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April 9, 2001
General:
- The importance of gender on outcome after major trauma: functional and psychologic outcomes in women versus men.
Holbrook TL, Hoyt DB, Anderson JP. J Trauma 2001; 50(2):270-273.
BACKGROUND: Outcome after major trauma is an increasingly important focus of injury research. The effect of gender on functional and psychological outcomes has not been examined. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life, functional outcome, and psychological sequelae such as depression and early symptoms of acute stress reaction. The specific objectives of the present report are to examine gender differences in short- and long-term functional and psychological outcomes in the Trauma Recovery Project population. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies Depression scale and early symptoms of acute stress reaction were assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. RESULTS: Functional outcome was significantly worse at each follow-up time point in women (n = 313) versus men (n = 735). Quality of Well-being scale scores were markedly and significantly lower at 6-month follow-up in women compared with those in men (0.606 vs. 0.646, p < 0.0001). This association persisted at 12-month (0.637 vs. 0.6685, p < 0.0001) and 18-month (0.646 vs. 0.6696, p < 0.0001) follow-up. Women were also significantly more likely to be depressed at all follow-up time points (discharge odds ratio [OR] = 1.4, p < 0.05; 6-month follow-up OR = 2.2, p < 0.01; 12-month follow-up OR = 2.0, p < 0.01; 18-month follow-up OR = 2.2, p < 0.01) and to have early symptoms of acute stress reaction at discharge (OR = 1.4, p < 0.05). These differences remained significant and independent after adjusting for injury severity, mechanism, age, and sociodemographic factors. CONCLUSION: Women are at risk for markedly worse functional and psychological outcomes after major trauma than men, independent of injury severity and mechanism. Gender differences in short- and long-term trauma outcomes have important implications for future studies of recovery from trauma.
- Marketing alcohol to young people: implications for industry regulation and research policy.
Jackson MC, Hastings G, Wheeler C, Eadie D, Mackintosh AM. Addiction 2000; 95(Suppl 4):S597-608.
This paper focuses on the marketing of alcohol to young people in the United Kingdom, but the lessons that emerge have international significance. Alcohol is a global enterprise and recent consolidation means that it is controlled by a decreasing number of expanding multi-nationals. Alcohol companies are able to allocate significant resources to researching consumer preferences, developing new products and promoting them on an international level. Recent years have seen a growth in the value that youth culture attaches to brand labels and symbols and a move away from the healthy-living ethos. The alcohol industry's response to these trends has been to design alcoholic beverages that appeal to young people, using well-informed and precisely targeted marketing strategies. This has led to growing concerns about the implications for public health and a demand for tighter controls to regulate alcohol marketing practices. In the United Kingdom, controls on alcohol are piecemeal and reactive and the current system of voluntary regulation appears ineffective. This paper argues for more research to establish current industry practice and inform the development of a comprehensive regulatory structure and system of monitoring.
- Roles of commercial interests in alcohol policies: recent developments in North America.
Giesbrecht N. Addiction 2000; 95(Suppl 4):S581-95.
This paper examines recent developments in Canada and the United States and the role of commercial interests in alcohol-related policies bearing on taxes, outlet density, advertising, counter-advertising, health messages and prevention. Case-study material is drawn from published papers, project reports, government documents and newspaper accounts. The main focus is at the federal level, with some reference to provincial, state and local experience. Alcohol industries have as their primary agenda that of maintaining and expanding their markets and maximizing profits. In order to achieve this they typically oppose restrictions on access to alcohol, tax increases, controls on marketing and some counter-advertising campaigns. They are powerful in influencing policy in both countries, at national and regional levels, and their efforts impact policy agenda and outcome of government deliberations. Their prevention efforts, which tend to be oriented to information and education, are mainly individualistic in focus and typically not supportive of environmentally based policy reforms. Governments appear to have a declining interest in policy issues, due partly to resistance by the industries to alcohol control policies. Governments are encouraged to apply an evidence-based orientation to funding prevention, and facilitate evaluation of industry-sponsored prevention efforts. Greatest attention and resources should be directed to interventions that are most likely to have the greatest impact in reducing drinking-related problems, and funding for prevention from alcohol industries should involve arms-length arrangements. Alcohol industries are encouraged to consider strategies that do not increase access to alcohol but rather reduce drinking-related risks.
- Boater training, drinking and boating, and other unsafe boating practices.
