Traffic accidents resulting in injuries: underreporting,characteristics, and case fatality rate

In order to describe traffic accidents in a medium-sized Brazilian city and compare the risks of injury and death among different types of vehicles and pedestrians, all traffic accidents identified through police and hospital emergency records were registered for two years Deaths by such accidents were identified and confirmed through the coroner's office. The number of registered vehicles in the municipality was obtained through the State traffic authority. Morbidity and mortality rates were calculated and tests of association between selected variables performed. There was a relevant underreporting of accidents by the police (up to 53%), which varied according to the type of accident and time of occurrence. The highest case fatality rate was observed among bicyclists and pedestrians (around 5%), followed by motorcyclists (3%). Pedestrians formed the highest contingent of deaths. Motorcyclists had an eightfold risk of dying, a fourfold risk of injury, and a twofold risk of running over pedestrians as compared to automobile drivers. We conclude that pedestrians and motorcyclists are priority groups for interventions aimed at reducing injury and death from traffic accidents.     

Global estimates of fatal occupational accidents.

Data on occupational accidents are not available from all countries in the world. Furthermore, underreporting, limited coverage by reporting and compensation schemes, and non-harmonized accident recording and notification systems undermine efforts to obtain worldwide information on occupational accidents. This paper presents a method and new estimated global figures of fatal accidents at work by region. The fatal occupational accident rates reported to the International Labour Office are extended to the total employed workforce in countries and regions. For areas not covered by the reported information, rates from other countries that have similar or comparable conditions are applied. In 1994, an average estimated fatal occupational accident rate in the whole world was 14.0 per 100,000 workers, and the total estimated number of fatal occupational accidents was 335,000. The rates are different for individual countries and regions and for separate branches of economic activity. In conclusion, fatal occupational accident figures are higher than previously estimated. The new estimates can be gradually improved by obtaining and adding data from countries where information is not yet available. Sectoral estimates for at least key economic branches in individual countries would further increase the accuracy.     

Analysis of knowledge attitudes and practices of health care workers facing blood exposure accidents in a general surgery service

In order to assess the degree of knowledge, attitudes and the personnel's practices exercising in a service of general surgery of the hospital Charles Nicolle of Tunis, concerning blood exposure accidents, we did a transverse survey during the month of January of the year 2002. A questionnaire has been addressed to 114 people while using the technique of the direct interview. The middle age of investigated is 35.7 years. The sex ratio is 0.7. Only the 2/3 declare have been vaccinated against the B hepatitis. The results show a good knowledge of the exposure risk to a communicable disease by blood (95.6%), but less good for the risk of contamination by the three viruses HBV, HCV and HIV. The resheathing of needles, considered like gesture to risk, is underestimated by 71.2% of investigated. The majority of investigated declare to know universal precaution principles (85.8%). However, to the maximum 4 measures only on the 10 advisable have been mentioned by investigated. The conduct to hold in case of blood exposure accident seems insufficiently known by our sample. It is represented, in 78.8% of cases, in the application of disinfectants Betadine type or alcohol iodized, whereas the practice of a serology to the patient source is ignored completely. 75% of investigated having had a blood exposure accident lasting the last 12 months (n = 44) didn't declare their blood exposure accident and only 11.4% declare to have undergone cares. Actions of information and formation, to the intention of the whole of the personnel of the service, on risks incurred by the nursing, gestures and procedures to risk, the universal precaution respect, the conduct to hold in case of a blood exposure accident, the interest of the declaration and the interest of the vaccination against the B hepatitis, are primordial.     

HIV occupational risk of surgical specialists and operating room personnel in the Saint Lucas Hospital in Amsterdam

All instrument and needle accidents, and mucosal exposure to blood involving surgical specialists and operating room personnel were recorded for a seven-month period in a middle-sized Amsterdam hospital, the St. Lucas. Fifty-four accidents were reported, of which 42 were percutaneous wounds and 12, blood splatters in the eyes. The frequency of percutaneous wounds per operation per person ranged from 0 to 0.013. In the same period 3098 patients who had to be operated on were asked to participate in an anonymous study for HIV antibody. One hundred and twenty patients refused participation (3.9%). Of the 2978 participating patients seven were seropositive for anti-HIV (0.23%). The observed percutaneous accident frequency and HIV prevalence were used in combination with reports from the literature on the risk of infection after a single exposure to HIV infected material, to calculate the HIV professional risk for operating room personnel in this hospital. For general surgeons the risk of infection (based on 500 operations per year) was calculated as 0.0012 for an occupational lifespan of 30 years. For the other specialists and functions the risk was the same or less. Considering the low risk our conclusion is that screening of preoperative patients is not necessary in this hospital. The observance of general protective measures provides sufficient protection for the professional group examined.     

