Deaths from violence in North Carolina, 2004: how deaths differ in females and males.

OBJECTIVE: To identify gender differences in violent deaths in terms of incidence, circumstances, and methods of death. DESIGN: Analysis of surveillance data. SETTING: North Carolina, a state of 8.6 million residents on the eastern seaboard of the US. SUBJECTS: 1674 North Carolina residents who died from violence in the state during 2004. METHODS: Information on violent deaths was collected by the North Carolina Violent Death Reporting System using data from death certificates, medical examiner reports, and law enforcement agency incidence reports. RESULTS: Suicide and homicide rates were lower for females than males. For suicides, females were more likely than males to have a diagnosis of depression (55% v 36%), a current mental health problem (66% v 42%), or a history of suicide attempts (25% v 13%). Firearms were the sole method of suicide in 65% of males and 42% of females. Poisonings were more common in female than male suicides (37% v 12%). Male and female homicide victims were most likely to die from a handgun or a sharp instrument. Fifty seven percent of female homicides involved intimate partner violence, compared with 13% of male homicides. Among female homicides involving intimate partner violence, 78% occurred in the woman's home. White females had a higher rate of suicide than African-American females, but African-American females had a higher rate of homicide than white females. CONCLUSIONS: The incidence, circumstances, and methods of fatal violence differ greatly between females and males. These differences should be taken into account in the development of violence prevention efforts.

Use of protective equipment in a cohort of rugby players.

PURPOSE: To describe the level of usage of protective devices and equipment in a cohort of New Zealand rugby players. METHODS: Male and female players (N = 327) from a range of competitive grades were followed over the course of the season. Participants were interviewed weekly about their participation in rugby and use of protective equipment. The main outcome measure was percentage of all player-weeks of follow-up for which each equipment item was used. RESULTS: Mouthguards, the most commonly used equipment item, were worn for 64.9% of player-weeks. Mouthguard usage ranged from 55.0% of player-weeks in Schoolgirls grade to 72.9% of player-weeks in Senior A competition. The next most common item was taping of body joints (23.7% of player-weeks). The sites most commonly taped were the ankle, knee, and hand. Overall usage for the other protective equipment items studied (shin guards, padded headgear, head tape, support sleeves, and grease) was below 15%. In general, forwards had higher usage of protective equipment than backs, and male players had higher usage than female players. The most common self-reported reasons for using protective equipment were to prevent injury and because of a past injury. Players exhibited considerable week-to-week variation in their usage of protective equipment. CONCLUSIONS: In general, equipment usage was highest in those at greatest risk of injury, namely, forwards, male players, and the senior grades. The high voluntary use of mouthguards is encouraging and indicative of a base of player support for their role in this sport.

The New Zealand rugby injury and performance project. VI. A prospective cohort study of risk factors for injury in rugby union football.

OBJECTIVES: Although the nature of rugby injury has been well documented, little is known about key risk factors. A prospective cohort study was undertaken to examine the association between potential risk factors and injury risk, measured both as an injury incidence rate and as a proportion of the playing season missed. The latter measure incorporates a measure of injury severity. METHODS: A cohort of 258 male players (mean (SD) age 20.6 (3.7) years) were followed through a full competitive season. At a preseason assessment, basic characteristics, health and lifestyle patterns, playing experience, injury experience, training patterns, and anthropometric characteristics were recorded, and then a battery of fitness tests were carried out. RESULTS: A multiple regression model identified grade and previous injury experience as risk factors for in season injury, measured as an injury incidence rate. A second model identified previous injury experience, hours of strenuous physical activity a week, playing position, cigarette smoking status, body mass index, years of rugby participation, stress, aerobic and anaerobic performance, and number of push ups as risk factors for in season injury, measured as proportion of season missed. CONCLUSIONS: The findings emphasise the importance of previous injury as a predictor of injury incidence and of missing play. They also show the importance of considering both the incidence rate and severity of injury when identifying risk factors for injury in sport.

Jockey injuries in the United States.