Bell NS, Howland J, Mangione T, Senier L. J Drug Educ 2000; 30(4):467-482.
OBJECTIVES: Identify associations between lack of formal boater training, drinking and boating, and other unsafe boating practices. METHODS: A telephone survey queried respondents (age 16 or older in continental United States) about boating experience, type of boat used, and training. RESULTS: Of the 3,042 boaters surveyed (70% response), most had no formal training (73%). Boaters with formal training failed to use PFDs about as often as those without formal training and were equally or more likely to use alcohol while boating. CONCLUSIONS: The unexpected association between formal training and unsafe boating practices is probably due to reduced risk perception and inadequacies of boater training programs. Such programs seldom mention the risks of alcohol use while boating. Decisions to mandate formal training should be informed by these results; if mandated, training should address the risks of alcohol use while boating, and should be renewed frequently enough to offset reductions in risk perception.
- Evaluating fire safety in older persons through home visits.
Stiles NJ, Brancher D, Ramsbottom-Lucier M, Hunter G. J Ky Med Assoc 2001; 99(3):105-110.
To evaluate elders' risk factors for fire injury, we performed in-home assessments on our Geriatric Clinic clients. Nearly two-thirds of the subjects had physical impairments that could compromise escaping a fire. Fire safety equipment often was suboptimal. Nearly three-fourths of our subjects were not worried about fire injury, yet all had at least one fire injury risk factor. Fire safety knowledge was poor. Apathy was common, with fewer than one-third of our subjects complying with our recommendations.
- Farm injuries in children: a review.
DeMuri DP, Purschwitz MA. Wis Med J 2000; 99(9):51-55.
Farming is one of the most dangerous occupations in the United States. Unfortunately, risk of injury and death extends not only to adults, but to children that live, play, and work on the farm. This article reviews the epidemiology, pathogenesis and prevention of farm injury in children and adolescents. In Wisconsin 39 children were killed in the agricultural setting between 1995 and 1999. Nationwide, over 100 children per year are killed and 27,000 injured on farms. The age distribution of injury in children is bimodal, with one peak at 3-4 years of age and a second peak at 13-16 years. Boys are much more likely to be injured on the farm than girls. Of the agents associated with the injury of children, tractors are most commonly implicated and are the most deadly. Drownings, injury by cows and horses, and other farm implements and machinery make up the remainder of most farm accidents. The head and face are the sites involved in preschoolers whereas the limbs are more likely to be injured in older children. Poor supervision, unreasonable expectations, financial difficulties and lack of safety devices are associated with risk of injury. Prevention or injury involves patient and family education, regulation and safety devices. Important resources are available for farm families and health care providers to prevent farm accidents in children.
- Factors affecting injury severity to rear-seated occupants in rural motor vehicle crashes.
Brown CK, Cline DM. Am J Emerg Med 2001; 19(2):93-98.
Injury to rear-seat occupants (RSOs) has received little systematic study in the literature. Past studies have focused on patterns of injury presented to the emergency department, various aspects of restraint usage and injury, or specific populations of RSOs. This is the first systematic analysis of injury severity to RSOs. RSOs involved in motor vehicle crashes (MVCs) sustain injuries of equal severity as do front-seated occupants (FSOs) involved in the same crash. The setting was a rural North Carolina emergency department where patients were evaluated at the sole hospital for the county. The design was a 2-year retrospective review of all MVCs with RSOs occurring in Pitt County North Carolina in calendar years 1988 and 1989. The Wilcoxon Rank-Sum Test and Logistic Regression Analysis with Injury Severity Score (ISS) as the dependent variable were performed. Three hundred forty-six crashes involving 367 vehicles with RSOs and 1,273 occupants that sent 222 patients to the hospital. ISS was higher for unrestrained occupants (1.87 versus 0.51), occupants of vehicles driven by legally intoxicated drivers (4.04 versus 0.73), occupants between the ages of 30 and 59 years (1.06 versus 0.65) and FSOs (1.04 versus 0.85) (Wilcoxon Rank-Sum test P <.0002). Logistic regression analysis confirmed these findings with the exception of more severe injuries for the 30 to 59 age range and impact speed. The analysis failed in these 2 cases. Restraint usage offered the greatest protective effect (OR 0.37). Lesser protective effects were noted with rear seat occupancy (OR 0.43) and age < 13 years (OR 0.77). More severe injuries were predicted by driver intoxication (OR 2.5), and age > 60 years (OR 1.25). In our rural population, RSOs sustain less severe injuries than FSOs. Restraint usage and sober drivers provide a greater protective effect however. Seat location does not replace restraint usage or sobriety.
