Short reports

The aim of the study was to evaluate a hospital-based injury recording system on hip fracture registration in elderly persons aged + 65 years from 1994 through 2008, and to examine the agreement between the number of validated fractures and the number of fractures reported to the Norwegian Patient Registry using three different sources: (1) Medical records, (2) Patient administrative system and (3) The hospital's hip fracture record to the Norwegian Patient Registry from 2002 through 2008. The injury recording system included 582 hip fracture events and 535 (92%) were confirmed through the medical records. Reasons for non-verification were different coding failures. Searching the patient administrative system using ICD codes identified 16 hip fractures not included in the fracture registry between 2002 through 2008. The total number was the same as the number of hip fractures reported to the Norwegian Patient Registry using ICD codes alone for identification. The conclusion is that on well-defined diagnosis like hip fractures, local fracture registries may obtain a high degree of reliability if different sources are available for quality control. Well-functioning patient administrative systems may be used to study numbers of hip fractures.     

The epidemiology of head injuries in Sweden from 1987 to 2000

The purpose of the present study was to evaluate the variability in the annual head injury incidence rate in Sweden from 1987 to 2000. It was hypothesized that the annual incidence rate would decrease over time due to a variety of primary preventive strategies that have been introduced in Swedish society. We used the Hospital Discharge Register at the National Board for Health and Welfare and head injury codes 800-804, and 850-854 from ICD9 system and S2.0-S2.9, and S6.0-S6.9 codes from ICD-10 system. We evaluated the patterns of age, gender, external cause of injury (E-code), type of injury, length of hospital stay, and trends over time. Head injuries due to transportation collision were reduced over the 14-year period analysis. Falls persisted as the dominant cause of head injury. Overall, men had 2.1 times the incidence of head injury compared to women. There was a decline in younger ages experiencing a head injury over this interval, while the number of head injuries among elderly people increased over time. Concussion was about three times more frequent than fractures. Hematoma and diffuse or focal contusions had a much lower incidence rate than concussion. Concussions and fractures decreased over time. Diffuse or focal injuries showed a steady rate of occurrence over the study interval while hematoma increased. Although length of hospital stay varied widely from zero to more than 50 days, 73.6% of hospital days were confined to two days or less. The incidence rate is stable over this time frame. While head injuries attributable to transportation accidents decreased, falls made up an increasing proportion of head injuries. Since we observed an increase in head injuries among elderly, primary prevention strategies may need to be targeted at this age group, and at preventing falls.     

Injuries from Motorcycle- and Moped crashes in Sweden from 1987 to 1999

The objective of this paper is to study injuries from motorcycle and moped crashes in Sweden from 1987 to 1999. Databases at the National Board for Health and Welfare and codes from both ICD9 and ICD10 systems were used, including patterns of age, gender, E-code and type of injury. Length of hospital stay, type of injuries and trends over time was evaluated. To get a more detailed picture of the age distribution, type of vehicle used and number of killed, data from the Swedish National Road Administration were also used. In Sweden, 27,122 individuals received in-patient care due to motorcycle and moped injuries between 1987 and 1999. The motorcycle and moped injury rate was reduced in the second half of the studied period and so were the total days of treatment per year. Males had eight times the incidence of injuries compared to females. Riders under the age of 26 and in particular those at an age of 15 had the highest incidence rate. Head injuries were the most frequent diagnosis, followed by fractures to the lower limbs. Concussion was the most frequent head injury. Focal and diffuse brain injuries combined showed the same frequency as concussion. It is concluded that more preventative strategies must be presented before the injury rate can be reduced.     

Injury classification: balancing continuity and utility

The approach to classifying injury and its causes in the International Classification of Diseases changed radically between ICD5 and ICD6. It has changed relatively little in the subsequent four revisions and fifty years. ICD6 introduced separate chapters for “injury and poisoning” and “external causes”, and the main groups in each of those chapters. Injury research has emerged as a discipline in the period since ICD6 was developed. Major themes are conceptual frameworks of aetiology and prevention, the empirical measurement of injury severity, and population-based and community injury prevention techniques. ICD-10 (in common with ICD-9) reflects these developments to a very limited extent. A response to limitations of the ICD for purposes of injury prevention and control was the development, particularly in the 1980s and 1990s, of special-purpose classifications of characteristics of events that result in injury. Recognition of strong commonality among several of these ‘multi-axial’ systems led to a view that an international system embodying shared characteristics was achievable and worthwhile. The draft ICECI is the latest outcome of this work. Compatibility with ICD-10 is a design criterion for ICECI because of the continuing central importance of the ICD for health classification. The precise meaning of “compatibility” in this context has not been resolved. At one extreme, “compatibility” could mean limiting ICECI simply to the ICD-10 external cause codes with subdivision of existing categories, and perhaps some additional data items that do not overlap conceptually with ICD-10. At other extremes, ICECI could be developed without specific reference to categories in ICD-10, or ICECI could replace the existing ICD external cause classification. It is not practicable to map every ICD-10 three-character external cause category to a unique equivalent combination of codes in a multi-axial system, mainly due to conceptual inconsistencies in the ICD-10 external cause classification. More limited mapping is possible and could be designed to ensure that data coded to ICECI could be grouped to be equivalent to important ICD external cause categories. The way chosen for classification of external causes should be one that recognises contemporary information requirements in the fields of injury prevention and control as well as the desirability of continuity in long-term monitoring of important categories of injury. Field-testing and consultation with data users will determine whether ICECI meets these criteria well enough to warrant its adoption as a member of the ICD family of classifications.     

