Comparación de dos métodos de detección de posibles efectos adversos intrahospitalarios / No disponible

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Diferencias en estilos de vida y calidad de la información autorreferida según nivel de estudios: el proyecto SUN / Differences in lifestyle and quality of self-reported information according to educational level: the SUN cohort study

El objetivo de este estudio fue valorar las diferencias en estilos de vida y calidad de información autorreferida según el nivel de estudios, a partir de la base de datos de participantes de una cohorte prospectiva. Para ello realizamos un análisis transversal basal de los participantes(n=15404) de la cohorte SUN. En los universitarios el índice de masa corporal y la prevalencia de hipercolesterolemia fueron signifi cativamenteinferiores, mientras que la ingesta de alcohol fue ligeramente superior. En el resto de las 37 variables comparadas sobre estilo de vida o alimentación no existieron diferencias estadísticamente signifi cativas.En cambio, los no universitarios tenían más datos perdidos (odds ratio ajustada: 1,99; IC 95%: 1,68-2,37). Excepto tres excepciones, no se apreciaron diferencias signifi cativas en el estilo de vida o alimentaciónsegún el nivel de estudios. Sin embargo, la calidad de las respuestas fue muy superior en los universitarios

We assessed differences across educational levels in lifestyle to evaluate selection bias and quality of self-reported information in the baseline data of participants in a prospective cohort. A baseline cross-sectional analysis of the data of participants (n=15,404) in the SUN cohort was conducted. Among participants with higher (university) educationallevels, body mass index and prevalence of high blood cholesterol were signifi cantly lower than in participants with lower educational level,whereas alcohol consumption was slightly higher. In another 37 lifestyle/nutrition variables compared, there were no signifi cant differences. Onother hand, missing data were more frequently found among participants with lower education (adjusted odds ratio: 1.99; 95% CI; 1.68-2.37). With only 3 exceptions, no signifi cant differences in lifestyle or foodhabits were found between educational levels. However, the quality of self-reported information was considerably greater among more highly educated participants10pt;}

Diferencias en estilos de vida y calidad de la información autorreferida según nivel de estudios: el proyecto SUN / No disponible

El objetivo de este estudio fue valorar las diferencias en estilos de viday calidad de información autorreferida según el nivel de estudios, apartir de la base de datos de participantes de una cohorte prospectiva.Para ello realizamos un análisis transversal basal de los participantes(n=15404) de la cohorte SUN. En los universitarios el índice de masacorporal y la prevalencia de hipercolesterolemia fueron signifi cativamenteinferiores, mientras que la ingesta de alcohol fue ligeramente superior.En el resto de las 37 variables comparadas sobre estilo de vida oalimentación no existieron diferencias estadísticamente signifi cativas.En cambio, los no universitarios tenían más datos perdidos (odds ratioajustada: 1,99; IC 95%: 1,68-2,37). Excepto tres excepciones, no seapreciaron diferencias signifi cativas en el estilo de vida o alimentaciónsegún el nivel de estudios. Sin embargo, la calidad de las respuestasfue muy superior en los universitarios(AU)

We assessed differences across educational levels in lifestyle to evaluateselection bias and quality of self-reported information in the baselinedata of participants in a prospective cohort. A baseline cross-sectionalanalysis of the data of participants (n=15,404) in the SUN cohort wasconducted. Among participants with higher (university) educationallevels, body mass index and prevalence of high blood cholesterol weresignifi cantly lower than in participants with lower educational level,whereas alcohol consumption was slightly higher. In another 37 lifestyle/nutrition variables compared, there were no signifi cant differences. Onother hand, missing data were more frequently found among participantswith lower education (adjusted odds ratio: 1.99; 95% CI; 1.68-2.37).With only 3 exceptions, no signifi cant differences in lifestyle or foodhabits were found between educational levels. However, the quality ofself-reported information was considerably greater among more highlyeducated participants(AU)

Use of national health interview data to measure the burden of disease and injuries.