CONTEXT: In the sport of horse racing, the position of the jockey and speed of the horse predispose the jockey to risk of injury. OBJECTIVE: To estimate rates of medically treated injuries among professional jockeys and identify patterns of injury events. DESIGN: Cross-sectional survey from data compiled by an insurance broker. Information on the cause of injury, location on the track, and body part injured was evaluated. SETTING: Official races at US professional racing facilities (n = 114) from January 1, 1993, through December 31, 1996. PARTICIPANTS: A licensed jockey population of approximately 2700 persons. MAIN OUTCOME MEASURES: Annual injury incidence rates per 1000 jockey-years, as well as injury type, cause, and location on the track. RESULTS: A total of 6545 injury events occurred during official races between 1993 and 1996 (606 per 1000 jockey-years). Nearly 1 in 5 injuries (18.8%) was to the jockey's head or neck. Other frequent sites included the leg (15.5%), foot/ankle (10.7%), back (10.7%), arm/hand (11.0%), and shoulder (9.6%). The most frequent location where injuries occurred was entering, within, or leaving the starting gate (35.1%), including 29.5% of head injuries, 39.8% of arm/hand injuries, and 52.0% of injuries to the leg/foot. Most head injuries resulted from being thrown from the horse (41.8%) or struck by the horse's head (23.2%). Being thrown from the horse was the cause of 55.1% of back and 49.6% of chest injuries. CONCLUSIONS: Our data suggest that jockeys have a high injury rate. Efforts are needed to reduce the number of potential injury events on the track and to improve protective equipment so events do not lead to injury.

The New Zealand Rugby Injury and Performance Project: V. Epidemiology of a season of rugby injury.

OBJECTIVE: To describe the incidence, nature, and circumstances of injury experienced by a cohort of rugby union players during a full competitive club season. METHODS: A prospective cohort study followed up 356 male and female rugby players throughout the 1993 competitive club season. Players were interviewed by telephone each week to obtain information on the amount of rugby played and the injury experienced. RESULTS: Detailed information was collected for 4403 player-games and 8653 player-practices. A total of 671 injury events were reported, of which 569 were rugby related. The injury rate for games was higher than that for practices (rate ratio 8.3). At 10.9 injuries per 100 player-games, males had a higher rate of injury than females at 6.1 injuries per 100 player-games (p<0.001). Injury rates varied by position, with male locks (13.0 injuries per 100 player-games) and female inside backs (12.3 injuries per 100 player-games) having the highest rate in their respective sexes. The lower limb was the body region most often injured in games (42.5%) and practices (58.4%). Sprains/strains were the most common type of injury in games (46.7%) and practices (76.1%). In games the tackle was the phase of play in which the most injuries occurred (40%), followed by rucks (17%) and mauls (12%). Thirteen per cent of game injury events were the result of foul play. CONCLUSIONS: Rugby injury was common among the study subjects and varied according to grade and gender. Identifying the causes of injuries in the tackle, lower limb injuries, and dealing with the issue of foul play are priority areas for the prevention of rugby injury.

Adult thermal injuries in New Zealand resulting in death and hospitalization.

This paper provides an overview of thermal injury resulting in death or hospitalization in New Zealand adults, defined as age 15 years and over. For the 10-year period 1978-1987, there were 493 adult thermal injury deaths resulting in an overall rate of 2.1 per 100000 person-years (95%CI: 1.9-2.3). For the year 1988, there were 644 hospitalizations resulting in a rate of 25.1 per 100000 (95%CI: 23.2-27.1). The highest rates of death and hospitalization were observed in the elderly (65 years of age and over). Young males (15-29 years) also had a very high rate of hospitalization. Residential fire was the most common type of burn event resulting in death (44%), and smoking materials were the most common source of ignition in fatal residential fires (37%). Hot liquids were the most common source of thermal energy for the hospitalized injuries (34%). Typical scenarios involved burns from hot water expelled from automobile radiators, from hot water use in the workplace, from hot beverages, and from household hot tap-water. The epidemiology of the adult thermal injuries in New Zealand is similar to that reported in other developed countries. Opportunities and strategies for the prevention of these injuries are discussed.

Occupational injuries among adolescents in Dunedin, New Zealand, 1990-1993.

