Increases in crash involvement and fatalities among motor vehicle occupants younger than 5 years old

OBJECTIVE: To determine whether increased exposure as car occupants could be a major contributor to increases observed in deaths of young children in car crashes. DESIGN AND SETTING: Crash data from police reports for Maryland, Michigan, Pennsylvania, and Washington for various years from 1982 through 1990 were examined to compare annual age mix of injured and uninjured occupants in crashes involving at least two passenger vehicles. Aggregate national data from the Fatal Accident Reporting System were also examined over the same time period and compared to population estimates for children younger than 5 years old to assess temporal trends in number of occupants in this age group who were involved in motor vehicle crashes in which a fatality occurred in fatal crashes and the number of them killed in passenger vehicles. RESULTS: In regression analyses for each state, the number of car occupants younger than 5 involved in crashes increased during the years studied; their percentage among nondriver occupants involved also increased. At a national level, similar analyses showed increases in the number of occupants younger than 5 involved in crashes in which a fatality occurred. CONCLUSIONS: Despite overall increases in the use of restraint devices (ie, both child safety seats and adult restraints), fatalities among restrained children have increased. Given that exposures to crash environments are increasing, clinicians need be aware of the importance of child restraints as a means of reducing the likelihood of injury.     

A microbore high performance liquid chromatography/electrospray ionization mass spectrometry method for the determination of the phytoestrogens genistein and daidzein in comminuted baby foods and soya flour

Motor vehicle crashes are a leading cause of death and disability among children in the United States despite the fact that child safety seats and seat belts can provide effective protection against serious and fatal injuries. Many child car seats and safety restraints are being used incorrectly. In addition, recent fatalities associated with children and air bags have heightened awareness of child passenger safety issues. Pediatric nurse practitioners are in an excellent position to offer motor vehicle occupant prevention strategies to families through health education and anticipatory guidance.     

A survey of parental knowledge about car seats in children

Motor vehicle accidents are the main cause of death and disability between 1 and 4 years of age. Since 1980 the Academy of Pediatrics has been promoting the correct use of car seats. The major reason that car seats are not fulfilling their full potential is their incorrect or lack of use. In order to evaluate parental knowledge about car seat use for children and their actual use in the population visiting HURRA, a survey was performed which demonstrated that only 57.6% of the parents interviewed had infant car seats and that only 83.3% of owners actually use it. As many as 94.4% had correct knowledge about car seat use, but the majority of correct information was not provided by the medical staff. The majority of parents use seat belts for their own protection but a significantly smaller percentage use car seats for their own children.     

机动车尾气和非尾气排放多环芳烃及其衍生物的影响因素研究进展

机动车尾气排放多环芳烃(PAHs)及其衍生物主要源于化石燃料的不完全燃烧,排放特征随燃烧条件和燃料种类变化而有所不同.随着尾气排放控制标准日益严格和新能源汽车的逐渐普及,非尾气排放污染对交通大气污染的贡献逐年加大.因此,包括刹车磨损、轮胎磨损、道路扬尘再悬浮和路面磨损在内的非尾气排放过程作为城市环境PAHs的重要污染源,其占比不容忽视.机动车来源PAHs及其衍生物的排放特征主要受燃烧条件、路面条件和机动车部件材料种类等多种因素影响.本文对国内外现有的机动车尾气排放以及非尾气排放PAHs及其衍生物的数据进行了梳理和总结.总的来说,对于尾气排放,严格的排放标准导致PAHs及其衍生物排放量降低;冷启动、加速等工况下,发动机燃烧效率降低,排放量增大;柴油车排放量远高于汽油车;汽油直喷发动机比气道喷射发动机排放更高;车辆行驶里程增加排放量增加.且研究发现刹车片化学成分、制动情况、轮胎材料和路面条件等均会影响排放,具有高度的不确定性,有待进一步研究.本文旨在分析机动车来源PAHs及其衍生物在不同影响因素下的排放特征,为排放控制技术发展和政策标准制定提供科学依据.     

Who is driving when unrestrained children and teenagers are hurt?

This paper examines driver characteristics in crashes where child and teenage motor vehicle crash victims were injured, in particular factors that determine whether or not the victim was restrained. Analyzing the data on children and teenagers who are injured revealed that the presence of a second adult in a vehicle increased the likelihood that these passengers were unrestrained. Other findings are more predictable: victim restraint use generally mirrored driver restraint use; a male driver, a young driver, a drinking driver, a speeding or reckless driver, an unlicenced or suspended driver, and a night-time trip each independently raised the odds that child and teenage passengers were not restrained when they were injured.     