BACKGROUND: Although it is acknowledged that injuries place a substantial burden on populations throughout the world, few studies have measured the burden of non-fatal injuries and compared it with that of other health conditions. METHODS: Data for the adult population were obtained from the 2001 Spanish National Health Interview, a household telephone survey of the Spanish population. Differences in six measures of burden were compared for up to 11 conditions by age and gender. Proportions and their 95% CIs are reported. RESULTS: Injuries contribute 11-23% of the total health burden of the adult Spanish population, depending on which of the six indicators is used. They rank first and second out of the 11 conditions with regard to emergency visits and hospital admission, respectively. They rank third to sixth when other measures are chosen (ie, reduction in leisure activities, reduction in main activities, consulting a doctor, bedridden for half a day). Rheumatological, cardiovascular, and respiratory conditions are the only other conditions with a burden of comparable magnitude. CONCLUSION: In the adult Spanish population, injuries are an important cause of burden, regardless of the specific indicator used to define burden. These findings are likely to be equally applicable in similar countries. This type of comparison may raise the profile of injuries among health professionals and policy makers.

A comparison of information on motor vehicle crashes as reported by written or telephone interviews.

OBJECTIVE: To compare information about traffic crash injuries and kilometers driven reported in a written questionnaire with information reported in a telephone interview. DESIGN: Telephone and paper surveys. SETTING: The Seguimiento Universidad de Navarra (SUN, University of Navarra Follow-up) study, in Spain. The SUN study is an open enrollment cohort study with 17 000 enrolled graduates followed through biennial mailed questionnaires. SUBJECTS: A sample of 542 individuals from the SUN study participants. MAIN OUTCOME MEASURE: Agreement on information about traffic crash injuries and mileage driven in a mailed questionnaire and a telephone survey. RESULTS: Participation was 90.4%. Considering the phone survey as the gold standard, data on traffic crash injuries in the mailed questionnaire had 83% sensitivity (95% CI 77% to 89%), 77% specificity (95% CI 71% to 82%), 74% positive predictive value (95% CI 67% to 80%), and 89% negative predictive value (95% CI 83% to 93%). Agreement beyond chance, measured by the kappa statistic, was 0.63 (95% CI 0.56 to 0.70). Correlation between questionnaire and telephone surveys and kilometers driven on average during a year assessed by the intraclass correlation coefficient was 0.64 (95% CI 0.57 to 0.70), p<0.001. CONCLUSIONS: Information on sustained traffic crash injuries and traveled mileage over the previous two years as reported through mailed questionnaires in a highly educated population could be used in the study of associations between traffic crash injuries and a variety of risk factors.

Changes in injury patterns in frontal crashes: preliminary comparisons of drivers of vehicles model years 1993-1997 to drivers of vehicles 1998-2001.

Injury severity among drivers of vehicles model year 1993-1997 was compared to that of drivers of vehicles 1998-2001. Data from the National Automotive Sampling System Crashworthiness Data Sets 1993-2000 were used. Differences in injury patterns by model year and gender, type of vehicle, single- or multiple-car crash, severity of crash, safety belt use and airbag deployment were investigated. The 1206 eligible drivers in newer vehicles presented significantly fewer and less severe injuries than their 3827 pre-1998 model year counterparts. This is true for men and women, across severity of crash, and even when confounders are accounted for. The re-design of frontal airbags that occurred around 1998 could be partly responsible for these improvements.

Factors associated with severity and hospital admission of motor-vehicle injury cases in a southern European urban area.

