与事故预防结合运作机制的探讨

从强化事故预防,切实保障劳动生产中受伤害职工的合法权益入手,着重对工伤保险与事故预防结合运作管理机制进行了探讨。     

Disparities in the prevalence of smoke alarms in U.S. households: Conclusions drawn from published case studies

Introduction

Deaths from fires and burns are a leading cause of fatal home injury in the United States. Smoke alarms are one of the most effective interventions to prevent residential fire deaths. Nationwide, more than 95% of homes are estimated to have at least one smoke alarm. There is evidence that homes at highest risk of fire deaths lag behind national averages in smoke alarm use and maintenance.

Method

We compiled a comprehensive list of published studies that focus on smoke alarm prevalence in high-risk homes. Our findings show that there are substantial gaps in both smoke alarm presence and functional status between high-risk homes and national average estimates.

Conclusions

To save more lives, improved efforts are needed to reduce the disparity in smoke alarm prevalence and functional use in the United States.     

Influence of the Anterior and Middle Cranial Fossae on Brain Kinematics During Sagittal Plane Head Rotation

A 2D physical model of the human head was used to investigate how the irregular skull base structure affects brain kinematics during sagittal plane head dynamics. The model consisted of a rigid skull vessel with interchangeable skull base structures. One version of the model used a skull base mimicking the irregular geometry of the human. A second version used a skull base structure approximating the anterior and middle fossae as a flat surface. Silicone gel simulated the brain and was separated from the vessel by a paraffin layer which provided a slip condition at the interface between the gel and vessel. The model was exposed to 7600 rad/s² peak rotational acceleration with 6 ms pulse duration and 5° forced rotation. After 90° free rotation, the model was decelerated during 30 ms. Five repeated tests were conducted with each version. Rigid body displacement, shear strain and principal strains were determined from high-speed video recorded trajectories of grid markers located at different positions in the surrogate brain. The humanlike skull base reduced peak displacements of the inferior surfaces of the temporal and frontal lobes up to 87% and 48%, respectively. Up to 48% and 36% higher peak strains were obtained in the frontal and superior regions of the surrogate brain in the version containing the humanlike skull base. In contrast, the humanlike skull base decreased peak strain up to 28% in the central region of the surrogate brain. The results indicate that the irregular skull base offers natural protection of nerves and vessels passing through fissures and foramina in the cranial floor but also that it affects kinematics in different regions throughout the cerebrum. Implications of these results are discussed with respect to brain injury and modeling of head impact.     

Influence of Seat Foam and Geometrical Properties on BioRID P3 Kinematic Response to Rear Impacts

As the primary interface with the human body during rear impact, the automotive seat holds great promise for mitigation of Whiplash Associated Disorders (WAD). Recent research has chronicled the potential influence of both seat geometrical and constitutive properties on occupant dynamics and injury potential. Geometrical elements such as reduced head to head restraint, rearward offset, and increased head restraint height have shown strong correlation with reductions in occupant kinematics. The stiffness and energy absorption of both the seating foam and the seat infrastructure are also influential on occupant motion; however, the trends in injury mitigation are not as clear as for the geometrical properties. It is of interest to determine whether, for a given seat frame and infrastructure, the properties of the seating foam alone can be tailored to mitigate WAD potential. Rear impact testing was conducted using three model year 2000 automotive seats (Chevrolet Camaro, Chevrolet S-10 pickup, and Pontiac Grand Prix), using the BioRID P3 anthropometric rear impact dummy. Each seat was distinct in construction and geometry. Each seat back was tested with various foams (i.e., standard, viscoelastic, low or high density). Seat geometries and infrastructures were constant so that the influence of the seating foams on occupant dynamics could be isolated. Three tests were conducted on each foam combination for a given seat (total of 102 tests), with a nominal impact severity of Delta V = 11 km/h (nominal duration of 100 msec). The seats were compared across a host of occupant kinematic variables most likely to be associated with WAD causation. No significant differences (p < 0.05) were found between seat back foams for tests within any given seat. However, seat comparisons yielded several significant differences (p < 0.05). The Camaro seat was found to result in several significantly different occupant kinematic variables when compared to the other seats. No significant differences were found between the Grand Prix and S-10 seats. Seat geometrical characteristics obtained from the Head Restraint Measuring Device (HRMD) showed good correlation with several occupant variables. It appears that for these seats and foams the head-to-head restraint horizontal and vertical distances are overwhelmingly more influential on occupant kinematics and WAD potential than the local foam properties within a given seat.     

