Risk Factors For Such Injuries Research Articles

Single Nucleotide Polymorphisms and Tendon/Ligament Injuries in Athletes: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis aimed to identify the association between genetic polymorphisms and tendon and ligament injuries in adolescent and adult athletes of multiple competition sports. The PubMed, Web of Science, EBSCO, Cochrane Library, and MEDLINE databases were searched until July 7, 2023. Eligible articles included genetic studies on tendon and ligament injuries and comparisons between injured and non-injured athletes. This review included 31 articles, comprising 1,687 injury cases and 2,227 controls, from a meta-analysis of 12 articles. We identified 144 candidate gene polymorphisms (only single nucleotide polymorphisms were identified). The meta-analyses included vascular endothelial growth factor A (VEGFA) rs699947, collagen type I alpha 1 rs1800012, collagen type V alpha 1 rs12722, and matrix metalloproteinase 3 rs679620. The VEGFA rs699947 polymorphism showed a lower risk of injuries in athletes with the C allele ([C vs. A]: OR=0.80, 95% CI: 0.65-0.98, I 2 =3.82%, p=0.03). The risk of these injuries were not affected by other polymorphisms. In conclusion, the VEGFA rs699947 polymorphism is associated with the risk of tendon and ligament injuries in athletes. This study provides insights into genetic variations that contribute to our understanding of the risk factors for such injuries in athletes.

Clinical profile and outcome of traumatic brain injury in children: record-based descriptive study

Background: Paediatric head injury is considered to be a major public health problem and is often associated with significant morbidity and mortality in severe cases. The present study aimed to explore the demographics, mechanism of injury and clinical aspects of injury in children in a peripheral hospital attached to tertiary care centre.Methods: Electronic medical records of all paediatric patients aged ≤12 years with traumatic brain injury admitted during one-year period from January to December 2018 were reviewed. Epidemiological and clinical data of paediatric patients with traumatic brain injury (TBI) were analysed using SPSS version 20.Results: The medical records of 203 paediatric patients with TBI were analysed. The majority of the injury occurred in patients belonging to age-group 1-6 years. The number of male children outnumbered (58.1%) that of female children (41.9%). Fall from height was the most common mode of injury, followed by fall from a staircase. As per the Glasgow coma scale, 4% patients had severe head injury. Vomiting and headache was the most common symptom at admission (50.2%), a subdural hematoma was the most common lesion seen on computed tomography scans; frontal bone was the most common site of skull bone injury. Cutaneous injuries associated with contused lacerated wounds were the most common external injuries, 92.1% completely recovered with conservative management.Conclusions: Increasing incidence of paediatric trauma suggests the need for supervision during play and identification of environmental risk factors for such injuries. Parental advice and supervision is recommended to prevent accidental falls.

Work-related musculoskeletal injuries among obstetricians and gynaecologists: A cross-sectional survey of Fellows of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

Obstetricians and gynaecologists (O&Gs) are at a risk of work-related musculoskeletal injuries (WRMI) on a daily basis. To describe the prevalence of WRMI among O&Gs in Australia and New Zealand, explore risk factors for such injuries, and evaluate their impact. An online survey of Fellows of Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted in July 2016. It comprised questions on personal attributes, type of work, site and cause of WRMI, if any and treatment required. We received responses from 765 O&Gs giving a response rate of 38.3% (765/1997). Four hundred and ten specialists (53.6%) reported suffering a WRMI at some point, including 252 (32.9%) who reported multiple injuries. In multivariable analysis, females had increased risk of WRMI (odds ratio (OR): 2.12; 95% CI: 1.54-2.91) and among generalists and subspecialists, gynaecological oncologists had highest risk for WRMI (OR: 3.13; 95% CI: 1.21-8.14). Commonest sites of injury were back (218/633, 34.4%) and shoulder (131/633, 20.7%). Laparoscopic surgery (117/633, 18.5%) was the commonest cause of injury. Treatment was required for 88.6% of injuries (561/633) including 8.4% (53/633) of cases which required surgery. Ongoing symptoms post-injury were reported for 52.1% of injuries (330/633) and in 25.8% (163/633) of instances the practitioner needed to modify their scope of work. This survey among a large cohort of O&Gs shows a high prevalence of WRMI with a profound negative impact on the practitioner and profession. There is a pressing need to advocate for improved ergonomics in their workplaces.