Indicators of injury burden: which types are the most important?

Injury indicators are used for monitoring the impact of injury prevention initiatives on the population burden of injury. The object of the present study was to identify the types of injury responsible for the major component of the population health burden of injury in a large cohort in Manitoba, Canada. Injury cases (ICD-9-CM 800-995) aged 18-64 years were identified from all Manitoba hospital data between 1988 and 1991. Morbidity data were obtained from hospital discharge abstracts 12 months prior to date of injury and for 12 months post-injury. Outcomes for individuals were calculated as the difference pre- and post-injury in hospital inpatient days. Death outcomes in the 12 months post-injury were obtained by linking the cohort with the population registry. Summed outcomes across the population were stratified into injury types based on the International Code of Diseases (ICD) code of the index injury. Outcomes were also stratified by injury severity score categories where the injury severity score was obtained using ICDMAP-90. When ranked by contribution to the cohort's cumulative hospital inpatient days in the 12 months post-injury, the six most common ICD subchapter groups accounted for 65% of the total inpatient days. These six injury types also accounted for 62% of the total number of deaths in this cohort in 12 months after injury. The suggested injury types to use as indicators of burden include fracture of the lower limb, fracture of the head and neck, poisonings, intracranial injury, fracture of the upper limb, and fracture of skull.     

Fracture incidence among elderly people in institutional care: linking injury surveillance data with a postal code-based register of residential and nursing homes

Fracture prevention strategies will be most cost-effective if targeted at groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in residential and nursing homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 living in the city of Cardiff. We linked a postal code-based register of all care homes in the city with injury data from Cardiff’s only Accident and Emergency department. Cardiff has 47,520 residents aged over 65, and 1,874 (3.9%) live in residential or nursing homes. Fracture incidence was 25/1,000/year overall, and 5/1,000/year for hip fracture. During 1997, the care home residents suffered 162 fractures, 82 of which were of the hip; an incidence of 86/1,000/year overall, 44/1,000/year for hip fracture. Even after adjustment for the age and sex profile of the care home population, fracture incidence remained 2.3 times higher and hip fracture incidence 3.6 times higher than in the general elderly population. Such figures support the potential cost-effectiveness of strategies that prevent fractures in care homes, and are of special interest to those planning intervention studies in this setting.     

True burden of drowning: compiling data to meet the new definition

The objective and aim of the study was to compile empirical data to quantify the underestimation of the true burden of drowning and to compare drowning rates using commonly reported codes compared with those revealed by use of the full range of drowning codes in ICD version 10. The authors reviewed mortality data (1999-2002) from Australia and the USA and compiled data to compare the burden of 'unintentional drowning' with that of 'all drowning'. In both Australia and the USA, drowning mortality is more than 35% higher when a full range of codes is examined. A more comprehensive representation of the drowning problem is needed to assist in strengthening prevention activities.     

Neck injuries among the elderly in Sweden

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patient.     

Cervical injuries in Sweden,a national survey of patient data from 1987 to 1999

Neck injuries are one of the most important injuries as they have the potential to influence the spinal cord. Data from most parts of the world are not sufficient to define a comprehensive view of mortality, morbidity, disability and handicap due to neck injuries. In Sweden, there are no data on the incidence of neck injuries. The aim of this study is to define the national incidence and causes of neck injuries in Sweden. An incidence study was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries over a period of three years, from 1997 to 1999. Data between 1987 and 1996 were reported in ICD 9, while data from 1997 to 1999 were reported in ICD 10. During the study period, 14,310 non-fatal and 782 fatal cervical injuries occurred. A decreasing incidence for cervical fractures can be seen for the Swedish population, except for the elderly that have a slight increase in incidence. The incidence for cervical soft tissue injuries is almost constant. Cervical fractures demand longer periods of hospitalization than the soft tissue injuries. Transportation-related cervical fractures have dropped since 1991, while soft tissue injuries increased slowly between 1997 and 1999. Fall accidents are now the largest external cause of cervical fractures, and the population above 65 years accounts for almost 50% of the fall accidents. The male population has a higher incidence of cervical fractures, disregarding age. It is concluded that safety programs for transportation-related injuries in Sweden have been successful, while fall accidents are still substantial. Much more can be done to prevent neck injuries; especially to reduce the number of transportation-related cervical soft tissue injuries and fall injuries in the elderly population.     

