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Objective: (1) To determine associations between radiographic features of lumbosacral (LS) spine disc space narrowing (DSN) and osteophytes (OST) and joint metabolism biomarkers (serum cartilage oligomeric matrix protein (COMP), hyaluronic acid (HA), collagen neoepitope (C2C), C-propeptide of type II procollagen (CP-II), urine C-terminal cross-linking telopeptide (CTX-II) and N-terminal telopeptide (NTX-I)). (2) To explore interactions with race, gender and low back symptoms., Design: Cross-sectional analysis of 547 participants enrolled in the Johnston County (JoCo) Osteoarthritis Project from 2003 to 2004. Mean biomarker levels were estimated with linear regression. Proportional and partial-proportional odds models were used to estimate associations. Interactions were tested with likelihood ratio tests at a P-value < 0.10. Biomarkers were natural log (ln) transformed., Results: Significant differences in mean biomarker levels were found across severity of DSN for lnHA and lnC2C and lnCTX-II across severity of both DSN and OST. Moderate-to-strong associations were found between biomarkers of type II collagen and DSN, whereas associations with OST were weak. An association between lnHA and DSN was seen in women (adjusted odds ratio [aOR] = 1.34 (95% confidence intervals (CI) 1.08, 1.65)) but no association among men (aOR = 0.90 (95% CI 0.63, 1.26)). In Caucasians there was a decreased association with NTX-I and OST (aOR = 0.67 (95% CI 0.49, 0.91)) and no association in African Americans (AAs) (aOR = 1.06 (95% CI 0.76, 1.47)). There was a positive association of lnCOMP with DSN among those with low back symptoms (aOR = 1.82 (95% CI 1.02, 3.27)), but no association in those without low back symptoms (aOR = 0.65 (95% CI 0.35, 1.20))., Conclusion: Joint metabolism biomarkers suggest biological differences in the pathologic process involved in DSN and OST that may be gender (HA) and ethnicity (NTX-I) specific., (Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

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

Homicide is the second leading cause of death on the job for workers in the United States. To identify workplace-level predictors of homicide risk, a case-control study of worker killings in North Carolina in 1994-1998 was conducted. Workplaces were the units of analysis: case workplaces (n = 105) were those where a worker was killed during the study period, while controls (n = 210) were a density sample of North Carolina workplaces, matched on time and industry sector. Potential risk and protective factors were assessed in telephone interviews with workplace managers. Associations were measured by the exposure odds ratio and 95% confidence interval, estimated via conditional logistic regression. Characteristics associated with notably higher risk included being at the current location for 2 years or less (odds ratio (OR) = 5.3, 95% confidence interval (CI): 2.2, 12.6), having only one worker (OR = 2.9, 95% CI: 1.2, 7.2), and having night (OR = 4.9, 95% CI: 2.7, 8.8) or Saturday (OR = 4.2, 95% CI: 1.9, 9.2) hours. Workplaces with only male employees (OR = 3.1, 95% CI: 1.5, 6.5) or with African-American or Asian employees were also more likely to experience a killing. While few of the preceding risk factors are directly modifiable through workplace interventions, it is important to identify them before developing or evaluating preventive measures.

Unlabelled: Baseball is a very popular team sport in the United States, but there has been concern with the number of injuries and fatalities., Objective: This study describes the incidence of injuries to Little League Baseball, Inc, players from 5 to 12 years old from 1987 through 1996., Methods: Descriptive statistical analyses of injuries derived from Little League Baseball, Inc, insurance data from 17,221,210 player-years of follow-up in the 10-year study period. An average of 1,722,121 children participated every year., Results: During the study, there were 29,038 injuries and an injury rate of 1.69 injuries per 1,000 participants per season. Ball-related injuries totaled 15,266, and batters had the greatest number of ball injuries. There were 12,306 facial and teeth injuries, mostly in defensive players. Sliding was associated with 60% of the injuries to base runners. Approximately 25% of the injuries were considered severe (fractures, dislocations, and concussions), and 13 players died., Conclusion: Based on the data, youth baseball appears to be a very safe sport, but there are areas where injury prevention is possible. Data and additional attention are needed concerning face mask use for players in the field, modified balls for minimizing contact injuries, education on sliding technique, and use of safety bases for runners.