A small number of daily pitches induces shoulder and elbow injuries among high school baseball pitchers: a prospective study

Baseball players frequently injure their shoulders and elbows. Preseason risk factors for such injuries have been relatively well studied, but in-season risk factors are less known, and the relationship between the number of pitches and the incidence of such injuries in baseball pitchers of any level is unclear. Identifying the risk factors related to the number of daily pitches is particularly important to prevent baseball-related arm injuries among young pitchers. Thus, we prospectively investigated the relationship between the number of daily full-power pitches in high school baseball pitchers and the incidence of shoulder and elbow injuries. We observed that a small number of daily full-power pitches, < 30 pitches per day, in high school baseball pitchers, significantly increased the risk of shoulder and elbow injuries: these players had a 2.3-times greater risk of injuries and a 45-day earlier occurrence of injuries than those pitching ≥ 30 pitches per day. Although unexpected, this was plausible as continuous daily pitching is required to maintain physical condition in growing and maturing high school pitchers. These findings may form the basis for establishing guidelines regarding the appropriate number of daily pitches required to prevent shoulder and elbow injuries in high school baseball pitchers.

Stress fractures: diagnosis and management in the primary care setting.

Stress fractures or fatigue fractures are common overuse injuries that occur following repetitive bouts of mechanical loading to bones. They most often occur in the weight-bearing bones of the lower limbs. Their diagnosis can be challenging due to their insidious onset and requirement for imaging to confirm a diagnosis. The risk factors for such injuries include an increase in load, which can be from an increase in volume, intensity, or duration of exercise, abnormal biomechanical factors, and reduced bone mineral density. Their management can be relatively straightforward, but symptoms can persist for many months if load management is not adhered to. If missed, the clinical consequences can be substantial, particularly when involving the femoral neck. Stress fractures occur when bones undergo repetitive stress at a rate greater than their ability to remodel. The initial microtrauma can cause symptoms, such as a pain and swelling, without the presence of a fracture on X-rays. This phenomenon is known as a ‘stress reaction’ and cannot be detected on X-rays in the early stages. If the causative factor continues, this can cause the cortex of the bone to weaken, leading to crack initiation. If this crack propagates across the bone then a complete fracture can occur. Stress fractures should not be confused with insufficiency fractures, which occur when physiological abnormal bone fractures under normal load (that is, secondary to osteoporosis). The incidence of stress fractures in the general population is not clear and most research has studied their incidence in the athletic …

All-Terrain Vehicle Injury in Children and Youth: Examining Current Knowledge and Future Needs

BackgroundAll-terrain vehicle (ATV)-related injuries remain a large public health problem in the United States and disproportionately affect American youth. Although children account for only 14–18% of ATV riders, they comprise 37–57% of those injured in ATV-related accidents. Since the U.S. Consumer Product Safety Commission began collecting data in 1982, 23% of ATV-related deaths have occurred in children. ObjectiveWith this review, we outline the major risk factors for injuries among young ATV riders in the United States and suggest research-based interventions to successfully modify such risk factors. DiscussionWe reviewed data from 16 published reviews regarding epidemiology and risk factors among ATV-related injuries in American children. All data pointed to young driver age and lack of appropriate safety equipment as major risk factors for such injuries. Although these risk factors are modifiable, legislation and programs designed to mitigate such risks have been unsuccessful. Among adults, the brief intervention model has become widely used among trauma patients exhibiting risky behaviors. Additionally, peer-to-peer interventions have demonstrated success with respect to drug and alcohol use in school-aged children. Both the brief and peer-to-peer interventions are promising avenues for decreasing risky ATV-related behavior in youths but have not been studied in this field. ConclusionsATV-related injuries disproportionately affect American youths. Although risk factors for such injuries are modifiable, current methods for intervention (mainly legislation) have not been successfully implemented. The brief intervention and peer-to-peer interventions have shown promise in other fields and should be studied with respect to pediatric ATV use.

Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players.

Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury.

Injury during U.S. Army basic combat training: a systematic review of risk factor studies.

Approximately one quarter of men and half of women in U.S. Army basic combat training experience an injury. Preventing basic combat training-related injuries would reduce associated human and economic costs and discharges from the Army. Identification of risk factors for such injuries is a crucial step toward their prevention. Although some research has begun to address this need, prior studies of risk factors for training-related injury have not been reviewed systematically. This study systematically reviews the literature on risk factors for injury during U.S. Army basic combat training. Original studies of risk factors for injury during U.S. Army basic combat training published since 1990 in peer-reviewed journals were identified using PubMed and manual searches of reference lists. This search was last performed in May 2013. Nineteen studies met the inclusion criteria. Methodologic quality and potential for bias were assessed. The findings of 11 studies deemed to be of high or medium quality were synthesized to determine the level of evidence supporting the association between each risk factor studied and risk of injury during basic combat training. Quality assessment and evidence synthesis were performed from June to September 2013. There is strong or moderate evidence supporting association of older age, history of smoking, and self-rated low physical activity level prior to basic combat training with increased risk of training-related injury among male trainees. There is limited, mixed, or insufficient evidence to identify risk factors for injury among female trainees.

Factors Affecting Sports-Related Orofacial Injuries and the Importance of Mouthguards

Sports dentistry is one of the most recent and upcoming fields in dentistry. It includes mainly the prevention and management of sports-related orofacial injuries and associated oral diseases or traumas. The dentist can play a critical role in informing athletes, coaches, and patients and their parents about the importance of prevention, treatment, and diagnosis for orofacial injuries in sports. The most significant aspect in preventing sports-related orofacial injuries is wearing basic protective devices such as properly fitting helmets, face masks, and/or mouthguards. A properly fitted mouthguard prevents violent contact between the upper and lower dentition. According to the American Society for Testing and Materials, there are three types of mouthguards: custom-fabricated mouthguards, mouth-formed guards, and stock mouthguards. Essential properties of the various materials used in the manufacture of mouthguards include water absorption, density, and thickness as well as temperature transmission, energy absorption, and drawing strength (tensile strength) of custom-made mouthguards. Currently, a variety of materials is being used for mouthguards, most commonly polyvinyl acetate-polyethylene copolymer or ethylene vinyl acetate copolymer and polyvinyl chloride. Mouthguard use is significant for athletes, since dentists play an important role in the design and application of these in clinical practice. The purpose of this article is to review the importance of mouthguard use, the incidence and location of orofacial sports injuries, the risk factors for such injuries, and the types of mouthguards and their roles in the prevention of sports-related orofacial injuries.

Disability-Related Injuries in Athletes with Disabilities

Athletes with disabilities are highly skilled. Sports-related injuries and disorders interfere with their efforts. Several aspects of these injuries have been studied in previous studies. The aim of this study was to correlate the types of injuries with the disability group in athletes with physical disabilities. One hundred and thirty nine elite athletes with physical disabilities completed a questionnaire about sports-related injuries that resulted in at least one day off from training or competition. All disability groups show soft tissue injuries in high percentages. Cerebral palsy (CP) athletes reported soft tissue injuries (P < 0.01) and lacerations (P < 0.001) in higher percentage than Other Disabled Athletes (ODA) and Spinal Cord Injured (SCI) athletes. Spinal cord injured athletes sustained fractures (P < 0.05) and blisters (P < 0.05) in higher percentages than the other groups. No differences were found between the studied groups for contusions, low back pain, ruptures, thermoregulation disorders, urinary tract infections, pressure sores and pneumonias. CP athletes sustained soft tissue injuries and lacerations more than other disability groups did because moving and walking patterns of this population add risk factors for such injuries. Fractures and blisters occur more frequently to SCI athletes because they participate in higher percentage in wheelchair basketball which is high risky sport.

