Effectiveness of bicycle helmets in preventing head injury in children: case-control study.

OBJECTIVE--To examine the risk of injury to the head and the effect of wearing helmets in bicycle accidents among children. DESIGN--Case-control study by questionnaire completed by the children and their carers. SETTING--Two large children''s hospitals in Brisbane, Australia. SUBJECT--445 children presenting with bicycle related injuries during 15 April 1991 to 30 June 1992. The cases comprised 102 children who had sustained injury to the upper head including the skull, forehead and scalp or loss of consciousness. The controls were 278 cyclists presenting with injuries other than to the head or face. A further 65 children with injuries to the face were considered as an extra comparison group. MAIN OUTCOME MEASURES--Cause and type of injury, wearing of helmet. RESULTS--Most children (230) were injured after losing control and falling from their bicycle. Only 31 had contact with another moving vehicle. Children with head injury were significantly more likely to have made contact with a moving vehicle than control children (19 (19%) v 12 (4%), P < 0.001). Head injuries were more likely to occur on paved surfaces than on grass, gravel, or dirt. Wearing a helmet reduced the risk of head injury by 63% (95% confidence interval 34% to 80%) and of loss of consciousness by 86% (62% to 95%). CONCLUSIONS--The risk of head injury in bicycle accidents is reduced among children wearing a helmet. Current helmet design maximises protection in the type of accident most commonly occurring in this study. Legislation enforcing helmet use among children should be considered.     

Head injuries in childhood: a 2-year survey.

A retrospective study was conducted of the 880 children with head injuries consecutively admitted to the Children''s Hospital of Eastern Ontario in Ottawa from July 1976 to June 1978. It confirmed a boy:girl ratio of about 2:1, with a peak of 3.5:1 around 7 years of age. The largest number of head injuries was in children under 1 year of age. Injuries were most common in summer and spring, and most were caused by falls. The most common place for head injuries was in the home, but the single most common cause of injuries was bicycle accidents, which were responsible for 12% of all the head injuries. Skull fractures were found in 30% of all the patients. Of the 34 patients with severe head injuries 8 (24%) died, 9 (26%) had a moderate residual disability and 17 (50%) made a good recovery. There were no other deaths, so the mortality for the entire group of 880 patients was 0.9%.     

Nonfatal childhood injuries: a survey at the Children's Hospital of eastern Ontario.

OBJECTIVE: To examine the types and severity of injuries seen in the Emergency Department of the Children''s Hospital of Eastern Ontario and the circumstances surrounding the events. DESIGN: Chart review. SETTING: A tertiary care hospital that serves a child population of 600,000 in eastern Ontario and western Quebec. PARTICIPANTS: Every sixth day''s charts of children up to 17 years of age who visited the Emergency Department because of injuries between Sept. 1, 1984, and Aug. 31, 1985, were examined retrospectively. RESULTS: A total of 2886 charts were reviewed. There were more boys than girls. Most (1354 [46.9%]) of the accidents had occurred at home. Falls and sports-related accidents were the leading causes of injury (in 1088 [37.7%] and 560 [19.4%] of the cases respectively). Most of the visits were for minor injuries (bumps, swellings, cuts, bruises and scrapes), and only 114 (4.0%) of the children were admitted to the hospital. Injuries from motor vehicle accidents accounted for the highest admission rate (17.4%). Important information regarding the circumstances surrounding the events (e.g., whether a seat belt or car seat was used) was frequently missing from the charts. CONCLUSIONS: Nonfatal injuries are common, especially in or around the home, and remain a significant problem in our society in terms of radiographic and consulting fees, time off from school or work and pain. Given the difficulties in obtaining information on the circumstances surrounding the events prospective studies are needed. Factors related to the occurrence and severity of childhood injury and whether these factors can be altered remain a high priority for research.     

Bicycle accidents in childhood.