Epidemiologic surveys of dog and cat bites in the Lyon area,France

The urban pet population has increased considerably in France during the last twenty years. Two main questions need to be answered regarding rabies and other bite transmitted zoonoses: What is the actual incidence rate of dog and cat bites in an urban area; and how sensitive is the animal bite reporting system? To answer these questions, four surveys were conducted in the Lyon area, France, in 1989: 1) an analysis of the consultation reports to the Pasteur Institute and of the bite reports sent by veterinarians to the local veterinary services for 1987 and 1988; 2) a survey of 10 veterinary clinics located in the Lyon area and an analysis of their bite reports for the period May 1987 — April 1989; 3) a questionnaire survey to 175 clients of these veterinary clinics; 4) a street survey of a random sample of the Lyon adult population (310 questionnaires). Bite incidence rates ranged from 10/100,000 persons/year for rabies post-exposure treatments to 37.5/100,000 persons/year for reported bites. However, less than half of the bite reports from the ten veterinary clinics were submitted to the veterinary services. The surveys conducted among pet owners and the general population indicated that, overall, bites were common events (3.4%) and occurred more often in pet owners (8.6%). In 74% of the cases, victims belonged to the pet owner's family and one fourth of the accidents occurred when playing with the pet. However, 12% of the accidents resulted from apparently unprovoked aggressions. According to these data, estimates of the incidence rate of bites for the Lyon area were at least one hundred times higher than the official reported rate of 37.5 bites/100,000 persons/year.     

Prevalence of sleepiness in a group of Brazilian lorry drivers

OBJECTIVE: To determine the prevalence of sleepiness in a group of Brazilian lorry drivers. STUDY DESIGN: Cross-sectional study. METHODS: This study used a self-administrated questionnaire and the Epworth Sleepiness Scale (ESS). The questionnaire included questions regarding demographic features, professional data, sleep habits, night-time symptoms, excessive daytime sleepiness and history of previous automobile accidents. RESULTS: Four hundred and thirty-eight male drivers, aged 34.2+/-9.5 years (mean+/-SD), were included in the study. The mean number of hours spent driving each day was 9.2+/-2.6h, compared with 4.5+/-2.3h for the night shift. The median distance covered weekly was 1,200 km (range 70-6,000 km). The most common sleep complaints were insomnia (26.6%), loud snoring (45%) and witnessed apnoea (7.6%). Eighty-six of 392 (22%) drivers reported falling asleep while driving, and 11 (2.8%) subjects indicated falling asleep daily or almost daily. One hundred and seventy-one drivers (39%) had been involved in a traffic accident, and 21 of 128 drivers (16.4%) indicated sleepiness as a possible contributing factor. The ESS was higher than 10 points in 120 (28%) of the interviewees. CONCLUSIONS: Sleepiness is a prevailing symptom in lorry drivers and is probably related to accidents.     

海宁市道路交通事故原因与疾病负担评价

目的探讨道路交通伤亡事故（简称车祸）原因与疾病负担。方法应用2001年全市车祸现场勘察信息及其相关资料，对车祸的成因、流行特征、人体损伤部位、经济损失情况等进行综合分析研究，并计算平均潜在寿命损失年（YPLL）、潜在工作寿命损失年（WYPLL）和潜在价值寿命损失年（VYPLL）在全死因中的位次。结果2001年海宁市人口车祸发生率188．59／10万、人口死亡率22．48／10万；万车事故发生率151．73、万车死亡率18．10。事故原因分析显示：人的因素占93．1％、其中驾驶员因素占89．4％，主要表现在：不按规定让行、措施不当、疏忽大意、纵向间距不够、违章行驶等；直接经济损失3127万元，平均每宗交通事故2．59万元，车祸导致的人均YPLL、WYPLL、VYPLL位居各类主要死因之首。结论提高驾驶员的综合素质，是预防车祸发生的关键。     

Occupational accidents with biohazards: the perception of the injured worker

This qualitative research aims at identifying the perception of health care workers of different categories from a specialized institution in emergency health service in the city of Goiania regarding the context involving biohazard accidents. Firstly, 382 workers were given a questionnaire in order to identify those who had experienced an accident, 39 of which also took part in an interview addressing the general aspects of the accidents. Among the main accident causes to be highlighted are: unattention, non-adherence to preventive measures, patient's severity and hurry. Among the experienced feelings the main ones are: inconfidence, fear of contamination, rage, and even calmness. Half reported no consequence resulted from the accident. Data points to the need of self-worth concerning the worker's health and also of programs aiming at occupational safety enhancement.     

