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Impact of socio-economic profiles on public health crisis of road traffic accidents: A qualitative study from South India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kristensen P, Kristiansen T, Rehn M, Gravseth HM, Bjerkedal T. Social inequalities in road traffic deaths at age 16-20 years among all 611,654 Norwegians born between 1967 and 1976: a multilevel analysis. Inj Prev 2011; 18:3-9. [PMID: 21606470 PMCID: PMC3262988 DOI: 10.1136/ip.2011.031682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Road traffic injury is a major cause of death among youths. Aims To estimate mortality differences in family socioeconomic position (SEP) and municipal disadvantage level. Methods Data on all Norwegians born in 1967–76, gathered from national registries, were linked by a unique national identification number. The 611 654 participants were followed-up for 5 years from age 16 years. Parental education level, father's income level, and proportion of high-income earners in the municipality served as SEP indicators. Associations between SEP and road traffic deaths were analysed by multilevel Poisson regression. Results Road traffic deaths (n=676, rate 22.2 per 100 000 person-years) constituted a major cause of death, of which 91.9% were motor vehicle occupants. SEP distributions differed according to gender and type of motor vehicle crash (collision, non-collision). There was an inverse relationship between municipal proportions of high-income earners and mortality (population attributable fraction (PAF) 0.43, 95% CI 0.30 to 0.53) in all categories of gender-specific crash types. Family SEP gradients were not found except for male non-collision deaths, where increasing mortality was found in association with decreasing parental education level (PAF 0.94, 95% CI 0.59 to 0.99) and increasing paternal income (PAF 0.25, 95% CI 0.06 to 0.40). Conclusion The different SEP patterns for road traffic deaths across gender and motor vehicle crash type illustrate that heterogeneity of social inequalities in health can be found even within narrow age bands and for similar causes of death.
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Affiliation(s)
- Petter Kristensen
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
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3
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Abstract
OBJECTIVE Although an association between behavior problems and childhood injuries has been established, the majority of studies have been cross-sectional and comorbidity has not been taken into account. The purpose of this study was to prospectively assess the relationship between behavior problems and the risk of unintentional injury in a population-based sample of Canadian children aged 4 to 11 years. METHOD This prospective cohort study considered data from Cycles 1 and 2 of the Canadian National Longitudinal Survey of Children and Youth. The outcome was injury in Cycle 2 (2 years later). The exposure was the presence of behavior problems in Cycle 1, defined as children with hyperactivity only, aggression only, anxiety only, hyperactivity with aggression, hyperactivity with anxiety, aggression with anxiety, and hyperactivity with aggression and anxiety. All groups were compared to children with no behavior problems. Covariates included child-related, parental, and social-environmental factors. RESULTS The final weighted longitudinal sample included 2,209,886 children, of which 11.4% were injured in Cycle 2. None of the behavior groups were at significant risk of injury 2 years later. However, children who lived with a single/no parent and children who did not live with a biological parent had a significantly greater risk of injury. After controlling for confounders, children who lived with a single/no parent had more than twice the risk of having an injury. CONCLUSION We need to look beyond behavior problems, and possibly at family and environmental factors, to reduce the burden of injuries in the Canadian population.
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Donroe J, Tincopa M, Gilman RH, Brugge D, Moore DAJ. Pedestrian road traffic injuries in urban Peruvian children and adolescents: case control analyses of personal and environmental risk factors. PLoS One 2008; 3:e3166. [PMID: 18781206 PMCID: PMC2528934 DOI: 10.1371/journal.pone.0003166] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 08/14/2008] [Indexed: 11/23/2022] Open
Abstract
Background Child pedestrian road traffic injuries (RTIs) are an important cause of death and disability in poorer nations, however RTI prevention strategies in those countries largely draw upon studies conducted in wealthier countries. This research investigated personal and environmental risk factors for child pedestrian RTIs relevant to an urban, developing world setting. Methods This is a case control study of personal and environmental risk factors for child pedestrian RTIs in San Juan de Miraflores, Lima, Perú. The analysis of personal risk factors included 100 cases of serious pedestrian RTIs and 200 age and gender matched controls. Demographic, socioeconomic, and injury data were collected. The environmental risk factor study evaluated vehicle and pedestrian movement and infrastructure at the sites in which 40 of the above case RTIs occurred and 80 control sites. Findings After adjustment, factors associated with increased risk of child pedestrian RTIs included high vehicle volume (OR 7·88, 95%CI 1·97–31·52), absent lane demarcations (OR 6·59, 95% CI 1·65–26·26), high vehicle speed (OR 5·35, 95%CI 1·55–18·54), high street vendor density (OR 1·25, 95%CI 1·01–1·55), and more children living in the home (OR 1·25, 95%CI 1·00–1·56). Protective factors included more hours/day spent in school (OR 0·52, 95%CI 0·33–0·82) and years of family residence in the same home (OR 0·97, 95%CI 0·95–0·99). Conclusion Reducing traffic volumes and speeds, limiting the number of street vendors on a given stretch of road, and improving lane demarcation should be evaluated as components of child pedestrian RTI interventions in poorer countries.