Critical Issues Children Face in the 2000s.

Children will face many critical issues in the 21st century. Unfortunately, most of these issues are not new and have remained the same from previous years. Millions of children lack safe, affordable, quality child care and early childhood education while their parents work. Seven and one-half million children are at home alone without supervision, frequently after school when they are at greatest risk for getting into trouble. Close to 12 million children are poor, millions are hungry and/or at risk for hunger, living in the worst housing conditions, or are homeless. Almost 80% of poor children live in working households. Data from the National Center for Children in Poverty (2003) indicate that: A total of 37% of children in the United States (27 million) live in low-income families. Homicide is the second leading cause of death for all 15 to 24-year olds, most killed with guns. In an average classroom of 20 children, there are most likely at least three children who are either victims or bullies. One-half of motor vehicle accidents involving adolescents are associated with alcohol and other drugs. Due to the scope of the issues children face in the 2000s, greater planning, collaboration, and program implementation across disciplines and agencies is required. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Observed child restraint use in automobiles

Visual observations were made on restraint use in occupants of 5,050 automobiles containing at least one passenger less than 10 years of age, and short interviews were conducted with the drivers. Ninety-three percent of passengers less than 10 years old were not restained. Eighty-nine percent of passengers 10 or older and 78% of the drivers were not restained. Sixteen percent of child motor vehicle restraint devices observed were not used, and 73% of those in use were not used correctly. Use of such devices declined sharply after age 1. Although child passengers were more likely to be restained if the driver was restrained, more than 75% of the children were not restrained when the driver was, even if the driver was the child's parent.     

Our experience with the use of the dorsal ulnar artery flap in hand and wrist tissue cover

A field study of 1146 drivers and passengers of vehicles equipped with motorized passive belts was conducted in shopping malls and other locations in the states of Arizona and Indiana. The Indiana data was collected the summer of 1994 and the Arizona data the summer of 1995. Shoulder belt use by drivers and passengers was 93.4% in Indiana and 87.8% in Arizona. Lap belt use was 65% in Indiana and 69.9% in Arizona. Over 99% of drivers in both states knew that a manually fastened lap belt was provided along with the motorized shoulder belt. Most drivers agreed that they are supposed to wear the lap belt (96.3% in Indiana and 94.3% in Arizona) and said that the vehicle they were driving provided a warning signal when the lap belt was not fastened (75.7% in Indiana and 79.4% in Arizona). Most drivers were also aware of warning labels telling them to use their lap belt (63.9% in Indiana and 68.2% in Arizona).     

Road traffic injuries in developing countries: a comprehensive review of epidemiological studies

Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. This review summarizes studies on the epidemiology of motor vehicle accidents in developing countries and examines the evidence for association with alcohol.     

Management of childhood splenic trauma--the Jos experience

We studied retrospectively 22 children who were managed for splenic injuries at Jos University Teaching Hospital between September 1988 and October 1995. Sixteen were males and six were females (M:F = 2.7:1) with their ages between five and 15 years and a mean of 10.3 years. Eleven were knocked down by vehicles while crossing the freeway, playing or hawking goods; seven fell from slippery mango trees after a downpour of rain while two were passengers in a vehicle that was involved in a head-on collision and another two were kicked in the abdomen as a result of assault. All had surgery. Four sustained Uphadhyaya and Simpson's Type 1 injuries while six sustained Type IV injuries. Twelve had total splenectomy, seven had total splenectomy with heterotopic autotransplantation of splenic wafers while three had splenorrhaphy augmented with omentoplasty. An average of 1.5 units of blood per patient were transfused. There was only one death. Considering that the majority (18) of these children sustained their splenic injuries while crossing the freeway (playing or hawking goods) and from falls from mango trees after the rains, we believe that there are preventable causes. Mandatory primary and junior secondary school education as well as legislature against child labour will help keep these children safe out of harm's way and thus drastically reduce the incidence of childhood splenic injuries in our environment.     

The prognostic importance of calcitonin screening in familial medullary thyroid carcinoma

A prospective study of 20 patients with traumatic amputations of the fingers and a thumb was carried out during a six week period at Mpilo Central Hospital, Bulawayo. Most of the adult injuries (17 patients) resulted from industrial accidents (76.5 pc) while two out the three children sustained their injury from domestic accidents. Inadequate safety precaution, ignorance and human error contributed significantly to the injuries. Safety education and preventive measures both at home and in industry should be inoculated into the daily life of individuals.     

Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults

Studies have consistently shown that sleep apnea patients have high accident rates, but the generalizability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-disordered breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-disordered breathing. Sleep-disordered breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a statewide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-disordered breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (vs. no sleep-disordered breathing) were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognized sleep-disordered breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-disordered breathing may account for a significant proportion of motor vehicle accidents.     

Effects of amniotic fluid embolism-like plasma on isolated perfused rabbit lungs

Information on road injury with analyses on the epidemiological features and determinants of fatality rate with prevention and control of road injury was presented in this paper. From 1951 to 1994, road injury and motor vehicle deaths had a continuous increase by 43 and 78 times respectively. Since 1987 about 250,000 cases, 5000 deaths and 15,000 trauma cases caused by road crashes year after year. The fatality rate increased by an average of 12.9% increase per year from 1984 to 1994 (from 2.43 to 5.56 per 100,000 pop). Zhejiang, Guangdong, Liaoning, Sichuan and Jiangsu occupied the first five places in 30 provinces, accounted for over 45% of total road injuries and one thirds of road fatalities. Both incidence and death rate were lowest in Beijing City and highest in Zhejiang Province. Three-quarters of the fatality on road injury were occurred on smooth and straight pavement in sunny days. Over 60% of the motor vehicle deaths were young males (age 20-50 yrs). Classified by occupation, majority of the victims were peasants (55%) and workers (19%). Two thirds of the road fatalities were pedestrians, bicycle riders and passengers. Human factors including driver's irresponsibility, non-licensing, bicycle rider and pedestrian carelessness, etc. were notified that accounted for over 90% of the causes for road injury. Primary causes from the drivers were rules and regulations violation, absent-mindedness, driving after drinking alcohol. The risk factors of road injuries were the increase of motor vehicles and traffic congestion. It is also necessary to improve the traffic safety knowledge among residents.     

机动车来源多环芳烃及其衍生物的排放特征研究进展

随着机动车保有量快速增长,机动车排放成为大部分大中城市大气中PAHs及其衍生物的主要来源之一。因此,基于以往的研究成果,汇总了台架实验、车载实验、隧道实验、路边实验等常用的机动车尾气采集方法,对机动车来源PAHs及其衍生物的排放特征（排放因子、气粒分配规律、成分谱研究以及机动车车型、工况和行驶里程的影响等）进行了总结,为不同研究需求下实验方法的选取以及机动车减排措施的制定提供科学参考。此外,为缓解能源问题和机动车排放污染问题,中国计划2020年在全国范围内推广使用车用乙醇汽油。由于乙醇汽油与普通汽油的性质存在诸多不同,乙醇汽油对机动车排放的影响也引起了研究者们的关注,因此分析了乙醇汽油实施对机动车尾气PAHs及其衍生物的污染特征变化的影响,以期为该领域未来的研究方向提供建议,为机动车污染防控研究提供科学合理的参考。      

Alcohol in fatal and nonfatal injuries: a comparison of coroner and emergency room data from the same county

Although alcohol is thought to be associated with severity of injury, relatively little data are available that compares alcohol's involvement in injury cases treated in the emergency room (ER) with coroner cases of injury fatality, both coming from the same county. Data from a probability sample of casualty patients 18 years and older treated at the University of Mississippi Medical Center ER in Jackson during a 6-month period (n = 275) are compared with data from coroner reports of all fatalities from unnatural causes among those 18 and older in the same county during a 1-year period surrounding the 6 months of data collection in the ER (n = 222). The two samples are compared on demographic characteristics, cause of injury, place of injury, and alcohol use before the event. A significantly larger proportion of the coroner sample was positive for alcohol (57%) and intoxicated (36%), compared with the proportion of those in the ER sample breathalyzed within 6 hr of injury, and reporting no drinking after the event who were positive (15%) and intoxicated (6%). Differences were most pronounced for motor vehicle accidents and fires. Violence-related injuries were more likely in the coroner sample (32%) than in the ER sample (16%), and they were more likely to involve alcohol at levels of intoxication. Those in the coroner sample were also more likely to be alcohol-positive for injuries occurring in all places except the home of another and the workplace. Using logistic regression, gender (male) and site (coroner) were predictive of a positive blood alcohol across all causes of injury combined. Gender (female), being alcohol-positive and site (coroner) were significantly predictive of motor vehicle accidents. Alcohol was not found to be a significant predictor for falls, other accidents, or injuries resulting from violence. Data suggest that alcohol's association with severity of injury varies by cause of injury.     