OBJECTIVES: To describe the characteristics of motor-vehicle (MV) injury cases admitted to Emergency departments (ED), and to assess factors related to injury severity and hospital admission. SETTING: Subjects were MV injury patients, aged 16 or more, admitted to four EDs in the city of Barcelona (Spain), from July 1995 to June 1996. METHODS: Cross-sectional design. The data analyzed were obtained from the information routinely transmitted from the EDs to the Municipal Institute of Health, based on the processing of ED logs. Severity was assessed with the Abbreviated Injury Scale and the Injury Severity Score. Univariate and bivariate descriptive statistical analyses were performed, as well as multiple logistic regressions. RESULTS: For the 3791 MV-injury cases included in the study period, a larger contribution of cases was noted for males (63.1%), for cases younger than 30 years (55.3%) and for motorcycle or moped occupants (47.1%). After adjusting for age, sex and the presence of multiple injuries, pedestrians, followed by moped and motorcycle occupants were at a higher risk of a more severe injury (OR: 1.77, 1.61 and 1.50 respectively). Correspondingly, these user groups also showed a higher likelihood of a hospital admission (OR: 2.03, 1.92 and 2.00 respectively), when attended to in an ED. Injury cases attended to in the ED during night hours (OR: 2.06) were also at a higher risk of a hospital admission. CONCLUSIONS: In Barcelona, pedestrians and two-wheel MV occupants, besides accounting for two-thirds of MV injury cases, are the user groups with a greater risk of a more severe injury. as well as a higher chance of a hospital admission, independently of demographic and health care factors.

An overview of the injury severity score and the new injury severity score.

OBJECTIVE: The research was undertaken to describe the injury severity score (ISS) and the new injury severity score (NISS) and to illustrate their statistical properties. DESIGN: Descriptive analysis and assessment of the distribution of these scales. METHODS: Three data sources--the National Pediatric Trauma Registry; the Massachusetts Uniform Hospital Discharge Data Set; and a trauma registry from an urban level I trauma center in Massachusetts--were used to describe the distribution of the ISS and NISS among injured patients. RESULTS: The ISS/NISS was found to have a positively skewed distribution and transformation did not improve their skewness. CONCLUSION: The findings suggest that for statistical or analytical purposes the ISS/ NISS should not be considered a continuous variable, particularly if ISS/NISS is treated as a continuous variable for correlation with an outcome measure.

Where children sit in cars: the impact of Rhode Island's new legislation.

OBJECTIVES: This study evaluated the impact of Rhode Island's legislation requiring children younger than 6 years to sit in the rear of motor vehicles. METHODS: Roadside observations were conducted in Rhode Island and Massachusetts in 1997 and 1998. Multivariate regression was used to evaluate the proportion of vehicles carrying a child in the front seat. RESULTS: Data were collected on 3226 vehicles carrying at least 1 child. In 1998, Rhode Island vehicles were less likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant changes in child passenger seating behavior occurred in Massachusetts during that period. CONCLUSIONS: Rhode Island's legislation seems to have promoted safer child passenger seating behavior.

Child passenger safety: decisions about seating location, airbag exposure, and restraint use.

The installation of passenger-side airbags in new vehicles complicates efforts to maximize child safety in motor vehicle crashes. It has been recommended by both public and private organizations that children sit in the rear seat with proper restraint to achieve maximum safety. Drivers now need to decide whether a child should be restrained, where the child should be seated (front versus rear), and whether the child should be seated in front of a passenger-side airbag. This research was undertaken to determine which choice minimizes the risk of fatality to children. Using data from the U.S. Fatality Analysis Reporting System for calendar years 1989 to 1998, fatal vehicle crashes with child passengers younger than 13 years were analyzed. The effectiveness of passenger-side airbags and rear seating for children, by age category and restraint use, was estimated using the double-pair comparison method. For each of four age categories, the fatality risk of each possible combination of restraint use, seating location, and airbag presence was also estimated using logistic regression. Passenger airbags were associated with an increase in child fatality risk of 31% for restrained children, and 84% for unrestrained children. Passenger airbags did appear to offer protection to restrained 9- to 12-year-old children. Restraint use and rear seating were associated with statistically significant reductions in the odds of a child dying in a crash. In order to minimize child fatality risk, parents should seat children in the rear of the vehicle while using the proper child restraint system, especially in vehicles with passenger airbags. These findings support current public education efforts in the United States.

Driver air bag effectiveness by severity of the crash.

