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On Tue, 30 Nov 2004 10:11:25 GMT,
John Doe wrote: There is evidence to support the role of cycle helmets in the prevention of injuries to the middle third of the face and some dental injuries. Even if you believe that a helmet protects your head how does it prevent injuries to your face, jaw and dentition? Obviously there are full-face helmets but I doubt that you could design a study involving them when used in general purpose riding. -- Andy Leighton = "The Lord is my shepherd, but we still lost the sheep dog trials" - Robert Rankin, _They Came And Ate Us_ |
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On Tue, 30 Nov 2004 10:11:25 GMT, John Doe
wrote: According to peer-reviewed, medical journal published doctors, neurosurgeons, and research scientists from around the world, a properly fitted bicycle helmet helps reduce serious head injury among children. According to other peer-reviewed evidence it doesn't. Which is right? Let's look at the experience of countries which have used legislation to force helmet use up. Oh! No change in head injury rates! There's your answer, then. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed "bicycle helmets" "head injuries" children Also pulls up studies which say the opposite. The BDJ study is a classic: it accepts that helmets prevent dental injuries. How, exactly? Guy -- May contain traces of irony. Contents liable to settle after posting. http://www.chapmancentral.co.uk 88% of helmet statistics are made up, 65% of them at Washington University |
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So what's your point, that peer reviewed helmet studies should be
viewed with sketicism? Did you read any of the studies you listed? I am familiar with the Canadian paper listed (Leblanc et al). If you look beyond the author's spin and examine the data, they show that the principal effect of the Nova Scotia helmet law was to reduce head injuries by reducing cycling. The cyclist injury rate actually went up after the law. Letters commenting on shortcomings of such reports are rarely picked up by Google searches. See http://www.cmaj.ca/cgi/eletters/166/5/592 and http://www.cmaj.ca/cgi/content/full/167/4/339 See also: Why are politicians and lobbyists misrepresenting the head injury "problem"? (under heading Claims Based on Questionable Research) at The Vehicular Cyclist http://www.magma.ca/~ocbc John Doe wrote in message .. . According to peer-reviewed, medical journal published doctors, neurosurgeons, and research scientists from around the world, a properly fitted bicycle helmet helps reduce serious head injury among children. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed "bicycle helmets" "head injuries" children The first 20 summaries found, unedited. Br Dent J. 2004 May 8;196(9):555-60; discussion 539. Bicycle helmets--does the dental profession have a role in promoting their use? Chapman HR, Curran AL. Paediatric Dentistry, 6 Woodlands Way, Southwater, Horsham, W Sussex RH13 9HZ, UK. OBJECTIVES: To review the available literature regarding the: epidemiology of bicycle related head injuries; consequences of head injuries; rates of cycle helmet use; impact of educational campaigns and legislation on usage rates; effectiveness of cycle helmets in protecting against head and facial injuries; arguments against the compulsory use of bicycle helmets. DATA SOURCES: A computerised Medline search was conducted using the keywords: head injury, facial injury, bicycle helmets, accidents. DATA SELECTION: All available information was considered. DATA SYNTHESIS: Data was collated manually. CONCLUSIONS: The wearing of bicycle helmets contributes significantly to the prevention of head injuries (HI) and traumatic brain injury (TBI), particularly in children and adolescents.There is evidence to support the role of cycle helmets in the prevention of injuries to the middle third of the face and some dental injuries. There is a case for the implementation of legislation accompanied by educational campaigns to increase significantly the use of cycle helmets.The dental profession could: play an active role in promoting cycle helmet use; support calls for the compulsory wearing of cycling helmets, particularly for children; press for modification of helmet design and standards to increase protection of the face. Traffic Inj Prev. 2003 Dec;4(4):285-90. Protective effect of different types of bicycle helmets. Hansen KS, Engesaeter LB, Viste A. Department of Surgery, Haukeland University Hospital, Bergen, Norway. The effectiveness of bicycle helmets in preventing head injuries is well documented. There are different opinions about the effectiveness of helmets in preventing face injuries, and few studies have analyzed the effect of different types of helmets. This study was performed to examine the effect of different helmet types to head and face injuries. The use of helmets was analyzed in