Emergency department visits by pediatric patients sustained as a passenger on a motorcycle

Objective: Currently only 5 out of the 50 states in the United States have laws restricting the age of passengers permitted to ride on a motorcycle. This study sought to characterize the visits by patients under the age of 16 to U.S. emergency departments (EDs) for injuries sustained as a passenger on a motorcycle.

Methods: In this retrospective cohort study, data were obtained from the Nationwide Emergency Department Sample (NEDS) for the years 2006 to 2011. Pediatric patients who were passengers on a motorcycle that was involved in a crash were identified using International Classification of Diseases, Ninth Revision (ICD-9) External Cause of Injury codes. We also examined gender, age, disposition, regional differences, common injuries, and charges.

Results: Between 2006 and 2011 there were an estimated 9,689 visits to U.S. EDs by patients under the age of 16 who were passengers on a motorcycle involved in a crash. The overall average patient age was 9.4 years, and they were predominately male (54.5%). The majority (85%) of these patients were treated and released. The average charges for discharged patients were $2,116.50 and amounted to roughly $17,500,000 during the 6 years. The average cost for admission was $51,446 per patient and totaled over $54 million. The most common primary injuries included superficial contusions; sprains and strains; upper limb fractures; open wounds of head, neck, and trunk; and intracranial injuries.

Conclusion: Although there were only about 9,700 visits to U.S. EDs for motorcycle crashes involving passengers less than 16 years old for 2006 to 2011, the total cost of visits that resulted in either ED discharge or hospital admission amounted to over $71 million.     

Phthalate exposure in pregnant women and their children in central Taiwan

Phthalate exposure was found to be associated with endocrine disruption, respiratory effects, reproductive and developmental toxicity. The intensive use of plastics may be increasing the exposure to phthalates in Taiwanese population, particularly for young children.We studied phthalate metabolites in pregnant women and their newborns in a prospective cohort from a medical center in Central Taiwan. One hundred maternal urine samples and 30 paired cord blood and milk samples were randomly selected from all of participants (430 pregnant women). Eleven phthalate metabolites (MEHP, 5OH-MEHP, 2cx-MEHP, 5cx-MEPP, 5oxo-MEHP, MiBP, MnBP, MBzP, OH-MiNP, oxo-MiNP, and cx-MiNP) representing the exposure to five commonly used phthalates (DEHP, di-isobutyl phthalate (DiBP), DnBP, BBP, DiNP) were measured in urine of pregnant women, cord serum and breast milk after delivery, and in urine of their children. Exposure was estimated with excretion factors and correlation among metabolites of the same parent compound. Thirty and 59 urinary samples from 2 and 5 years-old children were randomly selected from 185 children successfully followed.Total urinary phthalate metabolite concentration (geometric mean, μg L⁻¹) was found to be higher in 2-years-olds (398.6) and 5-years-olds (333.7) than pregnant women (205.2). Metabolites in urine are mainly from DEHP. The proportion of DiNP metabolites was higher in children urine (4.39 and 8.31%, ages 2 and 5) than in adults (0.83%) (p < 0.01). Compared to urinary levels, phthalate metabolite levels are low in cord blood (37.45) and milk (14.90). DEHP metabolite levels in women’s urine and their corresponding cord blood are significantly correlated. Compared to other populations in the world, DEHP derived metabolites in maternal urine were higher, while phthalate metabolite levels in milk and cord blood were similar. The level of phthalate metabolites in milk and cord blood were comparable to those found in other populations. Further studies of health effects related to DEHP and DiNP exposure are necessary for the children.     

Assessment of oral bioaccessibility of arsenic in playground soil in Madrid (Spain): a three-method comparison and implications for risk assessment

Three methodologies to assess As bioaccessibility were evaluated using playground soil collected from 16 playgrounds in Madrid, Spain: two (Simplified Bioaccessibility Extraction Test: SBET, and hydrochloric acid-extraction: HCl) assess gastric-only bioaccessibility and the third (Physiologically Based Extraction Test: PBET) evaluates mouth-gastric-intestinal bioaccessibility. Aqua regia-extractable (pseudo total) As contents, which are routinely employed in risk assessments, were used as the reference to establish the following percentages of bioaccessibility: SBET - 63.1; HCl - 51.8; PBET - 41.6, the highest values associated with the gastric-only extractions. For Madrid playground soils - characterised by a very uniform, weakly alkaline pH, and low Fe oxide and organic matter contents - the statistical analysis of the results indicates that, in contrast with other studies, the highest percentage of As in the samples was bound to carbonates and/or present as calcium arsenate. As opposed to the As bound to Fe oxides, this As is readily released in the gastric environment as the carbonate matrix is decomposed and calcium arsenate is dissolved, but some of it is subsequently sequestered in unavailable forms as the pH is raised to 5.5 to mimic intestinal conditions. The HCl extraction can be used as a simple and reliable (i.e. low residual standard error) proxy for the more expensive, time consuming, and error-prone PBET methodology. The HCl method would essentially halve the estimate of carcinogenic risk for children playing in Madrid playground soils, providing a more representative value of associated risk than the pseudo-total concentrations used at present.     

