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Biomedical subjects

I Roberts

Publications and source records attributed to I Roberts.

At least 199 records · Page 11Linked to original sources

Social policy as a cause of childhood accidents: the children of lone mothers.

Almost one in five British mothers is a lone mother. Their children have injury rates that are twice those of children in two parent families. In this article the link between lone parenthood and childhood injury is examined. The increased injury rates for the children of lone mothers can be explained by the poverty, poor housing conditions, and social isolation of lone mothers in Britain. The problem of reconciling the demands of paid work with the demands of the unpaid work of childrearing is particularly difficult for lone mothers, who find themselves in a benefit dependent poverty trap. Many such mothers would seek paid work if affordable day care were available. Day care would also provide a safe environment for their children, who are otherwise exposed to the environmental hazards of poor housing. Provision of day care is a social policy that would have important effects on the health and welfare of lone mothers and their children. These effects deserve to be properly evaluated.

Accidents↗

China takes to the roads.

China is undergoing rapid motorisation--motor vehicle registrations are growing at a rate of 10%-20% a year. Road trauma is already a major public health problem, and road deaths, officially estimated to be around 50,000 a year, will almost certainly rise with increasing motorisation. China, with its millions of bicycles, currently has one of the most environmentally friendly transportation systems on the planet. However, as the trend towards car travel continues, the problems of congestion and environmental pollution so evident in the West will also become critical public health issues in China.

Accidents, Traffic↗

Effect of environmental factors on risk of injury of child pedestrians by motor vehicles: a case-control study.

OBJECTIVE: To identify and assess contribution of environmental risk factors for injury of child pedestrians by motor vehicles. DESIGN: Community based case-control study. Environmental characteristics of sites of child pedestrian injury were compared with the environmental characteristics of selected comparison sites. Each comparison site was the same distance and direction from home of control child as was the injury site from home or relevant case child. Two control sites were selected for each injury site. SETTING: Auckland region of New Zealand. SUBJECTS: Cases were 190 child pedestrians aged < 15 who were killed or hospitalised after collision with a motor vehicle on a public road during two years and two months. Controls were 380 children randomly sampled from population and frequency matched for age and sex. MAIN OUTCOME MEASURE: Traffic volume and speed and level of parking on curbs at injury sites and comparison sites. RESULTS: Risk of injury of child pedestrians was strongly associated with traffic volume: risk of injury at sites with highest traffic volumes was 14 times greater than that at least busy sites (odds ratio 14.30; 95% confidence interval 6.98 to 29.20), and risk increased with increasing traffic volume. High density of curb parking was also associated with increased risk (odds ratio 8.12; 3.32 to 19.90). Risk was increased at sites with mean speeds over 40 km/h (odds ratio 2.68; 1.26 to 5.69), although risk did not increase further with increasing speed. CONCLUSION: Reducing traffic volume in urban areas could significantly reduce rates of child pedestrian injury. Restricting curb parking may also be effective.

Accidents, Traffic↗

The urban traffic environment and the risk of child pedestrian injury: a case-crossover approach.

We conducted a case-crossover study to quantify the effects of traffic volume and speed on the risk of child pedestrian injury on the school-home journey. We identified 46 children injured as pedestrians on the school-home journey. For each case, we compared the traffic volume and speed on the road where the child was struck with the volumes and speeds on the other roads the child would usually cross. We found strong associations between pedestrian injury risk and high traffic volume [relative risk = 6.3; 95% confidence interval (CI) = 2.1-18.8] and high speed (relative risk = 3.6; 95% CI = 1.5-8.4). These results provide suggestions as to future applications of the case-crossover design.

Accidents, Traffic↗

Inter-rater reliability in the medical diagnosis of child sexual abuse.

OBJECTIVE: To examine inter- and intra-rater reliability in the assessment of genital findings in cases of suspected child sexual abuse. METHODOLOGY: Colposcopic photographs of the external genitalia of 70 female children were independently assessed by child sexual abuse teams in Auckland and Sydney. For the Auckland centre, intra-rater reliability was assessed by making a second independent assessment 6 months following the first. Reliability was quantified using per cent of agreement and Cohen's Kappa statistic. RESULTS: There were high levels of inter- and intra-rater agreement. When photographs were classified as normal/non specific or strongly indicative of child sexual abuse, there was 93% agreement between the Auckland and Sydney teams with a kappa score of 0.70. For the two separate ratings made by the Auckland team there was 94% agreement with a kappa score of 0.75. CONCLUSIONS: The high levels of inter- and intra-rater agreement obtained in this study were reassuring. The results obtained compare favourably with the results of reliability studies in other areas of medical practice.

Child↗

Effects of carbohydrate feeding before and during prolonged exercise on subsequent maximal exercise performance capacity.