STUDY OBJECTIVE: In this study we describe occupational injuries among adolescents (ages 15 through 19 years) presenting at a hospital ED in Dunedin, New Zealand, 1990-1993. METHODS: We used a new database to identify work-related injuries, as well as type of injury, cause of injury, injury site, occupation, industry, age, and sex. RESULTS: During the 4 years of the study, 1,361 work-related injuries were treated at the ED, for an injury rate of 13.8 per 200,000 hours worked (100 full-time equivalents). Males had a rate of 20.6 injuries, females 5.8 injuries, per 200,000 hours. Compared with injury rates from other studies, rates were lower than, but reasonably comparable to, those rates estimated through more detailed surveys. Main injury sites included upper extremities (mostly hands), head (mostly eyes), and lower extremities. Laceration was the main type of injury, followed by sprain/strain and foreign body. External cause of injury was mainly cutting/piercing objects, followed by foreign body and being struck by or against an object. The rate was highest for the 16- and 17-year-olds and decreased for 18- and 19-year-olds. The rates of injuries in the construction sector were the highest of all occupational groups, at 27 injuries per 200,000 hours, followed by transportation/ communication, manufacturing (including meat and fish processing), and business and repair services. Laborers were the highest occupational risk group, with 36 injuries per 200,000 hours, followed by machine operators, precision production workers, and service workers. CONCLUSION: These findings may be helpful in focusing prevention efforts in high-incidence areas. This study demonstrates how a well-planned data-collection system can overcome some of the previously described difficulties of getting prevention-oriented information from EDs.

The New Zealand Rugby Injury and Performance Project: alcohol use patterns within a cohort of rugby players.

Although heavy drinking has traditionally been associated with rugby, the drinking patterns of New Zealand rugby players have not been examined. Three hundred and forty-eight rugby players (257 males and 91 females), completed the Alcohol Use Disorders Identification Test (AUDIT) at the beginning of the 1993 rugby season. The mean AUDIT scores were 11.2 (SD = 5.1) for the males and 8.7 (4.1) for the females: a cut-off of 8.0 has been recommended by the developers of the instrument for identifying alcohol use disorders. The consumption of large quantities of alcohol, and a high frequency of heavy drinking sessions were the norm for this group. Sixty-one per cent of males and 38% of females consumed six or more drinks in a session at least weekly: typically, men drank 10 or more drinks in a session and women 5-6 drinks. The patterns of drinking exhibited by the cohort give cause for concern regarding the health risks associated with such behaviour.

Repeated measures analysis of binary outcomes: applications to injury research.

Repeated measures are reasonably common in injury research and thus tools are required for appropriate analysis in order to account for the correlated nature of this type of data. Three methods for analyzing repeated measures binary outcome data are presented and contrasted: generalized estimating equations (GEE), a survey sample methodology, and logistic regression. These methods are applied to data collected from a cohort study of rugby players, designed to examine the risk and protective factors for rugby injury. It is not, however, the purpose of this paper to present causal models of rugby injuries. The GEE approach is attractive because it is able to account for the correlation among a subject's outcomes and several covariates can be included in a model. The survey sample method approach, which also accounts for the correlation but is restrictive in terms of the number of covariates it can handle, is another approach which is described. These two methods are contrasted to logistic regression, which assumes independence among a subject's outcomes. Under certain circumstances, the three methods do not differ substantially from one another. Under other circumstances, since logistic regression ignores the correlated nature of the data, standard errors may be incorrectly estimated and thus certain covariates may be incorrectly identified as significant predictors in a model.

Development and validation of an emergency department screening and referral protocol for victims of domestic violence.

STUDY OBJECTIVE: To describe the development, design, and validation of an emergency department protocol for the identification, documentation, and referral of victims of domestic violence. METHODS: We based protocol development and design on a departmental needs assessment. The validation component involved the screening of women 16 years and older treated in the ED during a 2-week period at both triage (stage 1) and nursing assessment (stage 2). Sensitivity and specificity of the triage screen were determined. RESULTS: The departmental needs assessment revealed several important limiting factors that motivated the design of the protocol. In response, the protocol design included a two-stage screening process, stage 1 taking place at triage and stage 2 as part of the nursing assessment. During the 2-week validation study, 595 women 16 years and older were treated in the ED, but complete two-stage screening data were obtained for only 114 (19%). Of the patients who were appropriately screened, eight screened positive at stage 1 and two of the eight were confirmed at stage 2. Two additional cases were identified at stage 2 in whom violence had not been suspected at stage 1. Triage screen sensitivity was 50%, specificity 95%. Of the women properly screened at both stages, 3.5% were identified as victims of domestic violence. CONCLUSION: We identified many obstacles to implementation of an ED domestic violence screening and referral protocol, demonstrating that evaluation is imperative in determining actual clinical impact.