Risk factors for fatal lateral condylar fracture of the third metacarpus/metatarsus in UK racing

Lateral condylar fractures of the third metacarpus/metatarsus are the most common cause of equine fatality on UK racecourses. Identification of risk factors for such injuries and the subsequent implementation of intervention strategies could significantly reduce the total number of racecourse fatalities. To identify horse-, race- and course-level risk factors for fatal lateral condylar fracture in Thoroughbreds on UK racecourses. Case-control study designs were used. Case horses were defined as those that were subjected to euthanasia having sustained an irreparable lateral condylar fracture while racing at any of the 59 UK racecourses. Case races were defined as those in which one or more horses sustained a fatal lateral condylar fracture. Three controls for each case horse were selected at random from the race in which the case was running. Three controls for each case race were selected at random from all races of the same type held in the same year. Ninety-eight cases were included in the study. Conditional logistic regression was used to identify the relationship between a number of independent variables and the likelihood of fracture. Horses doing no gallop work during training and those in their first year of racing were at significantly increased risk of fracture on the racecourse. Case horses were also more likely to have started racing as 3- or 4-year-olds. Fractures were found to be more likely in longer races with a larger number of runners, races in which professional jockeys were not permitted to ride and races in which the going was described as firm or hard. Modifications to training schedules, specifically within the first year of racing, may have a large impact on the risk of fatal lateral condylar fracture on the racecourse. Horses should do some gallop work in training and our results suggest that the minimum distance galloped should be between 201 m (1 furlong) and 1609 m (8 furlongs) per week. The association with age at first race requires further investigation for flat and National Hunt racing separately. A reduction in the number of races taking place on very firm going could have an impact on the number of lateral condylar fractures.

Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study.

To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data. This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007. Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged >or= 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. Hospitals in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues.

Pelvic Fractures in Professional Cyclists: A Report of 3 Cases

Background:Professional riders demonstrate increased risk factors for such injuries including both extensive time on the bike in addition to a possible underlying osteopenia secondary to the nonimpact nature of the sport.Hypothesis:Nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results.Study Design:Case series.Methods:Three cases of professional cyclists with pelvic fractures were reviewed.Results:All 3 cyclists were able to return to professional competition and remain symptom free.Conclusion:Accurate early diagnosis of pelvic fractures, with the aid of computed tomography, is crucial. Early nonweightbearing with a progression to weightbearing as tolerated and early return to stationary training are appropriate. Accurate diagnosis and careful nonoperative management of stable, nondisplaced pelvic fractures in professional cyclists offers excellent results.Clinical Relevance:Accurate diagnosis of pelvic fractures in high-demand athletes with few complaints and no obvious findings on plain film radiographs. Control of weightbearing and competitive status to prevent injury progression. Gauged return to competition at professional level.

Attention Deficit-Hyperactivity Disorder in Children With Burn Injuries

This study explored the characteristics of children with burns who were also diagnosed with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). The study was intended to identify and better understand the risk factors for such injuries and to help direct future burn prevention and education efforts for children with these underlying disorders. We performed a retrospective, comparison group study of 103 pediatric burn patients ranging in age from 5 to 18 years. Forty-four children who were diagnosed with ADD or ADHD at the time of their burn injury were compared with a random sample of 59 burn-injured children without the diagnosis of ADD or ADHD. Variables analyzed included patient demographics, cause of burn, length of hospitalization, engagement in high risk behavior at the time of injury, presence of other developmental, mental health diagnoses, and/or school behavior problems. The ADD or ADHD group had a significantly greater incidence of mental health and school behavior problems than other children with burn injuries. They also had a significantly greater history of high risk behavior at the time of injury than the comparison group. Children with ADD or ADHD who also had an additional mental health diagnosis had a higher incidence of school behavior problems. Our findings suggest the need for additional studies of children with ADD or ADHD who sustain burn injuries. Children with ADD or ADHD who have school behavior problems and/or a tendency to engage in high-risk behavior may be at greatest risk for burn injuries and most likely to benefit from educational counseling or other modalities of burn prevention.