Evaluation of two biological markers combined as a parameter of alcohol dependency

An important group of fatal incidents are slow-speed pedestrian non-traffic incidents to children, which account for 14% of accidental deaths from all causes in Victorian children under 5 years of age between 1985 and 1995, and 12% of pedestrian deaths of all ages. In Victoria, Australia, the database of the state Consultative Council on Obstetric and Paediatric Morbidity and Mortality was utilised to identify paediatric slow-speed pedestrian non-traffic-accident deaths in the local population. Additional data relating to the car and its driver, the child, and the circumstances of the incident were abstracted from records kept by the State Coroner and the Victorian compulsory third party traffic injury insurance organisation. Twenty eight Victorian children were identified who had died in one of three types of incident (driverless cars, child interacting with the vehicle and driver, and drivers who were unaware of the child's proximity). These incidents were more common in rural areas compared with urban, usually occurring at the child's home. The child was with or near an adult on all occasions. The vehicle was usually being driven by a relative, and was reversing in a higher proportion of 'unaware' incidents compared with the 'interactive' type. The association of 'off-road' family vehicles and trucks with these incidents appears to be increasing, especially in recent years. These findings suggest some countermeasures, including the separation of vehicle driveways from children's play areas, and object vicinity ultrasonic warning devices for vehicles.     

Physical restraints in nursing homes: a review of the literature since the Nursing Home Reform Act of 1987

The use of physical restraints is one of the most negative features of nursing home care. Their use significantly affects the quality of life of residents. In an attempt to limit the use of restraints, the Nursing Home Reform Act (NHRA) of 1987 contained provisions regulating their use. In this article, the authors review the literature on the use and consequences of physical restraints in nursing homes since the passage of the NHRA. First, they describe the history behind the use of restraints and define what is considered to be a physical restraint. Second, they examine the four most common justifications for restraint use. Third, they describe the incidence and prevalence of restraint use. Fourth, they address demographic and clinical characteristics of residents that have been found to be associated with restraint use. Fifth, they examine negative outcomes of restraining residents. Finally, they describe alternatives to using restraints.     

Low velocity vehicular injuries in children--"run-over" accidents

Fourteen children, mostly in the toddler to preschool age group, were treated for injuries resultant from low velocity vehicular accidents in which the child was literally run over. Multiple system injury and visceral injury to brain, lungs, liver, and kidneys were noted. One death and several permanent disabilities resulted in this small group. Most of the accidents could have been prevented by closer supervision of the children. Devices such as childproof door handles, which are currently available, and audible backing signals, currently available on industrial vehicles, might further reduce the incidence of this type of accident.     

Ordinal position differences in children's family interactions.

The purpose of this study was to compare the interactions of oldest and youngest children with parents and siblings. Twenty first-born and 17 last-born children between the ages of 4 and 8 from two- or three-child families were selected from a larger sample for this study. Their interactions at home with other family members were observed and coded. Oldest children emitted more of their total behaviors to parents than to siblings, whereas last-born children did not differ significantly in the total number of behaviors emitted to the two family member groups. When the incidence of individual behavior categories was examined, no significant main effect due to ordinal position was found; however, a significant interaction of ordinal position with family member group for some behaviors was found. Both parents and siblings emitted similar levels of prosocial responses toward oldest and last-born children. However, oldest children were more likely to be the recipient of negative responses from parents and siblings than were last-born children of the same age. Implications of these findings for understanding the influence of ordinal position on social behavior are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Young children's acquisition of the movement aspect in American Sign Language: parental report findings

The acquisition of the movement aspect of American Sign Language signs was examined longitudinally in 9 young children of deaf parents. During monthly home visits, the parents demonstrated on videotape how their children formed the different signs in their lexicons. The parents also demonstrated how they formed or modeled these same signs. Overall, the children correctly produced 61.4% of the movements that were present in the adult sign models. Although the production accuracy of the movement aspect of signs did not improve over the course of the study, the number and complexity of movements produced by the children did increase as they got older and their vocabularies grew in size. Of the different sign movements, contacting action was by far the most frequently produced. The children were also relatively successful in their production of closing action and downward movement. The order of acquisition for the remaining ASL movements, however, was quite variable, with the exception that bidirectional movements tended to be produced more accurately than unidirectional movements. The relationship between children's early rhythmical motor behaviors and the development of sign movements is discussed.