cyclists with head or face injuries and compared with two control groups. The main control group was cyclists that had injuries not including the head or neck, and another control group was cyclists that had been involved in an accident, regardless of whether they had sustained any injury. Cross- table and logistic regression analyses were applied to analyze the protective effect of helmets. A total of 991 injured patients served as a basis for this study. Most of the accidents, (82%) were single accidents with no other persons involved. Of patients with injuries to the head, excluding face, 11.4% had been using hard shell helmets, and 9.6% had been using foam helmets at the time of the accident. Among the emergency room controls, the proportion of hard shell helmet users and foam helmet users was 26.4% and 11.4%, respectively. Compared to non-helmet users, this gave an odds ratio of 0.36 (CI = 0.21-0.60) for getting head injuries if the cyclists had been using hard shell helmets at the time of the injury, and 0.83 (CI = 0.41- 1.67) for users of foam helmets. The odds ratio for getting face injuries was 0.90 (CI = 0.58-1.41) among users of hard shell helmets, and 1.87 (CI = 1.03-3.40) for users of foam helmets. The use of hard shell helmets reduced the risk of getting injuries to the head. Children less than nine years old that used foam helmets had an increased risk of getting face injuries. All bicyclists should be recommended to use hard shell bicycle helmets while cycling. Inj Prev. 2003 Sep;9(3):266-7. Trends in serious head injuries among English cyclists and pedestrians. Cook A, Sheikh A. Department of Primary Health Care and General Practice, Imperial College of Science, Technology and Medicine, London, UK. In England the use of bicycle helmets remains low as debate continues about their effectiveness. Time trend studies have previously shown an inverse association between helmet wearing rates and hospital admissions for head injury, but data on helmet wearing are often sparse and admission rates vary for numerous reasons. For the period of this study comprehensive data on helmet wearing are available, and pedestrians are used as a control to monitor trends in admission. Among cyclists admitted to hospital, the percentage with head injury reduced from 27.9% (n = 3070) to 20.4% (n = 2154), as helmet wearing rose from 16.0% to 21.8%. Pedestrian head injury admissions also declined but by a significantly smaller amount. The wearing of a cycle helmet is estimated to prevent 60% of head injuries. Am J Prev Med. 2003 May;24(4 Suppl):143-9. Bicycle helmet effectiveness in preventing injury and death. Novick LF, Wojtowycz M, Morrow CB, Sutphen SM. SUNY-Upstate Medical University, Preventive Medicine Program, Department of Medicine, Syracuse, New York 13210, USA. This case--bicycle helmet effectiveness--is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. This case examines the cost-effectiveness of three interventions to increase utilization of bicycle helmets to avert head injuries in individuals aged 18 years and under in Onondaga Count NY. Students are initially presented with data on head injuries, hospitalization, and death related to bicycle use. They then appraise a published study on the effectiveness of bicycle helmets in averting head injury. Finally, students work in groups to determine the cost-effectiveness of each intervention by calculating implementation costs and the specific number of head injuries averted associated with intervention. The three interventions are legislative, school, and community-based campaigns to increase helmet use. Students are provided with budget estimates and assumptions needed to complete the exercise. Cost-effectiveness analysis, cost- benefit analysis, and related concepts are discussed, including provider versus societal perspectives and importance of sensitivity analysis. Orthop Nurs. 2003 Jan-Feb;22(1):9-15. Bicycle injuries and safety helmets in children. Review of research. Coffman S. Nevada State University, Henderson, NV, USA. Bicycle injuries are the most common cause of serious head injury in children, and most of these injuries are preventable. The protective effect of bicycle helmets is well documented, but many child bicyclists do not wear them. This article summarizes the current state of research on bicycle injuries and helmet use and examines the effectiveness of legislation and injury-prevention strategies. Current studies indicate that children who wear helmets experience fewer head injuries and decreased severity of injury. Community-wide helmet-promotion campaigns combined with legislation are most successful in increasing helmet use and decreasing injury. Nurses can participate both at the institutional level and in community advocacy groups to promote bicycle safety for children. Inj Prev. 2002 Dec;8(4):317-20. New Zealand bicycle helmet law--do the costs outweigh the benefits? Taylor M, Scuffham P. Centre for the