The results of a 10 year study of bicycle fatalities and an eight year study of serious non-fatalities are reported for urban Brisbane (population 1,000,000). There were 845 serious non-fatal bicycle accidents and 46 fatalities during the study. Boys were involved in 86% of accidents. Boys have an accident rate of 134.21 per 100,000 population at risk and a fatality rate of 5.06 per 100,000 at risk. Serious bicycle accidents have increased by 50% in this decade; but considering fatal cases alone, no secular trend was evident over the 10 year period of the study. This suggests that an increase in the overall rate of bicycle accidents has been in part compensated by less serious injuries. In 70% of fatalities children had head injuries, and 87% of fatalities followed a collision between a cyclist and a motor vehicle or a train. Bicycle accidents on the roads most commonly occur to boys aged between 12 and 14 years on a straight road at "mid-block" between 3 and 5 pm in clear weather conditions and in daylight. It is concluded that injuries and fatalities after bicycle accidents can be reduced by protecting children''s heads, separating child cyclists from other road traffic, or educating and training both cyclists and other road users in safe behaviour. The compulsory use of helmets and the restriction of access to the roads by child cyclists to reduce injuries are, however, still controversial in many areas.     

Avoidable factors contributing to death of children with head injury.

OBJECTIVE--To assess the incidence of potentially avoidable complications contributing to death of children with head injuries. DESIGN--Retrospective review of children who died with head injuries from 1979 to 1986 from data of the Office of Population Censuses and Surveys, Hospital Activity Analyses, case notes, coroners'' records, and necropsy reports. SETTING--District general hospitals and two regional neurosurgical centres in Northern region. RESULTS--255 Children died from head injury in the region, the mortality being 5.3 per 100,000 children per year. Head injury was the single most important cause of death in children aged greater than 1 year, accounting for 15% of deaths in children aged 1-15 years and a quarter for those aged 5-15 years. 121 Potentially avoidable factors possibly or probably contributing to death occurred in 81 children (32%). Half the children (125) died before admission, 27 of whom (22%) had potentially avoidable factors possibly or probably contributing to death, and 130 died after admission, 54 of whom (42%) had 93 such factors, which included failure of diagnosis or delayed recognition of intracranial haemorrhage or associated injury, inadequate management of the airways, and poor management of the transfer between hospitals. IMPLICATIONS--Regions should revise urgently their guidelines for optimal management and indications for neurosurgical referral to include children with severe head injuries and audit their systems of care for all patients with head injuries.     

Attitudes to Animal use in Children

ABSTRACT

Six hundred and fifty children, aged between 11 and 15 years, from an urban and a rural area, completed a questionnaire in which they provided information regarding their attitudes towards 13 issues involving the use of animals. Information regarding the pets the children owned was also obtained. The child's sex (male, female), age (11–15 years), and residence area (urban, rural) were related to pet ownership, and, including pet ownership, to attitudes towards the use of animals. Over 90% of the sample owned a pet, with the dog being the most common. More pets were owned by children from rural than urban areas. With regards to the animal-use issues, all the children discriminated between animal uses that lead to death of or injury to the animal and those regarded as exploitation. Children disagreed more with uses leading to the animal's death or injury. Females expressed more disagreement than males, and children from urban areas expressed more disagreement than children from rural settings. The study revealed pet ownership to be high among school children. This was matched by a high concern over activities leading to the animal's death or injury, indicating that strong attitudes to animal use are formed early during development. Early education may be important in shaping these attitudes.     

Raynaud's phenomenon in forestry workers in Quebec.

A survey of 1540 forestry workers in Quebec found a prevalence of Raynaud''s phenomenon of 30.5% among chain-saw users and 8.7% among nonusers. Prevalence was related directly to duration of use of the chain-saw. The mean interval (+/- the standard deviation) between the time the chain-saw was first used and the onset of Raynaud''s phenomenon was 7.8 +/- 5.6 years. After 20 years of chain-saw use over 50% of the population had Raynaud''s phenomenon. Relative risks among those using a chain-saw for more than 10 years were 3.60 for nonsmokers and 6.55 for smokers. Other factors associated with the phenomenon included a family history of nonoccupational Raynaud''s phenomenon, previous injuries to the arms, climate and type of residence during the wood-cutting season. Decreased work capacity, interference with leisure activities and changes in professional orientation often resulted from this disease. These problems should be taken into account when disability compensation is being considered.     

