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Bicycle helmets help prevent serious head injury among children, part one.



 
 
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Old November 30th 04, 11:11 AM
John Doe
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Default Bicycle helmets help prevent serious head injury among children, part one.

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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Old November 30th 04, 02:37 PM
Andy Leighton
external usenet poster
 
Posts: n/a
Default

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_
  #3  
Old November 30th 04, 04:02 PM
Just zis Guy, you know?
external usenet poster
 
Posts: n/a
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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
  #4  
Old November 30th 04, 04:46 PM
JFJones
external usenet poster
 
Posts: n/a
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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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