The aim of this study was to describe temporal patterns in the frequency, nature and circumstances of injuries occurring among a cohort of 356 rugby players during a club rugby season in New Zealand. It was found that the rate of injury in games decreased significantly over time in both males and females. The reduction in injury rate over the season was more pronounced in some grades, but no differences were found when examined by gender. playing position, age, ethnicity or by health and fitness types. Trends in injury rate were consistent over the rugby season and did not appear to be the result of a bias involving under-reporting of end-of-season injuries. The types and severity of injury remained relatively constant, but the proportion of injuries occurring in back play fell significantly over the season and injuries were more likely to occur in the trunk body region as the season progressed. This study supported the hypothesis that higher rates of injury occur at the start of the rugby season and decrease over the course of the season. This reduction is consistent over time and across player types, and is not attributable either to decreasing injury severity or to increasing player fitness.

Motorcycle riding is a significant cause of serious injuries to young males. Little is known about the psychological and social characteristics of these riders, despite such knowledge being potentially important for the targeting of appropriate injury prevention interventions. Using problem-behaviour theory to broadly guide and structure the research, the present study focused on identifying predictors of motorcycle riding. Previous research investigating differences between riders and non-riders has tended to be inconclusive, methodologically limited, and lacking in explicit theoretical foundations. The present research was based on the birth cohort enrolled in the Dunedin Multidisciplinary Health and Development Study (DMHDS), a comprehensive New Zealand longitudinal study of health, development, attitudes, and behaviours. Logistic regression models were built using prior measures of health risk behaviour, other psychological and social factors, and motorcycle riding history as potential predictors of any motorcycle use at the age of 18 years. The strongest predictors were early motorcycle riding, including illegal on-road driving at age 13 (OR 4.0; 95% CI 1.7, 9.1), below average reading skills (OR 2.4; 95% CI 1.3, 4.6) and fighting in a public place at age 15 (OR 2.9; 95% CI 1.2, 6.9). It was of particular interest that this profile tended to fit less well those subgroups of riders with greatest exposure to on-road motorcycle driving. Although based on small numbers, this finding was consistent with earlier cross-sectional research that linked casual and unlicensed driving with less protective motorcycling opinions and behaviours. Some implications for injury prevention and public policies regarding motorcycling are discussed. In particular, stricter enforcement of present licensing regulations and stronger penalties for their violation could help to reduce the number of less responsible riders.

Aim: To characterise work related hand and lower arm injuries among New Zealand meat processors and to identify practices used for protecting the hands of this group of workers., Methods: These involved identifying and describing, from Department of Health national data, hand and lower arm injuries sustained by meat workers in New Zealand which resulted in hospitalisation during the period 1979-88, examining injury case records from selected meat processing plants for the period 1987-93 and identifying protective clothing practices in the meat processing industry., Results: A significant increase in the hospitalisation rate for the period 1979-88 was identified (3.3 per 1000 to 5.3 per 1000; chi(2) = 33.14, df = 1, p < 0.001) with cutting and piercing being the most common injury event. Reported use of protective gloves and covers for the lower arm by meat workers was high (93% and 66% respectively) and also probably increased., Conclusion: Why injury rates rose during a period in which use of protective gloves reportedly increased is unclear. Possible explanations are discussed.

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

The aim of this study was to describe the epidemiology of work-related hand and lower-arm injuries in New Zealand. Nonfatal hand and lower-arm injuries were identified from New Zealand's national database of hospital admissions for the period 1979 to 1988. Thirty-seven per cent (9714) of all such injuries (26,228) were work-related. Piercing and cutting instruments (38.5 per cent) and machinery (37.2 per cent) were the two most common agents of work-related hand and lower-arm injury. Specific occupations in which the number of cases was high included meat workers (n = 1020, 3.3 per 1000 employees), carpenters (n = 548, 2.2 per 1000), machine operators (n = 450, 11.9 per 1000) and sawmill workers (n = 498, 7.7 per 1000). The injury rate for meat workers, carpenter-joiners, machine operators and sawmillers increased significantly over the 10-year study period.