Injury patterns in cyclists attending an accident and emergency department: a comparison of helmet wearers and non-wearers.

OBJECTIVES--To study circumstances of bicycle accidents and nature of injuries sustained and to determine effect of safety helmets on pattern of injuries. DESIGN--Prospective study of patients with cycle related injuries. SETTING--Accident and emergency department of teaching hospital. SUBJECTS--1040 patients with complete data presenting to the department in one year with cycle related injuries, of whom 114 had worn cycle helmets when accident occurred. MAIN OUTCOME MEASURES--Type of accident and nature and distribution of injuries among patients with and without safety helmets. RESULTS--There were no significant differences between the two groups with respect to type of accident or nature and distribution of injuries other than those to the head. Head injury was sustained by 4/114 (4%) of helmet wearers compared with 100/928 (11%) of non-wearers (P = 0.023). Significantly more children wore helmets (50/309 (16%)) than did adults (64/731 (9%)) (P < 0.001). The incidence of head injuries sustained in accidents involving motor vehicles (52/288 (18%)) was significantly higher than in those not involving motor vehicles (52/754 (7%)) (chi 2 = 28.9, P < 0.0001). Multiple logistic regression analysis of probability of sustaining a head injury showed that only two variables were significant: helmet use and involvement of a motor vehicle. Mutually adjusted odds ratios showed a risk factor of 2.95 (95% confidence interval 1.95 to 4.47, P < 0.0001) for accidents involving a motor vehicle and a protective factor of 3.25 (1.17 to 9.06, P = 0.024) for wearing a helmet. CONCLUSION--The findings suggest an increased risk of sustaining head injury in a bicycle accident when a motor vehicle is involved and confirm protective effect of helmet wearing for any bicycle accident.     

Epidemiology of training injuries in amateur taekwondo athletes: a retrospective cohort study

The objectives of this study were to estimate the incidence and describe the pattern and severity of training injuries in taekwondo, and to compare pattern and severity of training injuries with competition injuries. One hundred and fifty-two active Australian amateur taekwondo athletes, aged 12 years or over, completed an online survey comprising questions on training exposure and injury history over the preceding 12 months. The main outcome measures were: overall injury incidence rate per athlete-year; training injury incidence rate per athlete-year, per 1000 athlete-training-sessions, and per 1000 athlete-hours of training; injury severity; and injury proportions by anatomical region and by type of injury. Injury incidence rates were calculated with 95% confidence intervals using standard methods, while injury proportions were compared using Fisher''s exact test. The vast majority (81.5%) of taekwondo injuries in an average athlete-year occurred during training. The training injury incidence rate was estimated to be 1.6 (95% CI: 1.4, 1.9) per athlete-year, 11.8 (95% CI: 10.4, 13.4) per 1000 athlete-training-sessions, and 7.0 (95% CI: 6.1, 7.9) per 1000 athlete-hours of training. Among athletes with five or fewer injuries, the severity and injury pattern of training injuries were, by and large, the same as for competition injuries. Approximately sixty percent (60.3%) of training injuries required treatment by a health professional. Considering the burden of training injuries exceeds that of competition injuries, taekwondo governing bodies and stakeholders are encouraged to devote more efforts towards the identification of risk factors for, and prevention of, training injuries in the sport of taekwondo.     

Serious childhood injuries caused by air guns.