The study examined the effect of carbohydrate ingestion on exercise performance capacity. Nine male cyclists performed two separate trials at 70% VO2max for 60 min followed by a maximal ride for 10 min. During trials subjects were fed either an 8% glucose solution (CHO) or a placebo solution (PL), which were administered at rest and during and immediately after submaximal exercise. Statistical analyses indicated that glucose levels at rest increased significantly 15 min after the ingestion of CHO compared to PL. At 30 and 60 min during submaximal exercise, plasma glucose levels decreased significantly in the CHO but not in the PL trial. Following the performance ride, glucose levels increased significantly only during the CHO test trial. Free fatty acids did not change significantly during testing trials. The maximal performance ride results showed that in the CHO trial, a significantly greater external work load was accomplished compared to the PL trial. It is concluded that CHO ingestion improves maximal exercise performance after prolonged exercise.

Adult↗

Sensory deficit and the risk of pedestrian injury.

OBJECTIVES: To examine the association between sensory deficit and the risk of child pedestrian-motor vehicle collisions. SETTING: The Auckland region of New Zealand. METHODS: A community based case-control study was conducted. Cases (n = 190) were all children (< 15 years) killed or hospitalised as a result of a pedestrian injury occurring on a public road between 1 January 1992 and 1 March 1994. Controls (n = 479) were a random sample of the child population. RESULTS: The risk of pedestrian injury for children whose parents reported abnormal vision was over four times that of children with reported normal vision (odds ratio = 4.25, 95% confidence interval 1.68 to 10.8). The risk of injury for children whose parents reported abnormal hearing was close to twice that of children with reported normal hearing (odds ratio = 1.73, 95% confidence interval 0.83 to 3.61). CONCLUSIONS: Children with sensory deficits constitute a high risk group for pedestrian injuries. Paediatricians caring for children with sensory impairments should be aware of this increased risk.

Accidents, Traffic↗

Methodologic issues in injury case-control studies.

In this paper some methodological problems particularly relevant to case-control studies of injury are illustrated by reference to previous childhood injury case-control studies. In contrast to studies of disease, where 'person time' constitutes the observational experience of interest, in injury studies person time engaged in a particular activity to often more appropriate. The implications for the definition of the study base are discussed. The potential for hospital admission bias in injury case-control studies is considered along with potential strategies for avoiding it. The importance of errors in exposure measurement, including those arising from inappropriate induction time assumptions, are illustrated. Finally, the potential for bias resulting from the combination of etiologically unrelated injury outcomes into a single outcome measure is illustrated and discussed.

Canada↗

Who's prepared for advocacy? Another inverse law.

OBJECTIVES: To examine the characteristics of parents responding to a petition calling for greater efforts to ensure the safety of children as pedestrians and to contrast factors predictive of advocacy with risk factors for child pedestrian injury. SETTING: The Auckland region of New Zealand. METHODS: Parents participating in the Auckland Child Pedestrian Injury Study, a community based case-control study, were invited to support a series of recommendations based on the study results, by signing and returning a petition that was to be delivered to the New Zealand Minister for Transport. Characteristics of petitioners were determined by linking their petition responses to the study questionnaires using an unique identifier. The characteristics of petitioners and nonpetitioners were summarised using odds ratios. RESULTS: 31% of parents signed and returned the petition; 19% were parents of cases and 36% were parents of controls. The sociodemographic groups whose children were at the lowest risk of pedestrian injury were the most likely to return the petition. Children in the most disadvantaged socioeconomic group and children of Pacific Island parents were at greatest risk of injury but the parents of these children were the least likely to respond to the petition. CONCLUSIONS: The frequency with which parents advocate for child safety varies inversely with the need for it. Models of health promotion based on community ownership and empowerment alone are unlikely to address the steep socioeconomic gradients in childhood injury mortality.

Accidents, Traffic↗

Adult accompaniment and the risk of pedestrian injury on the school-home journey.

STUDY OBJECTIVE: To quantify the effect of adult accompaniment on the risk of pedestrian injury on the school-home journey. DESIGN: A community based case-control study. SETTING: The Auckland region of New Zealand. PARTICIPANTS: Cases (n = 54) were all children killed or hospitalized as a result of a pedestrian injury occurring on the school-home journey between 1 January 1992 and 1 March 1994. The response rate for the case group was 98%. Controls (n = 157) were a random sample of all children who walk to and from school in the study region. The response rate for the control group was 100%. MAIN RESULTS: Adult accompaniment on the school-home journey was associated with a reduced risk of injury (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.04 to 1.66). This effect persisted after controlling for age, sex, and socioeconomic status (OR 0.31, 95% CI 0.07 to 1.49). CONCLUSIONS: Adult accompaniment on the school-home journey may have the potential to significantly reduce child pedestrian injury rates. The effect of adult accompaniment may have important implications for the interpretation of child pedestrian exposure studies.