Behavioral and psychosocial influences of risk perception among Hungarian adolescents

Summary Objective:  The main goal of the present study was to assess adolescents’ risk perception, namely, their estimates of the likelihood of smoking and alcohol-related illnesses and accidents. Methods:  The survey was conducted among high school students in Szeged (N = 560, aged between 14–19 years; mean: 16.7; S.D.: 1.4 years). The self-administered questionnaire contained items on sociodemographics, risk perception, health risk behaviors, and certain psychosocial variables. Results:  Being a male was associated with risk perception only in terms of alcohol-related illnesses. Smokers, alcohol users, and those who engaged in reckless transportation, evaluated themselves as being at higher risk for substance related illnesses and accidents compared to those who did not report such behaviors. Those who tended to use a seat belt, however, estimated the same amount of risk for an accident as did those who tended not to use them. Social attitudes tended to positively, whereas personal attitudes tended to negatively influence perceptions of health risks. The role of social comparison and self-efficacy, however, depends on the nature of behavior. Conclusion:  Besides behavioral influences, psychosocial variables also play a role in adolescents’ risk perception. Submitted: 25 July 2007; Accepted: 14 January 2008     

Is psychopathology related to children's unintentional injury?

This research aimed to study children's psychopathology and unintentional accidents in Thrace, northern Greece. We examined whether there was a correlation between each risk factor of the research and the dependent variables: 1) minor accidents, 2) serious accidents that required Emergency Room attendance (ER accidents), 3) serious accidents that led to hospital admission (admission accidents). High school children (n = 1,516) completed an anonymous questionnaire regarding the cause of their accident, as well as the "Strengths and difficulties questionnaire" (SDQ) by Goodman. The results indicate that sex, conduct disorders, hyperactivity, and abnormal score in SDQ were important risk factors for minor injuries and continued to be important risk factors for ER accidents. Sex, conduct disorders, hyperactivity, peer-problems, and abnormal score in SDQ were important risk factors for the most serious accidents (admission accidents). Because major accidents can result in serious health problems or disability, attention should be paid to the risk factors found.     

Accidents with exposure to biological material contaminated with HIV in workers at a third level hospital in Madrid

BACKGROUND: Human Immunodeficiency Virus (HIV) is an occupational hazard among healthcare professionals accidentally contaminated with HIV-positive blood. This study is aimed at describing the characteristics of the accidents involving blood of HIV-positive patients recorded over a sixteen-year period at a general hospital. METHODS: Epidemiological study of the accidents reported in 2001 involving biological material from an HIV-positive source by the healthcare personnel of a general hospital throughout the 1986-2001 period entailing the presence of biological material from HIV-positive serology individuals. Individual, time and place-related variables, in addition to the initial serologies and those throughout the protocolized follow-up were studied for those individuals involved in these accidents. RESULTS: A total 550 accidents entailing an HIV-positive source were reported. The average number of accidents was 34.4/year. The accidental exposure rate for the period under study was 7.5/1000 workers/year. The professional group showing the highest accident rate was the nursing staff (54.4%). Percutaneous injuries were the most frequent (80.2%). The mean exposure rate was 2.6/100 beds/year. The anatomical areas involved to the greatest degree were the fingers (75.6%). A total 53.4% of those injured completed the serological follow-up without having shown any seroconversion. CONCLUSIONS: Throughout the sixteen-year period under study, the annual incidence of accidents involving an HIV-positive source increased from the 27 accidents reported in 1986 to the 60 accidents reported in 1990, there having been a downward trend as of that point in time, to the point of 12 accidents having been recorded in 2001.     

Traffic accidents and related injuries in Iranian professional drivers

Aim

The WHO statistics show that Iran has one of the highest rates of morbidities and mortalities due to traffic accidents in the world, which occurs in professional and nonprofessional drivers and motorcyclists, pedestrians, etc. This study investigates the rate of accidents in heavy vehicle drivers and related factors.

Subjects and methods

This study was performed on 1,136 heavy vehicle drivers who presented for periodic examinations to one of the official centers for examining drivers in the city of Yazd, Iran. Necessary information such as the history of traffic accidents, age, work experience, weekly working hours, etc were gathered using a checklist.

Results

The rate of reported accidents was 88 cases (7.7%) in 1?year. A significant relationship was observed between age, body mass index (BMI), working hours, and shift working with the rate of accidents (P?<?0.05). However, no significant relationships were found between having a second occupation, chronic diseases, and work experience with the rate of accidents (P?>?0.05). Even after adjustment of the study variables by regression analysis, a significant relationship was seen between traffic accidents and weekly working hours, BMI, and age over 60?years old and less than 29?years old (P?<?0.05).