OBJECTIVE: To determine the severity of nonfatal injuries to children caused by air guns and pellet guns. DESIGN: Case series (hospital chart review). SETTING: Inpatient wards of the Children''s Hospital of Eastern Ontario. PATIENTS: All children under 18 years of age admitted to the hospital from Jan. 1, 1979, to Dec. 31, 1989, under ICD code E917, E922, E955, E965, E970 or E985 who had suffered air gun injuries. MAIN OUTCOME MEASURES: Personal data, circumstances of event and clinical data. RESULTS: The 43 children (37 boys) had a median age of 12 years. The circumstances of the accident were known in 20 cases: 17 children were playing and 3 were cleaning the gun when it went off. Four children thought the gun was unloaded. In five cases the bullet ricocheted into the eye. Nine injuries were self-inflicted. Injury was to the extremities in 21 (49%), the eyes in 15 (35%) and the head and neck in 7 (16%). The median length of hospital stay was 4 days. Six children had long-term disabilities, all the result of eye injuries; two had cataract surgery, and four required enucleation of the eye. CONCLUSIONS: Air guns can cause serious injury to children. Their sale needs to be banned or at least carefully regulated.     

Head Injuries in Children

Two-hundred children with head injury admitted consecutively to paediatric wards in the two main hospitals in Newcastle upon Tyne have been studied. Eight children required neurosurgical operation. There were two deaths. Details of the cause and consequences of the accidents have been analysed and an attempt has been made to identify psychological or physical factors that may predispose to injury. There was a slightly higher proportion of children with what are regarded as adverse personality factors among the head injuries than in a control group and there were more left-handed children than would be expected in the general population. The results suggest that the modern “high-rise” bicycle may carry a special risk of head injury.     

Development, problem behavior, and quality of life in a population based sample of eight-year-old children with Down syndrome

Objective

Children with Down syndrome (DS) have delayed psychomotor development. We investigated levels of development, problem behavior, and Health-Related Quality of Life (HRQoL) in a population sample of Dutch eight-year-old children with DS. Developmental outcomes were compared with normative data of eight-year-old children from the general population.

Method

Over a three-year-period all parents with an eight-year-old child with DS were approached by the national parent organization. Developmental skills were assessed by means of the McCarthy Scales of Children''s Ability. To measure emotional and behavioral problems we used the Child Behavior Checklist. HRQoL was assessed with the TNO-AZL Children''s Quality of Life questionnaire. Analyses of variance were applied to compare groups.

Results

A total of 337 children participated. Mean developmental age was substantially lower than mean calendar age (3.9 years, SD 0.87 and 8.1 years, SD 0.15 respectively). Mean developmental age was significantly lower among boys than girls (3.6 (SD 0.85) and 4.2 years (SD 0.82) respectively; p<0.001). Compared with the general population, children with DS had more emotional and behavioral problems (p<0.001). However on the anxious/depressed scale, they scored significantly more favorably (p<0.001). Significantly lower HRQoL scores for the scales gross motor skills, autonomy, social functioning and cognitive functioning were found (p-values<0.001). Hardly any differences were observed for the scales physical complaints, positive and negative emotions.

Conclusion

Eight-year-old children with DS have an average developmental delay of four years, more often have emotional and behavioral problems, and have a less favorable HRQoL compared with children from the general population.     

Blood Lead Levels and Associated Factors among Children in Guiyu of China: A Population-Based Study

Objectives

Children''s health problems caused by the electronic waste (e-waste) lead exposure in China remains. To assess children''s blood lead levels (BLLs) in Guiyu of China and investigate risk factors of children''s elevated BLLs in Guiyu.

Material and Methods

842 children under 11 years of age from Guiyu and Haojiang were enrolled in this population-based study during 2011–2013. Participants completed a lifestyle and residential environment questionnaire and their physical growth indices were measured, and blood samples taken. Blood samples were tested to assess BLLs. Children''s BLLs between the two groups were compared and factors associated with elevated BLLs among Guiyu children were analyzed by group Lasso logistic regression model.