Study Objective: To describe the epidemiology of serious non-fatal firearm injury in New Zealand., Methods: Cases of nonfatal firearm-related injury were extracted from the hospital inpatient data files of the New Zealand Health Information Service for the period 1979 to 1992 inclusive., Results: There were 1,239 firearm-related injuries, or 2.7 injuries per 100,000 population per year. Males, persons aged 15 to 24 years, certain occupational groups, and persons living in rural environments had higher rates of injury. Unintentional incidents accounted for 64% of the injuries. At least 25% of the incidents involved shotguns, and a further 20% involved rifles., Conclusion: The results presented here serve to support the attention that has been given to prevention of firearm injuries in New Zealand. Priority should be given to establishment of a surveillance system that would provide uniform data on firearm-related mortality and morbidity to aid in risk factor research and development and evaluation of intervention programs.

Aim: To determine the incidence of motor vehicle occupant injuries in New Zealand children and to consider future directions for prevention., Methods: The Ministry of Health's national mortality and morbidity files for the years 1981-1990 were examined to identify all deaths and hospital discharges for motor vehicle occupant injuries in children between the ages of 0-14 years., Results: Over the 10 year period, there was an average of 26 deaths and 433 hospitalisations annually. Fatality rates were highest for the age group 0-2 years, whereas hospitalisation rates were highest for those aged 3-4 years. Although mortality rates were similar for Maori and nonMaori children, the hospitalisation rate for Maori children was more than three times that for nonMaori children. No significant trends in either fatality or hospitalisation rates were evident., Discussion: Motor vehicle occupant injury is an important public health problem in New Zealand children. Reductions in the numbers of motor vehicle occupant deaths and hospitalisations will require not only legislative changes aimed at increasing restraint use, but also the development of strategies to ensure compliance with the legislation. The identification of barriers to the use of child restraints is likely to facilitate the development of effective strategies aimed at increasing occupant restraint use.

Aim: This paper presents a detailed investigation of the injury experience of New Zealand forestry workers, including loggers and silviculture workers., Methods: Record linkage of multiple data sources., Results: During the period 1975-88, there were 81 work-related fatalities among loggers and 10 fatalities among silviculture workers, yielding fatality rates of 2.03 and 0.15 per 1000 workers/year, respectively. These figures were substantially higher than the fatal injury rate among the overall New Zealand workforce of 0.07 deaths per 1000 workers/year. In addition there were 1068 work-related injuries resulting in hospitalisation among loggers, and 478 among silviculture workers, yielding hospitalisation rates of 38.93 and 9.58 per 1000 workers/year, respectively. The types of injury contact involved in each incident were analysed. Contact with falling trees was the leading cause of death in forestry, accounting for over half of the fatal injuries among loggers and a third among silviculture workers. For loggers, the three commonest types of contact resulting in hospitalisation were: chainsaw injuries (n = 351; 33%), falling trees (n = 269; 25%), and rolling logs (n = 82; 8%). Among silviculture workers, the three commonest types of contact resulting in hospitalisation were: chainsaw injuries (n = 108; 23%), falling trees (n = 96; 20%), and falls/slips and trips (n = 94; 20%), Conclusion: There is clear need for continued efforts to improve the overall safety of forestry work in New Zealand.