财务报告舞弊行政处罚严厉程度与审计意见购买

以2002-2008年间非金融类、非外资类正常交易A股公司为研究样本,考察财务报告舞弊行政处罚严厉程度与审计意见购买的关系。实证结果表明,财务报告舞弊行政处罚越严厉,越能显著地降低审计客户通过变更审计师购买审计意见的概率,越能显著降低审计客户盈利能力的增加或债务水平的降低,进而达到审计意见改善的目的。     

The cost of childhood injury in France

Injuries are a major public health problem worldwide. In the USA, injuries cause 146, 400 deaths annually, with 31 million non-fatal injury visits to emergency departments (EDs). EDs thus represent an important source of injury data. The primary objective of the current study was to describe the epidemiology of injury-related ED visits and assess injury-related utilization of health care resources in an inner-city hospital in Indiana, using data stored in a computerized medical record system. It involved a retrospective review of the records for injury visits to EDs and injury admissions over a 3-year period. The variables extracted and analysed included patients' demographics, external cause of injury, diagnosis, length of stay, ED and hospital charges. A total of 60,470 injury-related ED visits were made, the majority of patients were male (61.6%), uninsured (63.1%), treated in ED and discharged (98.4%). The leading causes of injury were falls (18.8%), motor vehicle crashes (18.4%), assaults (17.6%), being struck (11.2%) and overexertion (10.6). Firearms caused most injury deaths (32.4%; n = 314); motor vehicle crashes were the leading cause of hospitalization (26.6%; n = 642) and also the most expensive to treat as inpatients (mean charge $19,190). The mean charge per patient treated and discharged was $150 compared to $11,116 for patients admitted. These findings demonstrate the value of computerized medical records in capturing and storing E-coded injury data. The system generates data that can be used for epidemiological surveillance and injury prevention at the local level, and for assessment of impact of specific injuries on health care resources.     

THE IMPACT OF POINT‐OF‐SALE DATA INACCURACY AND INVENTORY RECORD DATA ERRORS

The presence or absence of error in point‐of‐sale (POS) data and inventory system records directly affects retailer performance. This study identifies various error sources in retail supply chains and studies the influence of inventory and POS (demand) errors in a simulated retail outlet according to fill rate and average inventory. Other things being equal, we find that inventory record error reduces fill rate more than demand error. This study adds further evidence to other studies that suggest the costs caused by errors in POS systems may be overstated.     

Who Files for Personal Bankruptcy in the United States?

Who files for bankruptcy in the United States is not well understood. Previous research relied on small samples from surveys or a small number of states from administrative records. Using over ten million administrative bankruptcy records linked to the 2000 Decennial Census and the 2001–2009 American Community Surveys, I document who files for bankruptcy. Compared to the US population, bankruptcy filers are middle income, more likely to be divorced, more likely to be black, more likely to be veterans, less likely to be immigrants, and more likely to have a high school degree or some college. Filers are more likely to be employed. The bankruptcy population is aging faster than the US population as a whole. Lastly, using pseudo‐panels I study what happens in the years around bankruptcy. Individuals are likely to get divorced in the years before bankruptcy and then remarry. Income falls before bankruptcy and rises after bankruptcy.     

The behavioural effects of corporate ethical codes: Empirical findings and discussion

The use of corporate ethical codes has been increasing. It is argued that the use of ethical codes solely as an instrument in a company's image management is morally questionable. Therefore, the introduction and use of ethical codes must have the intention of achieving behavioural change or the maintenance of already superior behaviour. This change or superior behaviour may apply to ethics in general, but also to the different sub‐structures of ethics, namely the areas of reliability ethics, human ethics, capability ethics and future ethics. Previous research has, with some exceptions, failed to demonstrate that the introduction of ethical codes has had any behavioural effect. A survey study of Norwegian professionals ( N =449) in business is reported here. Using the flexibility that a multivariate analysis provides, the existence or non‐existence of ethical codes, and their influence on attitudinal differences across the four ethical sub‐structures is tested. In the following discussion, three lines of argument are used, drawing on logical, social and managerial approaches, to explain why the codes do exist and yet do not seem to influence the members of a business organisation. Finally, the paper suggests some implications for business practice and for future research.     