Indoor and outdoor PM mass and number concentrations at schools in the Athens area

Simultaneous indoor and outdoor PM₁₀ and PM_2.5 concentration measurements were conducted in seven primary schools in the Athens area. Both gravimetric samplers and continuous monitors were used. Filters were subsequently analyzed for anion species. Moreover ultrafine particles number concentration was monitored continuously indoors and outdoors. Mean 8-hr PM₁₀ concentration was measured equal to 229 ± 182 μg/m³ indoors and 166 ± 133 μg/m³ outdoors. The respective PM_2.5 concentrations were 82 ± 56 μg/m³ indoors and 56 ± 26 μg/m³ outdoors. Ultrafine particles 8-h mean number concentration was measured equal to 24,000 ± 17,900 particles/cm³ indoors and 32,000 ± 14,200 particles/cm³ outdoors. PM₁₀ outdoor concentrations exhibited a greater spatial variability than the corresponding PM_2.5 ones. I/O ratios were close or above 1.00 for PM₁₀ and PM_2.5 and smaller than 1.00 for ultrafine particles. Very high I/O ratios were observed when intense activities took place. The initial results of the chemical analysis showed that accounts for the 6.6 ± 3.5% of the PM₁₀ and for the 3.1 ± 1.4%.The corresponding results for PM_2.5 are 12.0 ± 7.7% for and 3.1 ± 1.9% for . PM_2.5 indoor concentrations were highly correlated with outdoor ones and the regression line had the largest slope and a very low intercept, indicative of no indoor sources of fine particulate . The results of the statistical analysis of indoor and outdoor concentration data support the use of as a proper surrogate for indoor PM of outdoor origin.     

Is there a link between children's motor abilities and unintentional injuries?

PROBLEM: The common view is that clumsy children experience unintentional injury more frequently. Empirical evidence supporting this position is mixed. METHOD: One hundred 6- and 8-year-olds completed a battery of nine tasks designed to assess motor ability. Mothers completed a lifetime injury history measure about their children and families completed a 2-week injury diary assessing frequency and severity of daily injuries. RESULTS: Internal reliability for the motor ability battery was good. Correlations between motor ability measures and injury risk were nonsignificant and near zero. DISCUSSION: Motor ability does not appear to be directly related to injury risk. Possible explanations include: (a) coordinated and clumsy children engage in hazardous activities with differing frequency; or (b) other individual difference factors may interact with motor ability to explain children's injury risk. IMPACT ON INDUSTRY: Children's motor abilities do not appear to be directly linked to rate of unintentional injury, but instead may influence risk for injury in conjunction with other factors. Results could have implications to the engineering of children's toys and playground equipment and to the design of appropriate supervision strategies for children engaging in potentially dangerous activities.     

Modeling the exposure of children and adults via diet to chemicals in the environment with crop-specific models

Exposure to chemicals via diet is a major uptake pathway for many compounds but is often estimated in a rather generic way. We use a new model framework (NMF) with crop-specific models to predict the dietary intake by 4-5-year-old children and 14-75-year-old women of three environmental compounds from their background concentrations in soil and air. Calculated daily intakes of benzo(a)pyrene and 2,3,7,8-TCDD are in good agreement with measured results from diet studies. The major source of both compounds in human diet is deposition from air. Inhalation of air and ingestion of soil play a minor role. Children take up more than twice the amount than adults per kg bodyweight, due to higher consumption per kg bodyweight. Contrary, the methods for indirect human exposure suggested in the Technical Guidance Document (TGD) for chemical risk assessment in the EU lead to overprediction, due to unrealistic consumption data and a false root model.     

The impact of a nationwide effort to reduce airbag-related deaths among children: an examination of fatality trends among younger and older age groups

INTRODUCTION: The purpose of this study was to examine the impact of a nationwide response to emerging airbag-related deaths among children. This response, implemented in 1996, focused on moving children to a rear seat and increasing proper restraint usage. METHOD: Fatality trends from 1992 through 1996 and from 1996 through 2003 were examined for younger children (ages 0-3) and for older children (ages 4-12). RESULTS: Prior to 1997, a steady reduction in unrestrained deaths (among younger children) was offset by increases in restrained deaths (among younger and older children), increases in rear-seat deaths (among younger children), and increases in front-seat deaths (among older children). After 1996, there were significant decreases in fatalities in both age groups, with larger and more immediate reductions among the younger children. The largest reductions were immediately after 1996, when younger-child deaths declined by 16%, and after 1999, when deaths among both age groups declined by about 16%. CONCLUSIONS: The immediate reduction in front-seat deaths among younger children, particularly infants, appears to have been closely associated with the nationwide public information efforts implemented in 1996. Later reductions in front-seat and unrestrained deaths, among both younger and older children, were likely associated with the combination of legislative, enforcement, and public information programs, which increased after 1999. IMPACT ON INDUSTRY: The findings suggest that a large expenditure of resources by public and private-sector organizations after 1996 resulted in the prevention of hundreds of deaths among young children. In addition, the results provide insights with regard to the categories of deaths most affected by such programs and issues that deserve additional attention.     