OBJECTIVES: This analysis provided effectiveness estimates of the driver-side air bag while controlling for severity of the crash and other potential confounders. METHODS: Data were from the National Automotive Sampling System (1993-1996). Injury severity was described on the basis of the Abbreviated Injury Scale, Injury Severity Score, Functional Capacity Index, and survival. Ordinal, linear, and logistic multivariate regression methods were used. RESULTS: Air bag deployment in frontal or near-frontal crashes decreases the probability of having severe and fatal injuries (e.g., Abbreviated Injury Scale score of 4-6), including those causing a long-lasting high degree of functional limitation. However, air bag deployment in low-severity crashes increases the probability that a driver (particularly a woman) will sustain injuries of Abbreviated Injury Scale level 1 to 3. Air bag deployment exerts a net injurious effect in low-severity crashes and a net protective effect in high-severity crashes. The level of crash severity at which air bags are protective is higher for female than for male drivers. CONCLUSIONS: Air bag improvement should minimize the injuries induced by their deployment. One possibility is to raise their deployment level so that they deploy only in more severe crashes.

Evaluating worksite-based interventions that promote safety belt use.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of worksite-based interventions in increasing the use of safety belts among employees. SEARCH STRATEGIES: Using the Cochrane Collaboration search strategy, we searched in electronic databases, review articles, U.S. government documents, and reports of research agencies. SELECTION CRITERIA: Studies had to be evaluations of worksite-based interventions with a clear description of the program. The outcomes evaluated were the percentage of drivers using their safety belts before and after the intervention and (when possible) after a follow-up period. Safety belt use had to be measured in an objective manner, and a comparison group was necessary. RESULTS: Forty-eight interventions met the selection criteria. All interventions increased safety belt use among employees, and in 16 the increases were significant (p<0.05). In 15 of the 33 interventions in which follow-up observations were reported, safety belt use continued significantly higher than at baseline. Different strategies (and combinations of strategies) were used across interventions. Interventions incorporating incentives seemed to have stronger effects in increasing safety belt use. CONCLUSIONS: All reviewed interventions had a positive impact on increasing driver use of safety belts. However, it is important to note the low baseline safety belt use existing at the time when the studies took place, the short-term duration of most interventions, and the short-term follow-up reported (if any). More rigorous research in contemporary worksites is needed.

Patterns of injury among drivers hospitalized in Level-I Trauma Centers: have frontal airbags made a difference?

This study describes the injuries of drivers discharged from Level-I Trauma Centers between 1995-1997. Differences in the drivers' injuries and outcomes by airbag deployment status and gender were evaluated using Chi 2 and T-tests. Data on 1,065 drivers (66 with airbags, 423 females) were obtained from the Massachusetts Registry of Motor Vehicle and Trauma Registries. Once admitted to trauma centers, drivers with airbags did not differ from drivers without airbags regarding the number, type, clustering, severity or outcome of their injuries. The only exception was that female drivers sustained more fractures to the upper extremities and less injuries to blood vessels and certain traumatic complications (p < 0.05).

Motor-vehicle injury patterns in emergency-department patients in a south-European urban setting.

The objectives are to identify the main injury patterns in the various types of user (of cars, motorcycles/mopeds, bicycles and pedestrians) injured in traffic crashes and treated in hospital emergency services, along with their main demographic characteristics. One-year cumulative survey all of patients attended to emergency departments in Barcelona, Spain, over a 12-month period (1998) for injuries due to motor vehicle crashes. Bivariate descriptive analyses were conducted to identify the different profiles of motor-vehicle injury patients by age, sex, user type, injured body region and type of injuries. ISS scoring was used to determine injury severity. Of the nearly 17,000 injured traffic victims during 1998, 62% were men. Young people between 15 and 39 (71.6%) were most affected. 42% were users of two-wheeled motor vehicles, followed by car occupants (32%) and pedestrians (24%). Neck sprain (33%) was the most common injury among car occupants, multiple contusion and contusion of lower limbs among two-wheeled motor vehicles (23.5% and 14% respectively) and pedestrians (17.3% and 14.4% respectively) and upper limb fractures (20%) among cyclists. Motorcycle and moped users, mainly young males, have the highest probability of suffering injuries, with lower limbs being the most affected anatomical region. Elderly pedestrians sustaining injuries to the lower limbs and the head contribute substantially to the overall injury situation.