Validation of a booted finite element model of the WIAMan ATD lower limb in component and whole-body vertical loading impacts with an assessment of the boot influence model on response

Objective: A novel anthropomorphic test device (ATD) representative of the 50th percentile male soldier is being developed to predict injuries to a vehicle occupant during an underbody blast (UBB). The main objective of this study was to develop and validate a finite element (FE) model of the ATD lower limb outfitted with a military combat boot and to insert the validated lower limb into a model of the full ATD and simulate vertical loading experiments.

Methods: A Belleville desert combat boot model was assigned contacts and material properties based on previous experiments. The boot model was fit to a previously developed model of the barefoot ATD. Validation was performed through 6 matched pair component tests conducted on the Vertically Accelerated Loads Transfer System (VALTS). The load transfer capabilities of the FE model were assessed along with the force-mitigating properties of the boot. The booted lower limb subassembly was then incorporated into a whole-body model of the ATD. Two whole-body VALTS experiments were simulated to evaluate lower limb performance in the whole body.

Results: The lower limb model accurately predicted axial loads measured at heel, tibia, and knee load cells during matched pair component tests. Forces in booted simulations were compared to unbooted simulations and an amount of mitigation similar to that of experiments was observed. In a whole-body loading environment, the model kinematics match those recorded in experiments. The shape and magnitude of experimental force–time curves were accurately predicted by the model. Correlation between the experiments and simulations was backed up by high objective rating scores for all experiments.

Conclusion: The booted lower limb model is accurate in its ability to articulate and transfer loads similar to the physical dummy in simulated underbody loading experiments. The performance of the model leads to the recommendation to use it appropriately as an alternative to costly ATD experiments.     

Trauma demography and clinical epidemiology of motorcycle crash–related head injury in a neurosurgery practice in an African developing country

Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.

Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.

Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle–motorcycle crashes. The HI was moderate–severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS–head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%.

MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27–6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).

Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.     

Moving FOCUS – The Fire Service Organizational Culture of Safety survey – From research to practice

Introduction: FOCUS, the Fire Service Organizational Culture of Safety survey, has evolved from a research to practice enterprise within the United States fire and rescue service. The FOCUS tool was developed through a FEMA Assistance to Firefighters Research & Development grant. Then it moved to practice in the field. To date over 35,000 firefighters have participated. A current FEMA Fire Prevention & Safety grant can support FOCUS assessment in up to 1,000 fire departments, with the potential of nearly 120,000 respondents. With each funding cycle, the goal of the FOCUS program is to grow and measure its research to practice impact. Methods: We describe how FOCUS safety culture results are disseminated to fire service stakeholders. By utilizing customized reports and a training curriculum we demonstrate how FOCUS is moving research to practice by: (1) illustrating how survey results can be delivered effectively to practitioners, (2) providing examples of how fire departments are using results, and (3) sharing the reactions of the fire service to the FOCUS instrument, reports, and our flagship data training curriculum – Culture Camp. Results' Conclusions: Qualitative and quantitative data are analyzed to demonstrate the impact and acceptance of the FOCUS report and Culture Camps. Stakeholders reflect on the report and the experience of having quantitative safety culture data. Culture Camps are evaluated qualitatively and quantitatively using a matching game exercise, pre/post-test, a fire department teach back, and a Qualtrics evaluation. Practical Applications: Traditionally, the fire service has focused on reducing negative safety outcomes. FOCUS is helping shift their attention further upstream in the prevention pathway through the measurement of important organizational outcomes. The research to practice evolution of the FOCUS program may hold utility for other occupational groups when considering how to steadily move occupational health and safety research to practice in the field for measurable impact.