Conclusion

This study shows that increased risk of traffic accidents is associated with increasing work hours. Therefore, the reduction of work hours for professional drivers may decrease the rate of accidents and related injuries.     

Evolution and factors associated with biological-risk accidents reported in a university hospital in Spain, 1989 to 1995

BACKGROUND: The objective of this study was to describe the profile and evolution of accidents involving risk of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) reported in a large Spanish hospital, together with the preventive measures administered and the factors associated with high-risk accidents. METHODS: Data used were the accidents recorded in the hospital during the period from January 1989 to December 1995. A logistic model, using age, gender, service, occupation, and year of accident as independent variables was constructed to study the factors associated with these accidents. RESULTS: The study included 1,009 accidents. Accidents were more common among nurses, female doctors, younger workers, and persons who worked in surgical settings. Of the total sources of infection studied, 11.6% were positive for HBV, 28.2% for HCV, and 24.4% for HIV. No seroconversions were detected in the partial follow-ups conducted. The factors associated with high-risk accidents were gender (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.24-3.60); occupation as physician (RR, 2.57; CI95, 1.54-4.29) or as nursing staff (RR, 1.80; CI95, 1.12-2.89); and working in a surgical service (RR, 2.01; CI95, 1.27-3.18). Younger workers had more accidents overall, but older workers were more likely to have high-risk exposure. In the multivariate analysis, the occupation (physician and nursing staff) was the most important variable when adjusted by the other factors. CONCLUSIONS: Our results suggest that a greater effort still is required in the application and evaluation of preventive measures. New safety systems, with clearly proven cost-effectiveness, should be developed and applied.     

Survey on accidental exposure to biological materials in the Hospital-University Complex of Sassari during the period 1995-2000

To study professional exposure to biological materials an investigation was carried out in the Hospital-University Complex of Sassari during the period January 1st 1995-December 31 2000. 1003 occupational accidents were notified (incidence rate=6%). Infirmaries were the most at risk category (45%) and about the half part of the accidents occurred in surgical area (44.7%). The most frequent accident was needle puncture (53%); exposure involved principally the hands (76.3%). The basal serology of injured personnel showed low positivity for any HBV markers (72.7%), HCV (0.4%) and no positivity for HIV; while high levels were found among source patients. From the comparison between serological data (injured vs source), when ascertainable, emerged a biological hazard of 7.7% for HBV, 30.2% for HCV and 3.2% for HIV; however no seroconversions were observed at follow up. The study also pointed out the need of improve prevention programmes.     

Traffic accidents in a metropolitan area in Brazil, 1991-2000

A time series study described the trend in motor vehicle accidents from 1991 to 2000, using data from the State Transit Department in Salvador, Bahia State, Brazil. Rates were calculated for total motor vehicle accidents, number of casualties, and standardized mortality based on population and number of vehicles, comparing two periods (1991-1994 and 1995-2000), before and after the adoption of safety measures including compulsory seat belt use and the new National Transit Code (NTC). Vehicle accident and casualty rates were high and showed little variation during the study period. The mortality rate decreased from 25.7/100,000 inhabitants in 1995 to 18.1/100,000 in 1998 and remained stable thereafter. The only significant difference (p < 0.001) was in the mean motor vehicle accident mortality rate before and after the intervention. The case fatality rate decreased from 10.7% (1995) to 7% (2000). Although still representing a major public health problem in this important metropolitan area, the decrease in motor vehicle accident mortality was possibly due to interventions in 1995 and expanded NTC measures in 1998. Greater efforts to change driver and pedestrian behavior could further decrease the high number of accidents and related mortality.     

Occupational noise exposure and work accidents

The purpose of this study was to verify whether occupational noise exposure is a significant risk factor for work accidents in the city of Piracicaba, S?o Paulo State, Brazil. This hospital-based case-control study included 600 workers aged 15-60 who suffered typical occupational accidents between May and October 2004 and were seen at the Piracicaba Orthopedics and Trauma Center. The control group comprised 822 workers, aged 15-60, who were also seen at the Center, and either had a non-occupational accident or were accompanying someone who had suffered an accident. A multiple logistic regression model was adjusted with work accident as an independent variable, controlled by covariables of interest such as noise exposure. The risk of having a work accident was about twice as high among workers exposed to noise, after controlling for several covariables. Occupational noise exposure not only affected auditory health status but was also a risk factor for work accidents.     