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Affiliation(s)
- Joseph Donroe
- Fogarty International Center/ Ellison Medical Foundation Research Fellow, Asociación Benéfica PRISMA, San Miguel, Lima, Perú.
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Stone DH. Ten myths about injury prevention that hinder effective child safety policy making. THE JOURNAL OF THE ROYAL SOCIETY FOR THE PROMOTION OF HEALTH 2007; 127:161-3. [PMID: 17711058 DOI: 10.1177/1466424007079485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David H Stone
- Department of Child Health, Division of Developmental Medicine, University of Glasgow, UK
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Ferrando J, Rodríguez-Sanz M, Borrell C, Martínez V, Plasència A. Individual and contextual effects in injury morbidity in Barcelona (Spain). ACCIDENT; ANALYSIS AND PREVENTION 2005; 37:85-92. [PMID: 15607279 DOI: 10.1016/j.aap.2004.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Revised: 05/10/2004] [Accepted: 05/18/2004] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine the relationship between socioeconomic level (measured through individual educational level and material deprivation in the areas of residence) and injury morbidity in different age groups and in males as well as in females. DESIGN Cross-sectional survey. SETTING Barcelona (Spain). METHODS The study population included all cases over the age of 19 who, as a result of an injury (motor vehicles injuries, falls, hits and cuts), were admitted to the emergency departments of the six main hospitals of the city during the years 1990-1991. Age- and sex-specific morbidity rates were calculated for each educational level and each cause of injury. The contextual variable included was the proportion of unemployment in each neighbourhood. Multilevel Poisson regression models were fitted. RESULTS Morbidity rates were higher in males, in young people and for lower educational levels. Results from the multilevel models show that, at contextual level, neighbourhoods with more unemployment present a higher risk of injuries. At individual level, after adjusting for contextual variables, the risk of sustaining injuries was higher among young men and women for all injury causes except falls among women where the risk was higher in the elderly; among both men and women, the risk of sustaining injury was higher in the population with lower educational level (RR = 1.79, 95% CI = 1.73-1.86 in men; RR = 2.12, 95% CI = 2.04-2.21 in women). This trend was also observed separately for traffic injuries, falls, hits and cuts. CONCLUSION Our results provide information about individual and contextual social inequalities in injury morbidity, the highest risks of injury occur in individuals of lower educational level and who reside in the more private neighbourhoods. These results underscore the need to implement injury prevention strategies not only at the individual level, but also to tailor them to the socioeconomic position of the population.
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Affiliation(s)
- Josep Ferrando
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, Barcelona 08023, Spain
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Abstract
Systematic observations of 231 children (infancy to 5 years) and the 231 adults accompanying them were made in 29 supermarkets in Edmonton, Alberta, Canada. The objective of the study was to describe the influence of two indices of adult supervision in supermarkets on children's activities in shopping carts. Adult supervision was measured by whether the adult ever lost sight of the child and whether the adult was 10 feet or more from the child at any time during a shopping trip. 23% of the children stood on the ends or sides of carts; 49% climbed or tried to climb out of carts. Adults lost sight of a child, whether in or outside the cart, a mean of 3.3 times and were 10 feet away 2.7 times during an average shopping trip. Logistic regression showed that a child rather than an adult pushing a shopping cart through the store was the strongest factor related to standing on ends or sides of carts. Pushing by a child was more likely to occur when adult monitoring was low and when children were older. Climbing out was predicted by the number of times an adult was > or = 10 feet away, older children, and a child being in the cart basket as opposed to outside the cart or in the child safety seat.