Analysis of Safety Prevention and Attitudes to Risk, University of Newcastle-upon-Tyne, UK. OBJECTIVES: This paper examines the cost effectiveness of the compulsory bicycle helmet wearing law (HWL) introduced in New Zealand on 1 January 1994. The societal perspective of costs is used for the purchase of helmets and the value of injuries averted. This is augmented with healthcare costs averted from reduced head injuries. METHODS: Three age groups were examined: cyclists aged 5-12 years, 13-18 years, and /=19 years. The number of head and non-head injuries averted were obtained from epidemiological studies. Estimates of the numbers of cyclists and the costs of helmets are used to derive the total spending on new bicycle helmets. Healthcare costs were obtained from national hospitalisation database, and the value of injuries averted was obtained directly from a willingness- to-pay survey undertaken by the Land Transport Safety Authority. Cost effectiveness ratios, benefit:cost ratios, and the value of net benefits were estimated. RESULTS: The net benefit (benefit:cost ratios) of the HWL for the 5-12, 13-18, and /=19 year age groups was $0.3m (2.6), -$0.2m (0.8), and -$1.5m (0.7) (in NZ $, 2000 prices; NZ $1.00 = US $0.47 = UK pound 0.31 approx). These results were most sensitive to the cost and life of helmets, helmet wearing rates before the HWL, and the effectiveness of helmets in preventing head injuries. CONCLUSIONS: The HWL was cost saving in the youngest age group but large costs from the law were imposed on adult (/=19 years) cyclists. Ugeskr Laeger. 2002 Oct 28;164(44):5115-9. [The importance of the use of bicycle helmets for head injuries among injured bicyclists aged 0-15 years] [Article in Danish] Larsen LB. Odense Universitetshospital, UlykkesAnalyseGruppen. INTRODUCTION: We wanted to examine the preventative effect of bicycle helmets on head injuries in youngsters aged 0-15 years treated after road traffic accidents (RTAs). The data were based on hospital records. MATERIAL AND METHODS: We conducted a case-control study of all youngsters aged 0-15 years, who were treated at Odense University Hospital after RTAs on bicycles during the period 1993 to 1999. Bicyclists with injuries localised to the head or brain comprised the case group. The controls were all bicyclists with injuries to other body regions. RESULTS: Altogether 3285 persons were entered. Of these, 409 had injuries to the head or brain and 2876 had injuries to other body regions. Regression analysis showed that the use of helmets decreased the risk of head injury by a factor of 0.4 and the risk of concussion by a factor of 0.6. Only nine bicyclists with more severe brain injury were included in the study. Registered motor vehicles as the counterpart increased the risk of head injury in a given accident and no effect of the helmets could be shown in such accidents. DISCUSSION: Helmets offer bicyclists aged 0-15 years protection against head injury. The effect could not be shown in accidents involving a motor vehicle as the counterpart. Pediatr Nurs. 2000 Mar-Apr;26(2):159-62. Reducing one source of pediatric head injuries. Hendrickson SG, Becker H. School of Nursing, University of Texas at Austin, Austin, TX, USA. Evaluation of a school-based, bicycle helmet program was conducted using the PRECEDE model. The intervention targeted schools with low income, high minority, and nonurban fourth grade children. A repeated measures design was used with schools randomly assigned to each treatment: classroom, parent-classroom, or control. Reported helmet use was approximately 18% prior to the program. Following the intervention, between 34% and 98% of intervention students reported helmet use, with the best results reported in schools with parental contact. This educational intervention coupled with the provision of bicycle helmets increased reported helmet use, especially when parental contact was added. CMAJ. 2002 Mar 5;166(5):592-5. Effect of legislation on the use of bicycle helmets. Leblanc JC, Beattie TL, Culligan C. Department of Pediatrics, Dalhousie University, Halifax, NS. BACKGROUND: About 50 Canadian children and adolescents die each year from bicycle-related injuries, and 75% of all bicycle-related deaths are due to head injuries. Although the use of helmets can reduce the risk of head injury by 85%, the rate of voluntary helmet use continues to be low in many North American jurisdictions. We measured compliance before, during and after 1997, when legislation making the use of helmets mandatory for cyclists was enacted in Nova Scotia. METHODS: In the summers and autumns of 1995 through 1999, trained observers who had a direct view of oncoming bicycle traffic recorded helmet use, sex and age group of cyclists in Halifax on arterial, residential and recreational roads. Sampling was done during peak traffic times of sunny days. We abstracted data from the Canadian Hospitals Injury Reporting and Prevention Program