Prevalence of Traumatic Dental Injury in Grade 8 Children in Six Ontario Communities

To determine the prevalence of traumatic injury to the anterior dentition in Grade 8 children in six Ontario communities. Clinical examination of 3,010 children attending a stratified random sample of 66 schools in the communities served by 6 Ontario Public Health departments. Trauma to the hard tissues was classified according to the Trauma Index. Damage to the anterior dentition was observed in 18.5% of those examined. Unrestored fractures of the enamel were present in 13.0%, with more severe damage or damage sufficiently severe to have been treated being present in 5.9%. Of those with the more severe injuries, 20% had not received treatment. The prevalence of injury was higher in males than in females (21.3% vs. 13.4%: p < 0.0001) and varied across the six communities studied (10.7-29.4%: p < 0.01). There was an association between dental decay experience and traumatic dental injury. Those with more severe injuries had higher mean Decayed, Missing and Filled Teeth (DMFT) scores and were less likely to have a DMFT score of zero than those without injury (p < 0.01). The prevalence of traumatic dental injury in this Ontario child population was similar to those reported in national surveys in the US and UK. The association between injury and dental decay may reflect the fact that a subgroup of children live within environments or are prone to behaviours that place them at greater risk of multiple oral disorders. In order to provide a basis for prevention, further research needs to be undertaken to identify the causes of and the personal and environmental risk factors for such injuries in Ontario children.

Race- and course-level risk factors for fatal distal limb fracture in racing Thoroughbreds.

Considerable variation in the rates of equine fatality at different racecourses draws attention to probable risk factors at the level of course or race that might be partly responsible. Distal limb fractures are the most common cause of equine fatality on UK racecourses and identification of risk factors for such injuries and subsequent implementation of intervention strategies could significantly reduce the total number of racecourse fatalities. To identify race- and course-level risk factors for fatal distal limb fracture in Thoroughbreds on UK racecourses. A case-control study design was used. Case races were defined as those in which one or more horses sustained fatal fracture of the distal limb. Controls were selected in 2 different ways. Firstly, 3 races in which no fracture occurred were selected from all races of the same type held within 5 days of the case race (Analysis 1). Secondly, 3 control races were selected for each case race from all races of the same type held in the same year (Analysis 2). One hundred and nine cases were included in the study. Information about the race and the racecourses was collected from Computer Raceform. Conditional logistic regression was used to identify the relationship between a number of independent variables and the likelihood of fracture in a race. Longer races with a larger number of runners were more likely to contain a fracture. Firmer going and fewer days since the last race on the same course were associated with an increased risk of fracture. The going at the course at the previous race meeting was also associated with the likelihood of fracture. Modifications to the going on the day of a race and greater emphasis on ground maintenance between race meetings may have an impact on the risk of fatal distal limb fracture during racing. Modification of risk factors such as the going and number of days since the last race meeting could reduce the number of equine fatalities on UK racecourses. The condition of the racecourse may be an important risk factor and future research should focus on the identification of course maintenance techniques that produce the safest possible racing surfaces.

A small fraction of patients with repetitive injuries account for a large portion of medical costs.

The phenomenon of repetitive injuries has been judged to be of limited importance in the public health context. A study was therefore initiated in order to analyse all types of single and repetitive injuries using a longitudinal approach. Hospital care, medical costs and risk factors were examined for single and repetitive severe injuries. A cross-sectional survey with a 12-year follow-up was performed. Questionnaire information from a survey of a random sample of the adult population 20-89 years old in 1984 in Stockholm County were linked to the Swedish national inpatient and cause-of-death register up to 1996, inclusive. During the study period 13% of males and 15% of females were hospitalized or deceased as a result of injuries. Persons with three or more injuries comprise 19% of the injuries, but account for 63% of the total number of days of hospital care and medical costs. Injuries related to falls were most common among patients requiring hospital care. Factors such as high age, living alone, stroke earlier, and use of hypnotics and sedatives were especially associated with repetitive injuries. The risk factors for single and repetitive injuries covariate, but the size of the risk is overrepresented for stroke, drugs, self-reported injuries and living alone for two or more injuries. These results indicate that subjects with repetitive injuries, and with the observed risk factors for such injuries, should be given extra attention, both in policy and prevention, but also in integrated treatment programmes.