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Affiliation(s)
- W Andrew Harrell
- University of Alberta, Centre for Experimental Sociology, Edmonton, Canada.
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Abstract
Observations of 246 children and the adults accompanying them were carried out in supermarkets. Of those arriving and leaving by automobile (n = 194), 36% of adults used safety belts, and 51.1% of children used safety belts or restraining seats. While shopping, 79% of adults lost sight of the children in their care at least once, and 73.2% were 10 feet or more from their children at least once. 48% of children climbed or attempted to climb from carts; 27% stood in carts, and 23.6% handled hazardous products. 24% of adults purchased tobacco products. Poor adult supervision of children was related to adult's nonuse of safety belts and the child's and adult's ages. Climbing from the cart was related in a logistic regression to both poor adult supervision and child's age. Tobacco purchases were related to handling of hazards by children and standing in carts. Child's age and adult's safety belt use related to the restraint of children in vehicles.
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Affiliation(s)
- W Andrew Harrell
- University of Alberta, Centre for Experimental Sociology, Edmonton, Canada.
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Abstract
Injuries continue to place a tremendous burden on the public's health and rates vary widely among different groups in the population. Increasing attention has recently been given to the effects of socioeconomic status (SES) as a determinant of health among both individuals and communities. However, relatively few studies have focused on the influence of SES and injuries. Furthermore, those that have, and the other injury studies that have included measures of SES in their analysis, have varying degrees of conceptual and methodological rigor in their use of this measure. Recent advances in data linkage and analytic techniques have, however, provided new and improved methods to assess the relationship between SES and injuries. This review summarizes the relevant literature on SES and injuries, with particular attention to study design, and the measurement and interpretation of SES. We found that increasing SES has a strong inverse association with the risk of both homicide and fatal unintentional injuries, although the results for suicide were mixed. However, the relationship between SES and nonfatal injuries was less consistent than for fatal injuries. We offer potential explanatory mechanisms for the relationship between SES and injuries and make recommendations for future research in this area.
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Affiliation(s)
- Catherine Cubbin
- Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, 1000 Welch Road, Palo Alto, California 94304-1825, USA.
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Scott KK. The psychological aspects of pediatric trauma: perspectives on patient, family, and provider. Surg Clin North Am 2002; 82:419-34, viii. [PMID: 12113376 DOI: 10.1016/s0039-6109(02)00013-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pediatric trauma engenders multi-system injury--physiological as well as psychological. Not only does injury to a child affect the patient, but also the family system within which the child functions. Professional caregivers, too, are not immune to the emotional aftermath of pediatric traumatic injury. Effective management of the pediatric trauma patient must, therefore, include an understanding of the psychological aspects of injury--for the patient, the family, and the provider. This chapter seeks to delineate these variables in an effort to promote effective identification of the emotional components of injury and facilitation of necessary interventions in promoting positive overall injury outcomes.
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Affiliation(s)
- Kamela K Scott
- Department of Surgery, University of Florida Health Science Center, Jacksonville, USA.
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Chen E, Matthews KA, Boyce WT. Socioeconomic differences in children's health: how and why do these relationships change with age? Psychol Bull 2002; 128:295-329. [PMID: 11931521 DOI: 10.1037/0033-2909.128.2.295] [Citation(s) in RCA: 368] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effects of socioeconomic status (SES) on health are well documented in adulthood, but far less is known about its effects in childhood. The authors reviewed the literature and found support for a childhood SES effect, whereby each decrease in SES was associated with an increased health risk. The authors explored how this relationship changed as children underwent normal developmental changes and proposed 3 models to describe the temporal patterns. The authors found that a model's capacity to explain SES-health relationships varied across health outcomes. Childhood injury showed stronger relationships with SES at younger ages, whereas smoking showed stronger relationships with SES in adolescence. Finally, the authors proposed a developmental approach to exploring mechanisms that link SES and child health.