The New Zealand rugby injury and performance project. IV. Anthropometric and physical performance comparisons between positional categories of senior A rugby players.

OBJECTIVE: To describe the anthropometric and physical performance characteristics of a sample of senior A club rugby players and to highlight differences between the positional categories of the players within the forwards and backs. METHODS: 94 senior A male rugby players were assessed on a number of anthropometric and physical performance assessments. The forwards were categorised into props, hookers, locks, and loose forwards. Backs were categorised into inside, midfield, and outside backs. Categories within the forwards were compared with each other, as were the categories within the backs. RESULTS: The anthropometric characteristics of forwards differed significantly between positional categories. Front row forwards (props and hookers) possessed highly endo-mesomorphic somatotypes, and typically rated very low for ectomorphy. Props possessed greater body mass than hookers. Locks and loose forwards were taller than the front row forwards. In terms of physical performance fewer differences were observed. Hookers performed better than props on an aerobic assessment. Locks and loose forwards were faster than the front row forwards on a 30 m sprint from a running start. The inside backs were shorter and lighter than the midfield and outside backs. CONCLUSIONS: The combination of anthropometric characteristics and physical performance attributes observed allows players to best meet the demands imposed on them by their position.

Precompetition injury and subsequent tournament performance in full-contact taekwondo.

OBJECTIVE: To determine the pattern of injuries sustained by taekwondo competitors, and how previous injury affects performance in sporting competition. METHODS: Competitors at a major New Zealand full-contact taekwondo tournament were given a comprehensive questionnaire immediately before competition. Self reports of injuries sustained through taekwondo in the previous 12 months were determined. RESULTS: No significant sex differences were found. The injury prevalence was high, but comparatively less than reported for other contact sports such as rugby football. However, one in 20 injuries was a closed head injury. No significant associations between prior injury and tournament outcome were found. CONCLUSIONS: Taekwondo can be a source of disabling injury. However, the fact that prior injury did not appear to be associated with impaired competition performance may militate against acceptance of control and regulation by competitors and coaches.

The New Zealand rugby injury and performance project. III. Anthropometric and physical performance characteristics of players.

OBJECTIVE: To investigate the anthropometric and physical performance characteristics of New Zealand rugby players of different ages and both sexes. METHODS: 356 rugby players (264 male, 92 female) took part in the study during a single season. Playing grade ranged from schoolboys and schoolgirls to senior men and women. Assessment of height, weight, neck circumference, and somatotype was performed before the competitive rugby season. A battery of six physical performance assessments was completed after the anthropometry. Analysis of variance was used to examine differences in these variables between field positions and grades. RESULTS: Significant differences between forwards and backs on anthropometric and physical performance variables were apparent at all grades assessed. In terms of anthropometric characteristics, forwards of a given grade were generally taller, possessed greater body mass, and were more endomorphic and less ectomorphic than backs of the same grade. The backs tended to perform better on physical performance measures than forwards, being more aerobically fit, faster, more agile, and possessing a higher degree of muscular endurance. Differences in anthropometry and physical performance attributes were also apparent between players from the various grades. The players at higher levels were generally larger, and performed better on tests of physical performance than the players at lower levels. These differences were found in both sexes. CONCLUSIONS: The greater body mass of the forwards allows them to obtain greater momentum than the backs when sprinting. The ability to obtain greater momentum is important in the body contact phases of the game. Forwards may compromise their aerobic fitness and speed to some extent in order to maintain a high body mass. The anthropometric and physical performance characteristics of players appear to reflect the demands placed on them by the sport.

The New Zealand Rugby Injury and Performance Project: I. Design and methodology of a prospective follow-up study.