Accidents, Traffic↗

Child pedestrian deaths: sensitivity to traffic volume--evidence from the USA.

STUDY OBJECTIVE: In case centred epidemiological studies, traffic volume has been shown to be a potent risk factor for child pedestrian injuries. Nevertheless, over the past two decades child pedestrian death rates have fallen in many countries despite large increases in traffic volumes, suggesting that other factors are responsible for the long term decline in death rates. This study aimed to investigate the relationship between short term changes in traffic volume and child pedestrian death rates. DESIGN: The relationship between child pedestrian death rates and traffic volume in the USA for the period 1970-88 was investigated. Trends in death rates and in traffic volume were removed by the time series method of differencing. RESULTS: After removing the long term trends, there was a close relationship between the year to year variation in traffic volume and the year to year variation in the child pedestrian death rate. Most notably, in the two periods when traffic volume actually fell, the falls in the child pedestrian death rate were considerably larger than those seen at any other time. Overall, decelerations in the rate of increase in traffic volume were accompanied by accelerations in the rate of decline in the child pedestrian death rate. CONCLUSION: While other factors may determine long term trends in child pedestrian death rates, they are very sensitive to short term changes in traffic volume. Public policy changes which limit the growth in traffic volume have the potential to accelerate the decline in child pedestrian death rates.

Accidents, Traffic↗

Neurological 'soft' signs may identify children with sickle cell disease who are at risk for stroke.

UNLABELLED: Stroke is one of the most frequent complications of sickle cell disease (HbSS), occurring in 7-17% of children. Recent studies recognized more minor lesions on MRI, not associated with clinical signs on standard neurological examination, which however have been found to be a risk factor for developing stroke later. The aim of this study was to evaluate whether minor lesions observed on imaging could be associated with 'soft' neurological signs not detectable on conventional neurological examination. Fourteen children with HbSS were assessed with MRI, standard neurological examination and evaluation of 'soft' signs (Zurich Neuromotor Test) and motor function (Movement ABC). Eight of the 14 children scanned showed lesions on MRI but only 3 of the full cohort were abnormal on standard neurological examination. However, all of the eight children with MRI lesions also showed abnormal signs on at least one of the two tests (Zurich and Movement ABC). All the children with normal MRI were normal on all the tests performed. The sensitivity of Zurich Neuromotor Test and Movement ABC in the group of children with MRI lesions is 0.88 and 0.75, respectively, and increases to 1 when the two tests are used together. The specificity of both tests is 1 even when the tests are used separately. CONCLUSION: Although the number of cases is small, 'soft' signs may reliably identify the presence of even minor MRI lesions, allow the evaluation of the global incidence of major and minor neurological signs and may also help to identify the population at risk for developing strokes. This population could then be closely monitored and benefit from early intervention.

Adolescent↗

Driveway-related child pedestrian injuries: a case-control study.

OBJECTIVES: To examine risk factors for driveway-related child pedestrian injuries. DESIGN: A community based case-control study. SETTING: The Auckland region of New Zealand. PARTICIPANTS: Cases (n = 53) were children killed or hospitalized as a result of a driveway-related pedestrian injury, in the Auckland region over a period of 2 years and 2 months. Controls (n = 159) were an age-matched random sample of the child population of the Auckland region. RESULTS: The absence of physical separation of the driveway from the children's play area was associated with a threefold increase in the risk of driveway-related child pedestrian injury (OR = 3.50; 95% CI 1.38, 8.92). Children living in homes with shared driveways were also at significantly increased risk (OR = 3.24; 95% CI 1.22, 8.63). The population attributable risk associated with the absence of physical separation of the driveway from the children's play area was 50.0% (95% CI 24.7, 75.3). CONCLUSION: The fencing of residential driveways as a strategy for the prevention of driveway-related child pedestrian injuries deserves further attention.

Accidents, Home↗

Controlling for socioeconomic disadvantage in epidemiologic analyses.

Controlling for the effects of socioeconomic disadvantage is commonplace in epidemiologic studies. In New Zealand, the Elley Irving scale is used to classify individuals into socioeconomic groups. In this study, data from the control group of a large population based case-control study were used to examine the extent to which indicators of socioeconomic disadvantage vary between ethnic groups, within socioeconomic strata. In each of the commonly constructed socioeconomic strata, the proportion of subjects with car access was significantly lower in the Maori/Pacific Island group than in the nonMaori/Pacific Island group. Similarly, apart from in the highest socioeconomic stratum, where the numbers in the Maori/Pacific Island group were small, the proportion of subjects who were owner occupiers was significantly lower in the Maori/Pacific Island group compared with the nonMaori/Pacific Island group, in each stratum. The Elley Irving scale has limited utility as a measure of material well being. Its widespread use in epidemiologic research, to control for the effects of socioeconomic disadvantage must therefore be questioned.

Accidents, Traffic↗