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Affiliation(s)
- Edith Chen
- Department of Psychology, Washington University, St Louis, Missouri 63130, USA.
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Laflamme L, Diderichsen F. Social differences in traffic injury risks in childhood and youth--a literature review and a research agenda. Inj Prev 2000; 6:293-8. [PMID: 11144632 PMCID: PMC1730678 DOI: 10.1136/ip.6.4.293] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda. METHOD A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries. RESULTS For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender. CONCLUSIONS The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.
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Affiliation(s)
- L Laflamme
- Karolinska Institutet, Department of Public Health Sciences, Stockholm and National Institute of Public Health, Sweden.
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Nathens AB, Neff MJ, Goss CH, Maier RV, Rivara FP. Effect of an older sibling and birth interval on the risk of childhood injury. Inj Prev 2000; 6:219-22. [PMID: 11003189 PMCID: PMC1730635 DOI: 10.1136/ip.6.3.219] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Certain family structures have been identified as putting children at high risk for injury. To further define children at highest risk, we set out to explore the effect of an older sibling and birth interval on the risk of injury related hospital admission or death. METHODS Data were analyzed using a case-control design. Cases and controls were identified by linking longitudinal birth data from Washington state (1989-96) to death certificate records and hospital discharge data obtained from the Washington State Comprehensive Hospital Abstract Reporting System and frequency matched in a 1:2 ratio on year of birth. Cases consisted of singleton children 6 years of age or younger who were hospitalized or died as a result of injury during the years 1989-96. Multivariate logistic regression was used to identify and adjust for confounding variables. RESULTS There were 3145 cases and 8371 controls. The adjusted odds ratio for injury in children with an older sibling was 1.50 (95% confidence interval 1.37 to 1.65). The effect was greatest in children under 2 years of age, and in those with a birth interval of less than two years. As the number of older siblings increased, so did the risk of injury, with the highest risk in children with three or more older siblings. CONCLUSION These data suggest that the presence of an older sibling is associated with an increased risk of injury. The risk is highest in those with very short birth intervals. Potential mechanisms for this increased risk may relate to inadequate parental supervision. Pediatricians and other care providers need to be alert to these identifiable risk factors and then direct preventive strategies, such as home visits and educational programs, toward these families.
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Affiliation(s)
- A B Nathens
- Harborview Injury Prevention and Research Center, Department of Surgery, Seattle, Washington 98104, USA.
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Wazana A, Krueger P, Raina P, Chambers L. A review of risk factors for child pedestrian injuries: are they modifiable? Inj Prev 1997; 3:295-304. [PMID: 9493628 PMCID: PMC1067858 DOI: 10.1136/ip.3.4.295] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To identify modifiable risk factors for child pedestrian injuries. DATA SOURCES (1) MEDLINE search from 1985 to 1995; search term used was traffic accidents; (2) review of reference lists from retrieved articles and books; (3) review of reference lists from three systematic reviews on childhood injuries and (4) consultation with 'key informants'. STUDY SELECTION All studies that examined the risk factors for child pedestrian injuries were targeted for retrieval. Seventy potentially relevant articles were identified using article titles, and, when available, abstracts. Of the 70 retrieved articles, 44 were later assessed as being relevant. QUALITY ASSESSMENT Articles were classified on the basis of study design as being either descriptive (hypothesis generating) (26) or analytical (hypothesis testing) (18) studies. Consensus was used for difficult to classify articles. DATA EXTRACTION Variables judged to be risk factors for child pedestrian injuries were extracted by one author. DATA SYNTHESIS A qualitative summary of the information extracted from relevant articles is presented in tabular form. RESULTS Risk factors for child pedestrian injuries were classified as: (1) child, (2) social and cultural, (3) physical environment, and (4) driver. Risk factors within each classification are summarized and discussed.