Injury resulting from participation in sporting and physical recreational activities is a major contributor to the overall incidence of injury in the developed world. If sports injuries are to be reduced, a comprehensive approach must be taken to define the nature and magnitude of the problem, to establish models of relationships between risk factors, protective factors and injury experience, and to address injury through well designed intervention and evaluation programmes. The Rugby Injury and Performance Project (RIPP) is a prospective cohort study designed to examine the risk and protective factors for rugby injury. Data were collected on potential risk and protective factors from the RIPP cohort pre-season. Data on exposure to rugby, injury events and medical treatments were collected from the players each week during the season through telephone interviews. Pre-season measures were repeated post-season. A key feature of the design was that data were collected on both injured and non-injured players, allowing a longitudinal comparison of the injury experience of players with and without the factors of interest. A wealth of information was collected on each cohort member during the pre-season interview. A contact rate of 90% was achieved during the weekly follow-up phase. Post-season questionnaires were completed by 76% of the players and 88% of the coaches. Recommendations are made for the use of this methodology by other researchers and future directions for RIPP are described.

The New Zealand Rugby Injury and Performance Project: II. Previous injury experience of a rugby-playing cohort.

The Rugby Injury and Performance Project (RIPP) is a prospective cohort study by a multidisciplinary research group. Rugby injuries constitute an important area for research because rugby union is New Zealand's national sport and because of the considerable cost of all sports injury acknowledged by the Accident Rehabilitation and Compensation Insurance Corporation (ACC). The initial phase of data collection in the RIPP involved a pre-season questionnaire which, among other things, sought to establish variables relating to the past injury experience of players. The influence of previous injury, the use of safety equipment and the availability and significance of medical advice were among the variables identified by individual questionnaires. This paper analyses the responses to pre-season questions about injury experience in the previous 12 months. In so doing, it identifies baseline data which will be used to address a possible relationship between past injury experience and the prediction of injury during the season.

Childhood thermal injuries in New Zealand resulting in death and hospitalization.

Thermal injury is a significant contributor to the overall problem of injury among children. Children are at greater risk of hospitalization due to thermal injury than any other age group, and their fatality rate is second only to those over 60 years of age. This study provides an overview of thermal injury in New Zealand children, age 0-14 years, resulting in death or hospitalization. Eighty-one thermal fatalities were identified from Health Statistical Services (HSS), Department of Health, data accessed for the 10-year period from 1978 to 1987. The records of the Coroners' Court, held by the Justice Department, were also accessed in order to gather additional information about the circumstances of fatal injury in each case. Thermal injury hospital admissions (n = 634) were identified from HSS data for the year 1988. Children were more likely to die in house fires than any other thermal injury event. Most house fires were started by smoking paraphernalia or electrical appliances. Two-thirds of the childhood thermal injury hospitalizations were due to contact with hot water, the most commonly identified source being a hot beverage. Thermal injury rates for New Zealand children are higher than reported overseas. Prevention strategies that have proven effective elsewhere are discussed with recommendations for New Zealand.

An evaluation of a program to reduce home hot tap water temperatures.

Children are more likely to be hospitalised because of burns from hot liquids than from contact with fire and flames. Many of these hot liquid burns are from contact with hot tap water, usually in the home. Hot tap water burns to young children can be prevented completely by lowering the delivery temperature of the hot tap water. This study reports on the evaluation of a program designed to lower the temperature of home hot tap water in Dunedin, New Zealand. In conjunction with a national media campaign, the program provided an educational intervention to households with young children. Before and after measures were made and comparison groups were used to determine the effect of the intervention on tap water temperatures. Mean tap water temperature was 64.2 degrees C at baseline and 61.2 degrees C at follow-up. The proportion of households with water temperatures above 70 degrees C decreased by 50 per cent between baseline and follow-up while the proportion below 60 degrees C increased from 33 per cent to 47 per cent. The group receiving the intervention did not differ significantly from the comparison groups. There were significant decreases in tap water temperature across all groups, but the majority of households still had temperatures above 55 degrees C at the end of the study.

Hot water temperature in Dunedin homes with preschool children.

The mean temperature of the hot water supply of 62 randomly selected Dunedin homes with preschool children was 67.8 degrees C. More than 95% of the households visited had temperatures above the recommended temperature of 55 degrees C. The temperature was related to the socioeconomic status of the major earner of the household, the thermostat setting, the age of the water cylinder and its size. Accessible thermostats were of the water cylinder and its size. Accessible thermostats were only reliable in cylinders under 20 years old.