- Alcohol consumption in victims of violence: a trend study for the period 1970-1998.
Kingma J. Psychol Rep 2000; 87(3 Pt 1):803-11.
This 29-yr. retrospective study is about alcohol consumption by victims of violence intentionally injured (N = 13,048) and general patients unintentionally injured (N = 296,544) who were treated for their injuries at the Trauma Center of the University Hospital Groningen (The Netherlands) during the period 1970-1998. The incidence rate for general patients with alcohol consumption was statistically significantly greater than the incidence rate of victims of violence with alcohol consumption. A long-term significant linear trend was observed for both types of patients during the 29-yr. period. However, the increase in incidence rate among the general patients with alcohol consumption was four times greater than the increase in incidence rate for the victims of violence with alcohol consumption. Males predominated in both types of patients (with and without alcohol consumption). The statistically significant highest incidence rates (and male predominance) were found in the age group 20-24 years for both categories of patients.
- Children who murder: a review.
Shumaker DM, Prinz RJ. Clin Child Fam Psychol Rev 2000; 3(2):97-115.
Despite considerable research on juvenile homicide, pre-adolescent homicide offenders have received less attention. This paper reviews the existing literature on preteen murderers in order to characterize the current state of research knowledge about this population, and draws on some of the work on adolescent homicide as well. The analysis of this literature considers historical context, methodological issues, previous attempts to classify youthful homicide offenders, and predictors of preteen homicidal behavior. While there is a high degree of heterogeneity within this population, several developmental similarities emerged across cases that were associated with the perpetration of homicide by preteens. A high percentage of preteen homicide offenders come from homes characterized by physical abuse, domestic violence, poor or absent parenting, and overall instability. Gun availability may have been a facilitating factor. Support for different etiologies of preteen versus adolescent homicide is weak. Recommendations for future research directions are offered.
- Physicians, firearm counseling, and legal liability.
Paola FA. South Med J 2001; 94(1):88-92.
To explore the potential legal consequences to physicians of counseling their patients about gun violence, I consider the question: If a patient divests herself of a firearm upon the advice of her physician and is subsequently the victim of a rape, robbery, aggravated assault, or homicide, could she or her survivors argue convincingly that her physician was negligent? In attempting to answer this question, the four elements that a patient must establish to prevail in a malpractice action against a physician are discussed, and possible strategies for establishing them in the hypothetical case are explored. I conclude that plausible arguments can be made against the hypothetical physician engaged in firearm counseling as described. Conversely, physicians not engaging in discussions of gun safety face substantially lower liability risks.
- Association between illegal drugs and weapon carrying in young people in Scotland: schools' survey.
McKeganey N, Norrie J. BMJ 2000; 320(7240):982-4. .
OBJECTIVES: To identify the type and extent of weapons being carried among young people in Scotland, and to determine the relation between use of illegal drugs and weapon carrying. DESIGN: Questionnaire school survey. SETTING: Independent schools in central Scotland and schools in Lanarkshire and Perth and Kinross. PARTICIPANTS: 3121 students aged 11 to 16 in 20 schools. MAIN OUTCOME MEASURES: Self completion questionnaire reporting history of drug use and weapon carrying. RESULTS: Overall, 34.1% of males and 8. 6% of females reported having carried a weapon (P<0.0001), ranging from 29.2% of boys aged 11-13 (classes S1 to S2) to 39.3% of boys aged 13-15 (S3 to S4). These values are higher than those in a recent survey of young people in England. Weapon carrying in Lanarkshire was 70% higher for males than in the rural area of Perth and Kinross. Both males and females who had taken drugs were more likely to carry weapons (63.5% of male drug users versus 20.5% of non-users and 22.8% of female drug users versus 3.7% of non-users; both P<0.0001). The proportions of males carrying weapons who used none, one, two, three or four, or five or more illegal drugs were 21%, 52%, 68%, 74%, and 92% respectively. A similar trend was found among females. CONCLUSIONS: Better information is needed on the nature and extent of weapon carrying by young people in the United Kingdom, and better educational campaigns are needed warning of the dangers of carrying weapons.
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