Aim: To determine the incidence of injury deaths and hospitalisations associated with pedal cycle use in both traffic and nontraffic environments and in the national population of New Zealand., Methods: All cases of pedal cycle injuries resulting in death between 1979-88, and all those resulting in hospitalisation in 1988 were identified from health information services files., Results: Between 1979 and 1988, 238 cyclists died. Seventy-six percent were male, and 39% of all fatalities occurred to those aged 5-14 years. Collisions with motor vehicles accounted for most fatalities. Head injuries alone, or with other injuries, were associated with death in 60% of cases. In 1988, 1500 cyclists were admitted to hospital for the treatment of their injuries. Fifty-one percent of those hospitalised were aged 5-14, and males accounted for 70% of all admissions. Thirty-four percent involved a collision with a motor vehicle. Intracranial injuries and skull fractures accounted for 46% of hospital admissions, and had the highest scores on the abbreviated injury scale (AIS)., Conclusion: This study shows that head injuries are a common cause of death and hospital admission for cyclists. Increases in cycle helmet wearing rates are likely to reduce the frequency and severity of head injury. Other prevention strategies include cycling skills programmes that have been evaluated and shown to be effective, the identification and modification of aspects of cycle design that contribute to injuries, and changes to road design.

The hospital inpatient costs for the treatment of injury were obtained for Dunedin Hospital for a two-year period using the Resource Utilisation System. These data were used as a basis for estimating national inpatient costs for motor vehicle traffic crashes (MVTCs). The results show that injuries were on average more expensive to treat than non-injuries ($3,115 vs. $2,749 per case). At a mean cost of $5,253 per case, injuries due to MVTCs were the most expensive class of injury event to treat. The average cost of treating a case varied by the class of road user, nature of injury, and severity of injury. Pedestrians were on average, twice as costly to treat as motor vehicle occupants. Costs for treating the late effects of motor vehicle crashes were higher, with a mean cost of $5,695. Internal injuries were on average 4.5 times more expensive to treat than intracranial injuries, the least expensive group of injuries to treat. On average, critical injuries cost 15 times more to treat than minor injuries. The cost of treating pedestrians was disproportionately higher than that for other road users. Nationally pedestrians accounted for 10% of all hospitalised road users, but they contributed 18% of the total cost. Internal injuries had the highest disproportionate cost accounting for 7% of cases and 16% of the costs. Similarly, severe and critical injuries combined accounted for 6% of the national cases but contributed 19% of the national costs. Overall, the leading contribution to the total national cost were made by occupants (43%), lower limb fractures (24%), and moderate injuries (37%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aim: To describe the cost of inpatient admissions and emergency department attendances for injury at a major New Zealand hospital; and to extrapolate to indicative national costs for injury, with a view to facilitating decision making, in relation to injury prevention programs., Methods: By using data from the patient management system database and the resource utilisation system operating at Dunedin Hospital to describe the utilisation spectrum for injury related events., Results: The institutional cost of inpatient care for injury cases for the year ending 31 December 1990 amounted to $7,378,000, at an average of $3,020 a case. The costs for emergency department attendances (not resulting in admission) amounted to $2,585,000, at an average of $93 a case; the total of $9,963,000 equated to 15% of the hospitals annual operating budget. The most expensive causes of admission with injury were falls and motor vehicle traffic crashes. The commonest resulting injury was fractures of the lower limb, and the commonest and cumulatively most expensive injuries presenting at the emergency department were cuts, and sprains and strains. If these costs were extrapolated to New Zealand as a whole it would suggest hospital costs of approximately $457 million per annum; when taken in conjunction with other known medical and welfare costs this approximates to an annual bill to the state of approximately $1.2 billion per annum., Conclusion: Injuries are a significant, costly, potentially preventable, element of health care. The use of hospital data for the allocation of resources to preventive efforts to date, has been based primarily on hospital admission numbers. This study suggests that this is not however indicative of the costs to the state, and the use of financial and other utilisation data would assist in rationalising resource allocation to preventive programs.

The incidence and aetiology of facial fractures resulting in admission to public hospitals in New Zealand in 1987 were investigated retrospectively from data collected by the Health Statistical Services. Data were analysed by the age group, ethnic origin and gender of those affected. During 1987 the overall incidence of facial fractures was 47.9/100,000 of the population. The highest incidence was for Maori males at 152/100,000. A comparison with data for the period 1979 to 1988 showed a decrease for the population as a whole but an increase for those who declared themselves to be Maori. Assault was the most common cause of facial fractures resulting in hospitalisation for both males and females. Sport was the second most common cause of facial fractures with rugby football contributing two-thirds of these. These results indicate where future preventive measures should be targeted.