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Affiliation(s)
- A Wazana
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Affiliation(s)
- F P Rivara
- Harborview Injury Prevention and Research Center, Seattle, WA 98104-2499, USA
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Wazana A. Are there injury-prone children? A critical review of the literature. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1997; 42:602-10. [PMID: 9288422 DOI: 10.1177/070674379704200606] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To review the evidence of general injury and pedestrian injury studies to determine if there are child behavioural, emotional, developmental, or physical characteristics that put children at higher risk for injury and, if there are such proneness risk factors, to determine their importance relative to other risk factors. METHODS This paper critically assesses 11 general child injury studies and 6 child pedestrian injury studies that have examined variables of child proneness. Information on study design, source of data, magnitude and significance of the risk factors identified, and study limitations are presented in separate sections. RESULTS A critical review of the literature suggests that aggression is a consistent risk factor for general injuries but not for pedestrian injuries, hyperactivity is inconsistently associated with all types of injuries, and both a general measure of behaviour problems and a measure of unsafe behaviour were found to be significantly related to pedestrian injuries. A look at the pedestrian injury literature suggests that child risk factors make a consistent but minor contribution to injuries in comparison with environmental and social risk factors. CONCLUSIONS We need to address the environmental and social risk factors by educating parents about the roles of home stressors, poor supervision, and high-risk exposure in child injuries and by adding our voice to the efforts to bring into effect engineering and legislative interventions.
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Affiliation(s)
- A Wazana
- Department of Psychiatry, Montreal Children's Hospital, Quebec
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Affiliation(s)
- R A Schieber
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services, Atlanta, Georgia 30341, USA
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Abstract
OBJECTIVES To examine the association between sensory deficit and the risk of child pedestrian-motor vehicle collisions. SETTING The Auckland region of New Zealand. METHODS A community based case-control study was conducted. Cases (n = 190) were all children (< 15 years) killed or hospitalised as a result of a pedestrian injury occurring on a public road between 1 January 1992 and 1 March 1994. Controls (n = 479) were a random sample of the child population. RESULTS The risk of pedestrian injury for children whose parents reported abnormal vision was over four times that of children with reported normal vision (odds ratio = 4.25, 95% confidence interval 1.68 to 10.8). The risk of injury for children whose parents reported abnormal hearing was close to twice that of children with reported normal hearing (odds ratio = 1.73, 95% confidence interval 0.83 to 3.61). CONCLUSIONS Children with sensory deficits constitute a high risk group for pedestrian injuries. Paediatricians caring for children with sensory impairments should be aware of this increased risk.
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Affiliation(s)
- I Roberts
- Starship Children's Health, South Pacific, Auckland, New Zealand
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Correction: How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects. West J Med 1993. [DOI: 10.1136/bmj.306.6894.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Pedestrian injuries are a leading cause of childhood mortality and disability. Over the past two decades in Britain child pedestrian death rates have fallen despite large increases in traffic volume. In this paper Roberts examines the likely reasons for this decline. He argues that neither prevention programmes nor improvements in medical care are a plausible explanation and that the decline is most likely the result of a substantial reduction in children's traffic exposure. He believes, however, that restricting children's traffic exposure exacerbates socioeconomic differentials in childhood mortality and denies children their right to mobility. Roberts is convinced that one answer is for British transport policy to be aimed at providing mobility equitably rather than struggling to meet the ever increasing demands of car travel.
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Affiliation(s)
- I Roberts
- Department of Community Health, University of Auckland, New Zealand
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Abstract
In the week 3-9 March 1958, 98% of all births in England, Scotland and Wales (approximately 17,000) were studied in the Perinatal Mortality Survey. The follow-up of surviving children, known as the National Child Development Study, comprises four major sweeps at ages 7, 11, 16 and 23. Medical examinations were conducted at each age, except at 23 when health was self-reported. Details of the child's family background and socio-economic circumstances were recorded, together with assessments of their social development and educational attainment. Seventy-six per cent of the target population were interviewed at age 23. The health of subjects in the 1958 cohort has been described in over 200 publications but there is no comprehensive account of findings from birth to age 23. This overview attempts to redress this. As new data are gathered from the study subjects at age 33, opportunities will exist to investigate associations between childhood factors and health in midlife. Data on their partners and children will be included, allowing studies of inter-generational and family health. Further indications of changing illness patterns will be possible from comparisons with data collected on earlier and later born cohorts.
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Affiliation(s)
- C Power
- Department of Paediatric Epidemiology, Institute of Child Health, London, England
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