Cyclists injured while sharing the road with motor vehicles.

OBJECTIVE: To provide national estimates of non-fatal cyclist injuries treated in US hospital emergency departments (EDs) resulting from an encounter with a motor vehicle (MV) on the road. METHODS: Non-fatal injury data for 2001-4 from the National Electronic Injury Surveillance System All Injury Program were analyzed. RESULTS: An estimated 62,267 persons (21.5 per 100,000 population; 95% CI 14.3 to 28.7) were treated annually in US hospital EDs for unintentional non-fatal cyclist injuries involving an MV on the road. Among these cases, children aged 10-14 years (65.8 per 100,000) and males (35.3 per 100,000) had the highest injury rates. Many injuries involved the extremities (41.9%). The head was the primary body part affected for 38.6% of hospitalized/transferred patients, of which about 84.7% had a principal diagnosis of a concussion or internal head injury. CONCLUSIONS: Effective road environmental interventions (eg, bicycle-friendly roadway design, intersections and crossings) along with efforts to promote safe personal behavior (eg, helmet use and following rules of the road) are needed to help reduce injuries among cyclists while sharing the road.     

Trends in hospitalization associated with traumatic brain injury.

CONTEXT: Traumatic brain injury (TBI) is associated with more than 50000 deaths in the United States each year, and recent observations suggest a substantial decline in TBI-related hospitalizations and deaths. OBJECTIVE: To analyze long-term trends in TBI-related hospitalization in the United States. DESIGN, SETTING, AND PARTICIPANTS: Analysis of existing data from 1980 through 1995 from the National Hospital Discharge Survey, an annual survey representing the US general population. The number of participating hospitals ranged from 400 to 494. MAIN OUTCOME MEASURES: Annual rates of TBI-related hospitalization, stratified by age, sex, severity of injury, and outcome. RESULTS: The annual number of TBI cases identified from the sample during the study period ranged from 1611 to 3129. Overall rates of hospitalization for TBI declined an estimated 51%, from 199 to 98 per 100000 per year. When analyzed by severity of injury, mild TBIs declined most during this period, from 130 to 51 hospitalizations per 100000 per year (61% decline; P<.001 compared with intermediate and severe TBI). The decline was greatest among those aged 5-14 years (-66%) and least among those aged 65 years or older (-9%). The ratio of male to female rates showed little variation during the study period (ratio, 1.8; 95% confidence interval [CI], 1.6-2.0), as did the in-hospital mortality rate (mean, 5.3 per 100000; 95% CI, 3.6-7.1). CONCLUSIONS: Changes in hospital practices may be a major factor in the declining rates of TBI-related hospital admissions. These practices increasingly appear to exclude persons with less severe TBI from hospital admission and shift their care to outpatient settings.     

Epidemiology of injuries among women after physical assaults: the role of self-protective behaviors.

Physical assaults against women result in more than 5,000 deaths and 1 million nonfatal injuries per year in the United States. Data from the National Crime Victimization Survey, 1992-1995, were used to test the association between injury risk and self-protective behaviors, while controlling for victim, offender, and crime-related characteristics. Unlike in prior studies, a self-protective behavior measure that accounted for the temporal sequencing of the occurrence of injuries and self-protective behaviors was used. The study also examined whether the effect of self-protective behaviors varied as a function of victim-offender relationship status. The sample included 3,206 incidents in which females were physically assaulted by a lone male offender within the previous 6 months. Multivariate results revealed that women who used self-protective measures were less likely to be injured than were women who did not use self-protective measures or who did so only after being injured. The effect of self-protective behaviors on risk of injury did not vary as a function of the victim-offender relationship. The inverse association found between self-protective behaviors and injury risk differs from those of previous studies. Owing to inconsistent findings across studies, caution should be used when making recommendations to women regarding whether or not they should use self-protective behaviors during a physical assault.     

Changes in Suicide Rates by Hanging and/or Suffocation and Firearms Among Young Persons Aged 10–24 Years in the United States: 1992–2006

We examined changes in suicide rates among 10–24-year-olds in the United States from 1992 to 2006. The overall suicide rate and the rate by firearms, poisoning, and other methods declined markedly, whereas the hanging/suffocation rate increased significantly from 1992 to 2006. This increase occurred across every major demographic subgroup, but was most dramatic for females.     

The Driver's Angry Thoughts Questionnaire: A Measure of Angry Cognitions When Driving

Five forms of driving-related angry cognitions were identified—Judgmental/Disbelieving Thinking ( = .94), Pejorative Labeling/Verbally Aggressive Thinking ( = .92), Revenge/Retaliatory Thinking ( = .93), Physically Aggressive Thinking ( = .93), and Coping Self-instruction ( = .83). Pejorative labeling/verbally aggressive, physically aggressive, and revengeful/retaliatory thinking correlated positively with each other and with driving anger, aggressive driving anger expression, aggression, and risky driving behavior. Coping self-instruction tended to correlate negatively with these variables. Judgmental/disbelieving thinking correlated positively with other forms of angry thinking, but was only somewhat correlated with other variables. Driving-related angry thoughts, except coping self-instruction, correlated positively with general hostile automatic thoughts. Differences in strengths of correlations with specific variables, and contributions to regression analyses supported the discriminant and incremental validity of driving-related angry thoughts. Implications for cognitive processes in anger and interventions were discussed.     

Brief Motivational Intervention to Increase Self-reported Safety Belt Use among Emergency Department Patients

Objectives:  Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients.
Methods:  From February 2006 to May 2006, the authors conducted a randomized trial of adult ED patients at a teaching hospital in Boston. ED patients were systematically sampled for self-reported SBU. Those with SBU other than "always" were asked to participate. At baseline, participants answered a 9-item series of situational SBU questions, each scored on a 5-point Likert scale. SBU was defined as a continuous variable (9-item average) and as a dichotomous variable (response of "always" across all items). Participants were randomized to an intervention or a control group. The intervention group received a 5- to 7-minute intervention, adapted from classic motivational interviewing techniques, by a trained interventionist. Participants completed a 3-month follow-up phone survey to determine changes from baseline SBU. Continuous and dichotomous SBU were analyzed via analysis of covariance and chi-square testing.
Results:  Of 432 eligible patients, 292 enrolled (mean age 35 years, standard deviation [SD] ±11 years; 61% male). At baseline, the intervention and control groups had similar mean (±SD) SBU scores (2.8 [±1.1] vs. 2.6 [±1.1], p = 0.31) and SBU prevalence (each 0%). At 3 months, 81% completed follow-up. The intervention group had significantly greater improvement in mean (±SD) SBU scores than controls (0.76 [±0.91] vs. 0.34 [±0.88], p < 0.001). Also, SBU prevalence of "always" was higher for the intervention group than controls (14.4% vs. 5.9%, p = 0.03).
Conclusions:  Participants receiving a brief motivational intervention reported higher SBU at follow-up compared to controls. An ED-based intervention may be useful to increase SBU.