Results

Children living in Guiyu had significant higher BLLs (7.06 µg/dL) than the quantity (5.89 µg/dL) of Haojiang children (P<0.05). Subgroup analyses of BLLs exceeding 10 µg/dL showed the proportion (24.80%) of high-level BLLs for Guiyu children was greater than that (12.84%) in Haojiang (P<0.05). Boys had greater BLLs than girls, irrespectively of areas (P<0.05). The number of e-waste piles or recycling workshops around the house (odds ratio, 2.28; 95% confidence interval [CI], 1.37 to 3.87) significantly contributed to the elevated BLLs of children in Guiyu, and girls had less risk (odds ratio, 0.51; 95% CI, 0.31 to 0.83) of e-waste lead exposure than boys.

Conclusions

This analysis reinforces the importance of shifting e-waste recycling piles or workshops to non-populated areas as part of a comprehensive response to e-waste lead exposure control in Guiyu. To correct the problem of lead poisoning in children in Guiyu should be a long-term mission.     

Features and Risk Factors of Nonfatal Injury among the Rural Children: A Survey of Seven Schools in a Mountain Area in Southwest China

Objective

We aimed to investigate the patterns and risk factors of nonfatal injuries among rural mountain-area children in southwest China.

Methods

A stratified sampling method was used to recruit rural children aged 8 to 17 years (mainly 9–14 years) from 7 schools. Self-reported injuries during the past 12 months and relevant concerns were collected from June to December 2012 by using a structured questionnaire in a class interview.

Results

The mean age of the 2,854 children was 12.2±1.5 years. The probability of annual injury was 16.7% (95% confidence interval [95% CI] 15.3–18.1%), with slightly higher injury risk for boys than girls (17.7% vs. 16.0%; P>0.05). The top 3 causes of injuries were falls (37.3%), animal-related incidents (20.6%), and burns (14.9%). The main injury risk factors included being involved in a violent episode (odds ratio [OR] 1.34, 95% CI 1.08–1.66, P = 0.007), maltreatment by parents or guardians (1.42, 1.17–1.72, P<0.001), and being from a single-child family (1.30, 1.10–1.66, P = 0.039). Older age was a protective factor (0.81, 0.76–0.87, P<0.001).

Conclusions

The incidence of nonfatal injury among rural children was high, and falls were the leading cause. Younger children and boys from poor-care and poor-living environments were at increased risk of injury, which requires urgent attention. Injury prevention programs targeting these issues are needed in this mountain area and similar rural regions of China.     

Mortality from unintentional injuries in California, 1985.

In 1985 unintentional injuries were the fourth leading cause of death among California residents, causing 10,380 deaths. They were the leading cause of potential life lost, accounting for 278,109 years lost. This was more than twice the number of years lost due to heart disease and 1 1/2 times the number lost due to cancer. Motor vehicle traffic accidents were the leading cause of unintentional injury deaths, accounting for half (5,158) the deaths. The next two leading causes were poisoning (especially for men aged 25 to 44 years) and falls (especially among persons aged 75 and older). Drowning was second to motor vehicle accidents as a cause of death in children aged 1 to 14 years. California''s age-adjusted injury mortality rates in 1985 were lower in coastal and urban counties than in inland and rural counties, and these rates were generally lower in counties having organized systems of trauma care.     

Injuries to dancers: prevalence,treatment, and perceptions of causes.

A survey of injuries to dancers was commissioned by the National Organisation of Dance and Mime. Questionnaires asking about chronic and recent injuries were sent to 188 dancers and completed by 141 dancers from seven professional ballet and modern dance companies in the United Kingdom (75% response rate). It was found that of the 141 dancers, 67 (47%) had experienced a chronic injury and 59 (42%) an injury in the previous six months that had affected their dancing. A high proportion of injuries to the soft tissues had not responded to treatment. With correct treatment such injuries should usually heal completely. Dancers are aware of the high rate of injuries and also of procedures that might help to prevent injury--for example, dancing on floors that are sprung and in warmer studios; teachers'' and choreographers'' awareness of a dancer''s limitations and the need for rest and adequate treatment when an injury occurs.     

Can children with a psychiatric disorder be treated in a general ward?