database on bicycle-related injuries treated during the same period at the Emergency Department of the IWK Health Centre, Halifax. RESULTS: The rate of helmet use rose dramatically after legislation was enacted, from 36% in 1995 and 38% in 1996, to 75% in 1997, 86% in 1998 and 84% in 1999. The proportion of injured cyclists with head injuries in 1998/99 was half that in 1995/96 (7/443 [1.6%] v. 15/416 [3.6%]) (p = 0.06). Police carried out regular education and enforcement. There were no helmet-promoting mass media education campaigns after 1997. INTERPRETATION: Rates of helmet use rose rapidly following the introduction of legislation mandating the use of helmets while bicycling. The increased rates were sustained for 2 years afterward, with regular education and enforcement by police. Pediatrics. 2001 Oct;108(4):1030-2. Bicycle helmets. American Academy of Pediatrics. Committee on Injury and Poison Prevention.. Bicycling remains one of the most popular recreational sports among children in America and is the leading cause of recreational sports injuries treated in emergency departments. An estimated 23 000 children younger than 21 years sustained head injuries (excluding the face) while bicycling in 1998. The bicycle helmet is a very effective device that can prevent the occurrence of up to 88% of serious brain injuries. Despite this, most children do not wear a helmet each time they ride a bicycle, and adolescents are particularly resistant to helmet use. Recently, a group of national experts and government agencies renewed the call for all bicyclists to wear helmets. This policy statement describes the role of the pediatrician in helping attain universal helmet use among children and teens for each bicycle ride. Tidsskr Nor Laegeforen. 2000 Jun 30;120(17):1955-9. [A potential for prevention of bicycling-related head injuries] [Article in Norwegian] Alvaer K, Kopjar B. Statens institutt for folkehelse Avdeling for samfunnsmedisin, Oslo. BACKGROUND: Bicycle helmets prevent head injury in bicycle riders. Still, only a portion of bicycle riders in Norway use bicycle helmets. The aim of this study was to estimate the number of head injuries among bicycle riders that might be prevented by increased helmet use in Norway. MATERIAL AND METHODS: We used data from the Norwegian National Injury Register for the years 1995 and 1996 to estimate the number of bicycle injuries in Norway. In order to estimate the number of bicycle users and helmet users in different age groups, we used data from earlier surveys of bicycle use. Data on the effectiveness of helmet promotion interventions have been obtained from a systematic review of the literature. RESULTS: The overall annual incidence rate was 92 injuries per 100,000 bicycle users. The incidence varied with age and was highest among children. If every rider used a helmet, about 1,600 head injuries would be avoided every year, of these, 800 among children aged 0-14. Currently available helmet promotion interventions may improve the use among children by about 40%, thus preventing about 1,500 head injuries over a period of three years. Successful helmet promotion interventions use a combination of health education and helmet distribution strategies. INTERPRETATIONS: There is a significant health improvement potential in promoting bicycle helmets in Norway by implementation of evaluated modes of intervention. Inj Prev. 2000 Sep;6(3):235-8. Population preventable fraction of bicycle related head injuries. Kopjar B. Department of Population Health Sciences, National Institute of Public Health, Oslo, Norway. OBJECTIVE: This study analyzes the population attributable fraction (PAF) of bicycle head injuries due to non-helmet use. METHODS: The concept of the PAF and Levin's formula for its calculation were used to develop mathematical models for estimation of: (i) attributable fraction of bicycle related head injuries in the population due to non-helmet use, (ii) expected proportion of helmeted cases among all head injuries, and (iii) estimate of the helmet use rate in the population based on patient case information. The PAF was calculated for a sample of injuries from Stavanger, Norway. RESULTS: Levin's formula was used to calculate the PAF. Two additional mathematical models were developed for calculating the expected proportion of helmeted cases and the estimation of the helmet use rate in the population. The P calculation examples for all models were is shown. It was estimated that 133 out of 210 injuries could have been avoided in Stavanger between 1990 and 1996 if all children aged 0-14 had used helmets. CONCLUSIONS: If applied correctly, the PAF is a valid and useful indicator for the population effects of bicycle helmets. The models developed in this study may help to better interpret and predict the population effects of helmet promotion interventions. Epidemiol Rev. 2000;22(1):112-9. Epidemiology of injuries: current trends and future