Rehabilitation service to the elder person victim of accidents and violence on different regions of Brazil

The purpose of this work is to describe the structure and characterize the services offered for rehabilitation of elder people, victims of accidents and violence, based on the main public policies of health for this population in Brazil. Following the principles of the triangulation method, a 27 question questionnaire was applied to 19 rehabilitation services (five in Manaus, seven in Recife, two in Brasília, two in Rio de Janeiro and three in Curitiba) about structure and organization of the service besides data registration. Managers and health professionals were interviewed about the flow, characterization and specificities of the service to elder people, protection chains, services evaluation and suggestions. Services in Manaus and Brasília are better prepared to attend elder victims of accidents and violence. The services in Brasília surpass the specific issues of elderly care. The rehabilitation units in Recife are more unprepared, especially regarding laboratorial support, qualification of professionals to identify and attend the cases of violence, registration and analysis of data. It is concluded that the rehabilitation service presents great fragility on the implantation of public policies and in insertion of the violence theme.     

Workers knowledge of accidents' causes

Accident constitutes a big problem of occupational health. It causes an economic loss to the work and worker. Six hundred workers were investigated by a well standardized questionnaire through interview. Most workers believed that the most important causes of accidents are those belonging to environment and work pattern. They did not know or denied that there are many important personal factors that are considered to be a corner stone in increasing accident rate. Ninety one percent of the investigated workers believed that the improper guarded machines are one of the most important causes of accidents, only 23% of the involved workers considered the psychological and social disturbance to cause accidents. It is concluded that there should be a well prepared program of health education to learn the workers the different causes of accidents and the methods to prevent and decrease the accident rates.     

Factors determining inpatient satisfaction with care

The objective of the study was to identify factors associated with satisfaction among inpatients receiving medical and surgical care for cardiovascular, respiratory, urinary and locomotor system diseases. Two weeks after discharge, 533 patients completed a Patient Judgments Hospital Quality questionnaire covering seven dimensions of satisfaction (admission, nursing and daily care, medical care, information, hospital environment and ancillary staff, overall quality of care and services, recommendations/intentions). Patient satisfaction and complaints were treated as dependent variables in multivariate ordinal polychotomous and dichotomous logistic stepwise regressions, respectively. Patient sociodemographic, health and stay characteristics as well as organization/ activity of service were used as independent variables. The two strongest predictors of satisfaction for all dimensions were older age and better self-perceived health status at admission. Men tended to be more satisfied than women. Other predictors specific for certain dimensions of satisfaction were: married, Karnofsky index more than 70, critical/serious self-reported condition at admission, emergency admission, choice of hospital by her/himself, stay in a medical service, stay in a private room, length of stay less than one week, stay in a service with a mean length of stay longer than one week. The factors associated with inpatient satisfaction elucidated in this study may be helpful in interpreting patient satisfaction scores when comparing hospitals, services or time periods, in targeting patient groups at risk of worse experiences and in focusing care quality programs.     

Occupational disparities in accidents and roles of lifestyle factors and disabilities: a population-based study in north-eastern France

OBJECTIVE: To assess occupational disparities with regard to the occurrence of occupational, traffic, domestic and sports accidents, and the role of factors such as smoking, excessive alcohol consumption, obesity, psychotropic drug intake and disability in mediating these disparities. METHODS: The sample included 3368 economically active subjects aged 18-64 years, selected at random in north-eastern France. Subjects completed a postal questionnaire about sociodemographic and lifestyle information, and recorded the occurrence of accidents by type during the previous 2 years. Data were analysed using a logistic regression model with different sets of independent variables and covariates in order to describe the disparities and investigate the role of personal factors. RESULTS: During the 2 years preceding the survey, 11.8% of men and 5.4% of women had an occupational accident, 3.7% of men and 4.5% of women had a traffic accident, 4.1% of men and 1.5% of women had a domestic accident, and 6.1% of men and 1.9% of women had a sports accident. Personal factors were strongly related to the occurrence of accidents, with different patterns in men compared with women, and according to the type of accident. Men in intermediary occupations, clerks, craftsmen and tradesmen and, to an even greater extent, manual workers and farmers had a much higher occurrence of occupational accidents than men in the upper occupations, while craftsmen and tradesmen had a much higher occurrence of traffic accidents. Manual workers had a lower occurrence of sports accidents. After adjustment for lifestyle factors and disability, estimated odds ratios were reduced slightly but remained significant. Occupational disparities in accidents were virtually non-existent among women. CONCLUSION: Occupational disparities in accidents mainly concern men and are predominantly observed in occupational and traffic accidents. Lifestyle factors do play a role in explaining these disparities, but are fairly limited. Improved work conditions, equipment, health behaviours, safe driving practices and accommodation of people with disabilities are needed to reduce the risk of accidents.