Because admission to a regional child and adolescent psychiatric unit is often fraught with difficulties children with psychiatric disorders were admitted to a general children''s ward. Over the four years (1980-4) 24 patients accounted for 31 admissions. Of these, five had feeding disorders (anorexia, bulimia), seven neuroses, three psychoses, four elimination disorders, and five other diagnoses. All the children were later discharged to their homes, most having appreciably improved. Because of the proximity of the hospital to the child''s natural environment work with the families and schools was not interrupted by the admission. The results of this approach are encouraging and could have implications for future planning of services for this category of patients.     

Bell ringers' bruises and broken bones: capers and crises in campanology.

OBJECTIVE--To determine the incidence, aeriology, and outcome of injuries due to bell ringing. DESIGN--Retrospective review of the last six years'' issues of Ringing World, advertisement in Ringing World, and a postal questionnaire sent to 20 active ringing towers. SUBJECTS--Regular bell ringers. RESULTS--Seventy nine injuries were identified both from review and by advertisement in Ringing World. The incidence of injury among 221 ringers identified by postal questionnaire was 1.8% a year. CONCLUSION--Although sonerous, bell ringing can be dangerous and occasionally even fatal. Doctors should be aware of the dangers to which campanologists expose themselves.     

Causes of fatal childhood accidents involving head injury in northern region, 1979-86.

OBJECTIVE--To examine the causes and circumstances surrounding fatal accidents involving head injuries in children in the Northern region. DESIGN--Retrospective review of the hospital case notes, necropsy reports, and records of the coroners'' inquests. SETTING--Northern Regional Health Authority. PATIENTS--All 255 children aged less than 16 years who died with a head injury during 1979-86. MAIN OUTCOME MEASURES--Cause of injury and circumstances of accident according to reports of inquests; injury severity score; number of fatal accidents and mortality per 100,000 children in 10 groups of local authority wards ranked according to their score on the overall deprivation index; and distance of site of accident from child''s home. RESULTS--Of the 255 children who died after a head injury, 136 (53%) children were playing at the time of the accident. 195 (76%) children sustained the head injury in road traffic accidents, 135 as pedestrians, 35 as cyclists, and 25 as passengers in a vehicle. In 120 accidents in child pedestrians the primary cause of accident was the unsafe behaviour of the child. 172 (67%) accidents occurred within one to two km of the child''s home and 153 (63%) between 3 pm and 9 pm. The mortality was significantly related to social deprivation; excluding eight children injured while on holiday in the region, 15-fold decrease in mortality was recorded between the local authority wards that ranked highest on the overall deprivation index and those that ranked lowest (14.0/100,000 children, group 10 v 0.9/100,000, group 1 respectively, p less than 0.00001). CONCLUSIONS--The finding that most accidents occurred in children living in deprived areas who were playing unsupervised near their home suggests that childhood mortality might be appreciably reduced if children at play were protected from traffic, particularly in socially deprived areas.     

Dogs that bite.

OBJECTIVE--To study the circumstances of dog bites and identify risk factors. DESIGN--Postal questionnaire survey and case note review of victims of dog bites referred between 1982 and 1989. SETTING--One referral based regional plastic surgery unit. PATIENTS--146 consecutive patients referred for primary treatment of dog bites, for whom current addresses were available for 133, 107 (81%) of whom returned the questionnaire. RESULTS--The male to female ratio was 74:72; 79 (54%) patients were aged below 15 years. The commonest dogs producing bites were Staffordshire bull terriers (15 cases), Jack Russell terriers (13), medium sized mongrels (10), and Alsatians (nine). 82 of 96 (85%) dogs were male. 29 of 47 (62%) adults were bitten at home and 45 of 60 (75%) children at a friend''s, neighbour''s, or relative''s house. 91 of 107 (85%) bites occurred in the dog''s home. Bites occurred during playing with 13 (12%), petting 14 (13%), or waking 16 (15%) dogs. 45 (42%) bites were judged as unprovoked. 32 bites were identified as severe and 11 attacks as sustained. CONCLUSIONS--Most victims are bitten by male dogs which they either own or have had frequent contact with, and the bite occurs in the dog''s home.