challenges. MacKenzie EJ. Center for Injury Research and Policy, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205-1996, USA. For the above challenges to be met, it will be important for the field of injury epidemiology to move from the largely descriptive studies that have predominated in the literature to the application of more rigorous analytical methods for defining the underlying casual patterns of injury. Studies focusing on the descriptive epidemiology of injury have and will continue to serve the field well, perhaps even more so than in other fields, since the proximal etiology of injuries (i.e., acute exposure to physical agents such as mechanical energy) is well known. However, major new advances in the prevention of injuries will continue to require a more analytical approach to understanding the complex array of factors that influence the incidence, severity, and outcomes of injury. At the same time, it will be important for investigators in this field to conduct rigorous evaluations of new interventions to better inform the establishment of programs and policies. These evaluations must include assessments of both the effectiveness and the costs of the intervention. For example, in a recently published systematic review of 10 different strategies for preventing motor vehicle injuries, 54,708 papers and reports were identified in the literature but only 161 met the initial screening criteria for inclusion in the published review (44). Of these, a much smaller number were randomized controlled trials or well executed controlled time series trials. Major advancements in the prevention and control of injuries will continue to rely on effective collaborations between epidemiologists and scientists from other disciplines, including the behavioral sciences, sociology, criminology, law, engineering, and biomechanics. Only through truly collaborative efforts across these disciplines will we be able to establish a foundation for cost-effective interventions. For example, understanding the principles of injury mechanics and the physical and physiologic responses of the human body to the impact of injury is fundamental to the study of injury causation (6). While significant advances have been made in this regard, more work needs to be done. The biomechanics of head injury are still not well understood, yet head injuries account for nearly 50 percent of all injury deaths and remain the leading cause of both injury death and disability among children and young adults. Animal and human cadaver research combined with rapidly evolving techniques of computerized modeling will continue to play a critical role in increasing our understanding of injury mechanisms. At the same time, the development of effective interventions is dependent on a better understanding of the role of behavior in injury causation and prevention (45). We know, for example, that the use of personal protective devices such as seat belts, car seats, and bicycle helmets reduces injury risk and that these behaviors can be influenced through educational, behavioral, and legislative strategies (46-49). Interventions addressing individuals at risk can be enhanced by additional research into risk perception, risk-taking, and behavioral responses to safety improvements. However, behavioral strategies may also be used effectively with key decision-makers who design and manufacture products and who pass and implement laws that affect the injury risk of entire populations; more research is needed to understand and influence the process of behavior change in these groups (50). The importance of injury as a major public health problem worldwide was highlighted in the seminal report "The Global Burden of Disease" (25). Worldwide, injuries account for approximately one in eight deaths among males and one in 14 deaths among females (51). Motor vehicle injuries alone constitute the ninth leading cause of disease burden as measured by the number of associated disability-adjusted life years (25). By the year 2020, motor vehicle injuries are projected to increase in rank to third. (ABSTRACT TRUNCATED) Pediatrics. 2000 Jul;106(1 Pt 1):6-9. Police enforcement as part of a comprehensive bicycle helmet program. Gilchrist J, Schieber RA, Leadbetter S, Davidson SC. Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. BACKGROUND: Bicycle-related head injuries cause 150 deaths and 45 000 nonfatal injuries among children in the United States annually. Although bicycle helmets are highly effective against head injury, only 24% of US children regularly wear one. Georgia mandated bicycle helmet use for children, effective July 1993. During that summer, 1 rural Georgia community passed an ordinance instructing police officers to impound the bicycle of any unhelmeted child. We evaluated the effect of active police enforcement of this ordinance, combined with a helmet giveaway and education program. METHODS: During April 1997, approximately 580 children in kindergarten through grade 7 received free helmets, fitting instructions, and safety education. Police then began impounding bicycles of unhelmeted children. We conducted an observational study, unobtrusively observing helmet use just before helmet distribution, several times during the next 5 months, and once 2 years later. RESULTS: Before the program began, none of 97 observed riders wore a helmet. During the next 5 months, helmet use among 358 observed children averaged 45% (range: 30%-71%), a significant increase in all race and gender groups. In contrast, adult use did not change significantly. Police impounded 167 bicycles during the study, an average of 1 per day. Two years after program initiation, 21 of 39 child riders (54%) were observed wearing a helmet. CONCLUSIONS: Without enforcement, the state and local laws did not prompt helmet use in this community, yet active police enforcement, coupled with helmet giveaways and education, was effective and lasting. Prev Med. 2000 May;30(5):401-6. Age gradient in the cost-effectiveness of bicycle helmets. Kopjar B, Wickizer TM. Department of Population Health Sciences, National Institute of Public Health, Oslo, Norway. OBJECTIVES: This study analyzed the reduction in risk of head injuries associated with use of bicycle helmets among persons ages 3 to 70 and the cost-effectiveness of helmet use based on this estimated risk reduction. METHODS: To derive our cost-effectiveness estimates, we combined injury incidence data gathered through a detailed and comprehensive injury registration system in Norway, acute medical treatment cost information for the Norwegian health service, and information reported in the scientific literature regarding the health protective effects of helmet use. The analysis included all cases of head injuries reported through the registration system from 1990 through 1996. We performed an age-stratified analysis to determine the incidence of bicycle-related head injuries, the 5-year reduction in absolute risk of injury, the number needed to treat, and the cost-effectiveness of helmet use. To test the robustness of the findings to parameter assumptions, we performed sensitivity analysis. RESULTS: The risk of head injury was highest among children aged 5 to 16. The greatest reduction in absolute risk of head injury, 1.0 to 1.4% over 5 years estimated helmet lifetime, occurred among children who started using a helmet between the ages of 3 and 13. Estimates indicate that it would cost approximately U.S. $2,200 in bicycle helmet expenses to prevent any one upper head injury in children ages 3-13. In contrast, it would cost U.S. $10,000-25,000 to avoid a single injury among adults. CONCLUSIONS: Bicycle safety helmets appear to be several times more cost-effective for children than adults, primarily because of the higher risk of head injury among children. Programs aiming to increase helmet use should consider the differences in injury risk and cost-effectiveness among different age groups and target their efforts accordingly. J Community Health Nurs. 2000 Summer;17(2):85-92. Promoting helmet use among children. Stanken BA. University of Kentucky, USA. Despite the proven efficacy of bicycle helmets, helmet use among children remains low. Helmet use among children riding bicycles significantly reduces head injuries and death. A variety of promotional programs to increase helmet use in children have demonstrated limited success. This article reviews a variety of approaches to increase helmet use among children. The PRECEDE-PROCEED model is applied and recommendations for community health nurses to promote helmet use among children are provided. Accid Anal Prev. 2000 Jan;32(1):111-5. Exploration of the barriers to bicycle helmet use among 12 and 13 year old children. Loubeau PR. Department of Health Care Programs, Iona College, New Rochelle, NY 10801, USA. Despite the fact that bicycle helmet usage reduces the risk of bicycle-related head injuries, only a small percentage of children routinely wear helmets. The aim of this study was to qualitatively explore the barriers to bicycle helmet usage among 12 and 13 year old children. The study is based on four focus groups with 31 children from schools is an urban New York City area. A majority of both boys and girls did not perceive a need for wearing helmets for routine riding or short trips, and felt that helmet usage was uncomfortable and made them appear dumb. Also, students could not recall any health promotion efforts by a variety of health providers and felt local legislation had little impact on usage rates. The qualitative findings of this study provide valuable material for researchers seeking to understand the factors associated with non-use of bicycle helmets. Inj Prev. 1999 Sep;5(3):194-7. Fit of bicycle safety helmets and risk of head injuries in children. Rivara FP, Astley SJ, Clarren SK, Thompson DC, Thompson RS. Harborview Injury Prevention and