INJURY INCIDENCE AND RISK FACTORS FOR MALE MILITARY POLICE (ARMY)

Previous injury studies of Army soldiers have examined soldiers in infantry, combat engineer, and field artillery units. PURPOSE This study evaluated the incidence of musculoskeletal injuries, and risk factors for such injuries, among men in a military police (MP) unit at Fort Riley, Kansas. METHODS Musculoskeletal injuries were compiled through a medical record review. Only injuries that occurred while assigned to this unit during one year were included. Age, rank, race, height, and weight were obtained from personal medical records. Data of assignment to the unit and physical fitness measures (2-mile run time, maximum sit-ups and push-ups in separate two minute periods) were obtained from the MP unit. Cox regression was used to obtain the crude and adjusted relative risk (RR) and 95% confidence intervals (CI) for the risk factors. RESULTS Of the 268 men whose records were reviewed, 140 sustained one or more musculoskeletal injuries, with an annualized injury rate of 70 injuries/100 person-years at risk. There was a total of 462 clinic visits (2.3 visits/person-year), 213 injuries (110 injuries/100 person-years), and 6,529 days of limited duty (32.5 days of limited duty/person-year). Fifty-two percent of injuries with a known cause were related to physical exercise or sports activities, while 34% of injuries were related specifically to military training activities. In the univariate analysis, risk factors associated with increased injury risk were age (RR = 1.04, CI = 1.01,1.06) and body mass index (BMI) (highest vs. lowest quartile, RR = 2.47, CI = 1.37–4.46). In the multivariate analysis, age (RR = 1.03, CI = 1.00,1.06) and BMI (RR = 2.16, CI = 1.17,3.96) were independently associated with an increased injury risk. CONCLUSIONS Among male Army MPs, injuries account for about 1 month of limited duty per soldier per year. Most injuries appear to be associated with sports and exercise. Age and BMI are independently associated with increased risk of injury.

Risk factors for injury to women from domestic violence.

Domestic violence is the most common cause of nonfatal injury to women in the United States. To identify risk factors for such injuries, we examined the socioeconomic and behavioral characteristics of women who were victims of domestic violence and the men who injured them. We conducted a case-control study at eight large, university-affiliated emergency departments. The 256 intentionally injured women had acute injuries resulting from a physical assault by a male partner. The 659 controls were women treated for other conditions in the emergency department. Information was collected with a standardized questionnaire; no information was obtained directly from the male partners. The 256 intentionally injured women had a total of 434 contusions and abrasions, 89 lacerations, and 41 fractures and dislocations. In a multivariate analysis, the characteristics of the partners that were most closely associated with an increased risk of inflicting injury as a result of domestic violence were alcohol abuse (adjusted relative risk, 3.6; 95 percent confidence interval, 2.2 to 5.9); drug use (adjusted relative risk, 3.5; 95 percent confidence interval, 2.0 to 6.4); intermittent employment (adjusted relative risk, 3.1; 95 percent confidence interval, 1.1 to 8.8); recent unemployment (adjusted relative risk, 2.7; 95 percent confidence interval, 1.2 to 6.5); having less than a high-school-graduate's education (adjusted relative risk, 2.5; 95 percent confidence interval, 1.4 to 4.4); and being a former husband, estranged husband, or former boyfriend (adjusted relative risk, 3.5; 95 percent confidence interval, 1.5 to 8.3). Women at greatest risk for injury from domestic violence include those with male partners who abuse alcohol or use drugs, are unemployed or intermittently employed, have less than a high-school-graduate's education, and are former husbands, estranged husbands, or former boyfriends of the women.