Business Institutions and Behaviour in Australia: A New Perspective

There are no ready explanations for the shift from private to public ownership of the infrastructure which occurred in many Western countries in the period from about 1850 onwards. This paper presents for the first time, from parliamentary and trade sources, a comprehensive record of the number of gas undertakings in England and Wales, their geographical spread and the incidence of municipal ownership. The experience of some 400 towns are analysed for the period 1851–1939 to ascertain the causes of municipalisation. These are identified as the desire of local authorities to get access to gas company profits in order to relieve local taxes and finance urban improvements, and to control the monopoly position of local suppliers. Municipalisation also involved costs, mainly of an administrative and legal nature. The differential incidence of these costs and benefits can be used to explain the complex pattern of public and private ownership which persisted to the Second World War.     

Using simulation to establish appropriate vaccination rates and copayment policies from a cost perspective

Making the best decisions on vaccination policy during influenza seasons can be critical in minimizing overall costs for an insurance company. Using administrative data, company records, and published reports for the flu season during 2007–2008, a simulation model is developed to mimic the spread of influenza in children, to calculate the cost of vaccination, and the cost of treatment for infected children. The model is designed to allow for sensitivity analysis with different scenarios of vaccination rates and is implemented in a healthcare insurance company located in Southeast region of the USA. The experimental results show several advantages of simulation methodology, including its ability to mimic the complex behavior of a spreading influenza in a selected population group, while testing a range of alternative solutions for different disease scenarios. Based on the historical data, the proposed simulation suggests a vaccination policy that could significantly reduce the overall cost of the vaccination program.     

Principles and Influence in Codes of Ethics: A Centering Resonance Analysis Comparing Pre- and Post-Sarbanes-Oxley Codes of Ethics

This study examines the similarities and differences in pre- and post-Sarbanes-Oxley corporate ethics codes and codes of conduct using the framework of structuration theory. Following the passage of the Sarbanes-Oxley (SOX) legislation in 2002 in the United States, publicly traded companies there undertook development and revision of their codes of ethics in response to new regulatory requirements as well as incentives under the U.S. Corporate Sentencing Guidelines, which were also revised as part of the SOX mandates. Questions that remain are whether these new or revised codes are effective means of communicating changed ethical foci and attitudes in organizations. Centering resonance analysis (CRA) is used to identify differences and similarities across time and industries by analyzing word networks of 46 pre- and post-SOX corporate codes of ethics. Analyses focus on content and structure of generated word networks as well as resulting factors that emerged from the texts. Results are interpreted from the structuration perspective that content and structure of codes are constrained and enabled by system structures while they function to produce and reproduce those structures. Results indicate that corporate codes of ethics are formal discourses of ethics, laws, and control. Code structure has changed across time, with an increased emphasis on compliance in post-SOX codes. Implications for research and practice are discussed in light of findings.     

How can we reliably measure the occurrence of non-fatal injury?

Introduction In England, there is no reliable indicator for measuring the occurrence of non-fatal injury. As a consequence, we do not know whether the rates of non-fatal injury are increasing or decreasing. Purpose This paper addresses two questions: what criteria should an indicator of non-fatal injury satisfy, and can we identify an indicator that satisfies these criteria? Method Criteria for a good indicator of non-fatal injury are postulated, and an indicator based on serious long-bone fractures is proposed. Inferences from the literature and the various non-fatal injury data to which we have access are used to justify the criteria, and to test the proposed indicator of serious injury against the criteria. Findings There is significant evidence to justify the use of the following criteria to assess indicators of non-fatal injury: the indicator should reflect the occurrence of injury satisfying some case definition of anatomical damage; the injury cases ascertained should be important in terms of incapacity, impairment, disability, quality of life, cost, and/or threat-to-life; cases should be completely ascertained from routinely or easily collected data; and the probability of a case being ascertained should be independent of social, health services supply and access factors. Our analysis indicates that an indicator based on serious long-bone fracture admitted to hospital is likely to satisfy each of these criteria for a good indicator. Conclusion An indicator of non-fatal injury occurrence based on serious long-bone fractures exhibits favourable characteristics when judged against our criteria for a good indicator.     

江门区域经济差异测度及影响因素分析

采用人均GDP指标在多个空间层次上综合运用极差率、变异系数、加权变异系数以及泰尔指数对江门2002-2013年间的区域经济差异进行测度。基本结论是：江门四市三区之间、中心区域和外围区域之间的区域经济差异均经历了逐步增大继而略有缩小的发展过程,2008年全球金融危机一定程度上降低了江门区域经济差异程度。与佛山对比,江门区域经济不平衡问题突出,并且中心区域和外围区域之间的差异是构成江门总体差异的主要力量。影响江门区域经济差异的因素是多方面的,包括地理区位、要素投入、外向化程度、产业结构和城市化水平、区域经济政策等。促进江门区域经济协调发展、提高区域经济发展质量需要着力关注江门中心区域与外围区域的差距缩小。