Research Center, Seattle, WA 98104, USA. BACKGROUND: Although bicycle helmets are effective in preventing head and brain injury, some helmeted individuals nevertheless sustain head injury. One of the possible reasons may be poor fit of the helmet on the head. This study was undertaken to examine the relationship between helmet fit and risk of injury. METHODS: 1718 individuals who were helmeted riders in a crash were queried on helmet fit and position. A sample of 28 children 2-14 years of age who sustained a head injury while wearing a bicycle helmet and 98 helmeted individuals of the same age treated in the same hospital emergency departments for injuries other than to the head, underwent anthropometric measurements of helmet fit. Measurements were made of the child's head, the helmet, and on a cast made of the child's head. RESULTS: Individuals whose helmets were reported to fit poorly had a 1.96-fold increased risk of head injury compared with those whose helmets fit well. Children with head injuries had helmets which were significantly wider than their heads compared with children without head injuries. Helmet fit was poorer among males and among younger children. CONCLUSIONS: Poor fit of helmets may be associated with an increased risk of head injury in children, especially in males. Helmets may not be designed to provide optimal protection. Accid Anal Prev. 1999 Jan-Mar;31(1-2):13-9. Bicycle injuries in Western Sweden: a comparison between counties. Welander G, Ekman R, Svanstrom L, Schelp L, Karlsson A. Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden. The objectives of the study were to investigate whether there are differences in the incidence of bicycle-related injuries by geographic district (county), age, and gender in Sweden's Western Road Administration Region, and to utilize any detected differences to suggest priorities for intervention and prevention. Injury data come from the Swedish national hospital-discharge registry and a specialized national register of occupational injuries. Both bodily injuries in general and head injuries in particular show intra- regional differences. The rural part of Skaraborg County was shown to have a significantly higher injury incidence than other parts of the Western Region. Females generally show a lower incidence than males, but older women are more likely to be seriously injured than younger (age-related differences being greater than for males). Some striking findings were found with regard to occupational differences. Females sustain more work-related bicycle injuries than males. Head injuries account for more than half of the bicycle injuries in the Western Region that require hospitalization. All this indicates that targeted measures are required. Some studies have shown that the use of bicycle helmets reduces the incidence of head injuries, the degree of their severity, and the number of bicycle-related fatalities. There is a need for mandatory helmet-wearing legislation, which must go hand-in-hand with special efforts to reach groups with a low rate of helmet wearing, in particular those in the middle age range. Although the grown-up/older cycling population has been the subject of targeted action in some countries, the focus of preventive activity has generally been on children. The results of the study suggest the need for further injury-related research into adult cycling. South Med J. 1998 Nov;91(11):1033-7. Profile of pediatric bicycle injuries. Puranik S, Long J, Coffman S. Broward General Medical Center, Trauma Services, Fort Lauderdale, Fla 33316, USA. BACKGROUND: Bicycle injury data from local communities are important for developing injury prevention and control programs. This study represents the efforts of one community trauma center to describe bicycle injuries. METHODS: We conducted a retrospective analysis of bicycle injury data from hospital charts, emergency medical services reports, and medical examiner reports. The review encompassed a 4- year period. The study sample included 211 trauma alert patients, ages 1 through 15 years, who were treated for bicycle-related injuries at our level II pediatric trauma center. RESULTS: Bicycle injuries accounted for 18% of all pediatric trauma alert patients. The mean age of injured children was 10 years, and 79% were males. Bicycle-motor vehicle collisions caused 84% of injuries. Only 3 children (1.4%) wore bicycle helmets. Resulting injuries included external wounds (86%), head injuries (47%), fractures (29%), and internal organs (9%). Six children died. CONCLUSIONS: Bicycle injuries are a significant cause of mortality and morbidity for children in our community. Use of safety helmets by child bicyclists is inadequate. The data from this study can be used as a baseline in testing the effectiveness of local and state interventions, including new legislation mandating helmet use by children in our state. |
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