Driver distance from the steering wheel: perception and objective measurement.

OBJECTIVES: This study assessed the accuracy of driver perceptions of the distance between the driver's nose and the steering wheel of the vehicle as a factor in considering driver disconnection of an airbag contained in the steering wheel for preventing injury to the driver in an accident. METHODS: A cross-sectional survey of 1000 drivers was done to obtain perceived and objective measurements of the distance between the driver's nose and the steering wheel of the vehicle. RESULTS: Of 234 drivers who believed that they sat within 12 inches of the steering wheel, only 8 (3%) actually did so, whereas of 658 drivers who did not believe that they sat within 12 inches of the wheel, 14 (2%) did so. Shorter drivers were more likely than taller ones to both underestimate and overestimate their seating distance. CONCLUSIONS: Considerable misperception of drivers' distance from the wheel indicates that drivers should objectively measure this distance.

Evaluating interventions that promote the use of rear seats for children.

OBJECTIVE: To evaluate interventions that promote the use of the rear seat among children riding in motor vehicles. SEARCH STRATEGIES: Using the Cochrane Collaboration search strategy, we searched in electronic databases and reference lists of past reviews and review articles. We also searched among studies from government and research agencies in the United States and abroad, and contacted experts in the field. SELECTION CRITERIA: Studies for selection had to be evaluations of interventions in defined populations, with a clear description of the program and the outcomes evaluated. Outcomes had to be measured in an objective manner, and there needed to be a comparison group. DATA COLLECTION AND ANALYSIS: Six studies met the selection criteria. Changes in the proportion of observed children traveling in the rear seats before and after the implementation of the intervention were the main outcome of interest. MAIN RESULTS: Two studies evaluating the effectiveness of educational campaigns promoting the use of the rear seat found increases in the proportion of children riding in the rear seats, but only in one study were the increases statistically significant (from 86% to 91%). The four remaining studies reported changes in seating location as a side effect of legislation requiring child restraint use among children traveling in the front seats. In two of these four studies, the percentage of children riding in the rear seats significantly increased from 49% to 62% and from 88% to 98%. In the remaining two studies there were small, but not statistically significant, changes in the proportion of children riding in the rear seats, with percentages remaining around 60% and 85%. CONCLUSIONS: Interventions aimed at promoting the use of rear seats by children traveling in motor vehicles have been rare. Only one educational program whose only objective was to promote rear seating location was found and this 1973 Danish study had a positive impact. The other educational campaign, a pilot program that also focused on improving child restraint use, had no significant impact in promoting seating of children in the rear. We did not find any evaluation of legislation prohibiting children to sit in the front seats. Legislation requiring proper child restraint use in the front seats (and thus, compelling unrestrained children to seat in the rear) has produced, for the most part, a nonsignificant increase in the proportions of children sitting in the rear.

Reducing risks to children in vehicles with passenger airbags.

This review examines the risk that passenger airbags pose for children and discusses behavioral and technologic measures aimed at protecting children from airbag deployment. Although airbags reduce fatal crash injuries among adult drivers and passengers, this safety technology increases mortality risk among children younger than age 12. The magnitude of the risk is multiplied when children are unrestrained or restrained improperly. As new vehicles are resold to buyers who tend to be less safety-conscious than new car owners, the number of children endangered by passenger airbag deployment may increase. For vehicles already in the fleet, strong measures are required to secure children in the rear seat and increase the proper use of appropriate restraint systems through police enforcement of laws. One promising strategy is to amend child passenger safety laws to require that parents secure children in the rear seats. For future vehicles, a mandatory performance standard should be adopted that suppresses airbag deployment automatically if a child is located in the front passenger seat. Other promising improvements in airbag design also are discussed. Major changes in passenger airbag design must be evaluated in a broad analytical framework that considers the welfare of adults as well as children.