Young driver risk in relation to parents' retrospective driving record

PROBLEM: Parents are an important potential influence on the driving safety of their children. This study examined the relationship of parental driving record on male and female offspring's at-fault collision risk. METHOD: Drivers aged 16-21 on the date of full licensure were selected from driver records and a matching process was used to identify putative parents in two-parent households. Poisson regression models were developed to predict at-fault collisions of male and female youth in the three years following full licensure from parents' at-fault collisions, speeding offenses, and other moving offenses in the four years prior to children's licensure. One set of models examined the relative risk associated with increasing numbers of maternal and paternal at-fault collisions and offenses. Other models examined the joint versus separate maternal and parental contributions. RESULTS: Controlling for region of residence, both mothers' and fathers' at-fault collisions were associated with an increased risk in both male and female youth at-fault collisions. Mothers' and fathers' speeding offenses were also associated with increased relative risk of at-fault collisions for both sons and daughters, while fathers' other moving offenses increased collision risk for sons but not daughters. DISCUSSION: Further research is required to identify how parental driving risk is transmitted to children. IMPACT ON INDUSTRY: (a) Parents of young children should be informed of their role in influencing their children's future driving risk; (b) The results identify risk factors that could be of interest to licensing authorities and the insurance industry.     

Characterizing the child passenger safety workforce in Michigan: A statewide survey in 2015

Objective: In this study, we assessed the number of child passenger safety technicians (CPSTs) in Michigan over 4 years and characterized the CPST workforce in 2015 to identify factors associated with high productivity and longevity in the field.

Methods: We determined the number of CPSTs and those newly certified using lists from the Michigan Office of Highway Safety Planning (OHSP) from 2012 to 2015. We conducted a statewide survey of Michigan CPSTs in October 2015. Analyses were conducted in 2016. The survey assessed demographic characteristics, reasons to enter the field and maintain certification, and motivations to conduct seat checks. We used CPST-reported time devoted to seat checks and average number of seats checked per month to create a composite “activity level” variable. We examined activity levels across several characteristics.

Results: The number of CPSTs ranged from 941 to 980 over the study period, with approximately 200 new certifications annually. In 2015, surveys were started by 496 of 962 eligible CPSTs and 427 submitted complete responses. CPST-instructors had a higher response rate than CPSTs in general (89 vs. 49%, P < .0001). The majority of respondents were women (71%) and self-identified as white (88%). More than one third were 35–44 years old. Just 7% were comfortable checking seats using a language other than English. “Personal reasons” were most often cited motivation for becoming a CPST and maintaining certification. Natural fit/job enhancement were more common reasons to maintain certification than become a CPST. Time and distance had the greatest influence on seat check participation. Perceived need, appointments vs. drop-in, and employer factors were very influential for 10–15% of CPSTs. Few CPSTs considered free food and payments/giveaways very influential. About 40% of respondents were considered high-activity (>24 seats checked/year), one third medium-activity (5 to 24 seats checked/year), and one quarter low-activity (<5 seats checked/year). High-activity CPSTs most commonly reported both being paid and volunteering their time to check seats, worked with a Safe Kids coalition, worked in law enforcement or social services, and had recertified at least once. Motivation to participate in seat checks did not vary with activity level.

Conclusions: Understanding the demographic characteristics and motivations of CPSTs can help Michigan OHSP recruit and retain a workforce dedicated to increasing the safety of child passengers. Agencies hosting seat checks can use these results to align the strategies they employ to incentivize CPSTs to serve in their communities with the factors that have the greatest influence on CPST participation.     

Factors affecting use and nonuse of child safety car seats in Gorgan,Iran

Objective: Motor vehicle accidents, which are among the main causes of child mortality in Iran and the Middle East, impose staggering costs for the community. Ignoring use of safety devices for children in most motor vehicle crashes will lead to death or serious injury. Because few studies have been performed on effective and predictive factors regarding use of child safety seats, the purpose of this study was to examine the factors affecting the use and nonuse of child safety seats, along with the factors that can facilitate how a child safety seat is used.

Method: This study was conducted in the urban area of Gorgan using a questionnaire. Through random selection, 204 parents with at least one child, aged 8?years or younger, reported their knowledge about the benefits of using a child safety seat.

Results: The results showed that 80% of parents never use a child safety seat, and 13% always use a child safety seat. More than 93% thought that it was necessary to make usage of the child safety seat obligatory. In addition, 80% of parents believed that a child safety seat prevents children from injury in crashes. In addition, 38% of parents were not aware of child safety devices and child safety, less than 20% said that they did not use a child safety seat because their spouse did not support its use, and 28% of them thought that a child safety seat does not affect the safety of the child. In general, 91% of parents reported that if child safety seat use were mandated, the frequency of use would increase. A law on the use of child safety seats is a very important variable in their use, which can enhance the chance of using a child safety seat by 6.5 times.

Conclusion: Special instructions should be developed to create incentive strategies for using a child safety seat. Mandating the use of a child safety seat, equipping cars with a child safety seat, encouraging children to use it, and providing continuous education and training are important factors for increasing the use of child safety seats.