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May 21, 2001
Suicidal children and adolescents with first emergency room presentations: predictors of six-month outcome
Stewart SE, Manion IG, Davidson S, Cloutier P. J Am Acad Child Adolesc Psychiatry , 2001; 40(5):580-587.
Correspondence: Ian G. Manion, Mental Health Research, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1, manion@cheo.on.ca
The authors looked for risk factors for repeat suicide attempts within 6 months among the 548 5- to 19-year-olds seen over a 1-year interval in a Canadian emergency department for suicidal self-harm behavior. Thirty-two percent (n=73)returned to the emergency department within six months and 24.1 percent (n=54) had a documented suicide attempt. Predictors for emergency department return and additional suicide attempt included 15- to 19-year age range, having a suicide plan, sobriety at the emergency department visit, and past foster or group home placement. Knowledge of these risk factors may assist with assessment of the likelihood of future self-harm activity. Excess mortality of suicide attempters.
Ostamo A, Lonnqvist J. Soc Psychiatry Psychiatr Epidemiol 2001; 36(1):29-35
Correspondence: Aini Ostamo, National Public Health Institute, Department of Mental Health and Alcohol Research, Mannerheimintie 166, FIN-00300 Helsinki, Finland. aini.ostamo@ktl.fi
The authors followed 2782 patients seen in emergency departments between 1989 and 1996 in urban Helsinki, Finland after a suicide attempt. The mean follow-up period was 5.3 years. Standardized mortality ratios (SMR) for suicide, disease, accident, homicide, and undetermined death were calculated. Mortality from all causes was 15 times higher than that expected among men and nine times higher in women. Fifteen percent of all suicide attempters died during the average 5.3-year follow-up of the index attempt. Deaths from suicide accounted for 37% of all excess deaths in men and 44% in women. The mortality ratio was highest during the 1st follow-up year. A suicide attempt indicates a severe risk of premature death, and suicide is the main cause of excess deaths. However, it appears that concentrating efficient treatment only on the most suicidal patients could prevent no more than two of five premature deaths. More effort is therefore needed to prevent the excess mortality of suicide attempters by also addressing causes of death other than suicide such as homicide.
Vehicle and driver attributes affecting distance from the steering wheel in motor vehicles.
McFadden M, Powers J, Brown W, Walker M. Hum Factors 2000; 42(4):676-682
Correspondence: Dr. McFadden, Australian Transport Safety Bureau, Canberra. stats@atsb.gov.au
Close proximity to the steering wheel has been associated with increased risk of injury and increased injury severity from airbag deployment. The authors studied driver body dimensions and seating distance from the steering wheel among a sample of 150 men and 150 women. In general, women sit closer to the steering wheel than men do. This difference is accounted for by variations in body dimensions, especially height. The authors suggest that this research supports changes in vehicle design that allows independent adjustment of the relative distance among the driver's seat, the steering wheel, and the floor pedals.
The crash reduction effectiveness of a network-wide traffic police deployment system.
Newstead SV, Cameron MH, Leggett LMW. Accid Anal Prev 2001; 33(3):393-406.
Correspondence: Stuart V. Newstead, Accident Research Centre, P.O. Box 70A, Monash University, Victoria, Australia 3800, stuart.newstead@general.monash.edu.au
The authors evaluated Random Road Watch (RRW), an enforcement resource management technique that randomly schedules levels of police enforcement in a manner intended to provide long-term, widespread coverage of a road network. Implementation of the program studied in Queensland covered 55% of total crashes within the state. A quasi-experimental study design was used for the evaluation incorporating Poisson regression statistical analysis techniques. Analysis of the effects of the Queensland RRW program on crash frequency has shown the program to be effective overall. Estimated program effects were largest on fatal crashes, with an estimated reduction of 31%. Estimated aggregate program crash effects reduced with crash severity and increased with time after program introduction. Crash reductions in the third year after program introduction translated into savings, at state level, of some 12% of the state's crashes of all severities and some 15% of the state's fatal road crashes. Overall, the program produced a significant 11% reduction in total crashes in areas outside of metropolitan Brisbane. The opportunity-cost benefit/cost ratio for the program was estimated to be 55:1.
Motor-Vehicle Occupant Injury: Strategies for Increasing Use of Child Safety Seats, Increasing Use of Safety Belts, and Reducing Alcohol-Impaired Driving
Task Force on Community Preventive Services. MMWR 2001; 50(RR-7):1-16.
Available online: HERE.
For the past four to five years, the Task Force on Community Preventive Services has conducted systematic reviews of interventions designed to increase use of child safety seats, increase use of safety belts, and reduce alcohol-impaired driving. The Task Force strongly recommends the following interventions: laws requiring use of child safety seats, distribution and education programs for child safety seats, laws requiring use of safety belts, both primary and enhanced enforcement of safety belt use laws, laws that lower the legal blood alcohol concentration (BAC) limit for adult drivers to 0.08%, laws that maintain the minimum legal drinking age at 21 years, and use of sobriety checkpoints. The Task Force recommends community wide information and enforcement campaigns for use of child safety seats, incentive and education programs for use of child safety seats, and a lower legal BAC for young drivers (in the United States, those under the minimum legal drinking age). This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, and provides information to help apply the interventions locally. The full report will be published this fall.
Attitudes of New York City high school students regarding firearm violence
Kahn DJ, Kazimi MM, Mulvihill MN. Pediatrics 2001; 107(5): 1125-1132.
Correspondence: Michael N. Mulvihill, Department of Family Medicine and Community Health, Albert Einstein College of Medicine, 906 Belfer, 1300 Morris Park Avenue, Bronx, NY 10461, USA, mulvihill@aecom.yu.edu
The authors report on the prevalence of firearm possession, attitudes regarding firearm possession, attitudes toward firearm violence, and the potential role of physicians and other adults in education about firearm violence prevention. The authors circulated an anonymous questionnaire to 9th through 12th graders at three public high schools in New York City. Of the 342 questionnaires distributed, all were returned. Most (79.8%) were returned complete. About half (43.2%) thought that it was okay for anyone to own a gun but only 8.0% thought that it was appropriate for children and adolescents to have guns. The prevalence of guns in the student households was 19.6%, however the prevalence of ever having a gun in the household was 41.0%. Thirty-five percent of the respondents stated that they considered getting a gun at one time. Of respondents, 57.3% stated that a gun had injured them or one of their relatives. Of those who have lived in a household with a gun, 79.5% answered that either they or a relative had been injured by a gun, compared with 41.7% of those who haven't lived in a household with a gun. Only 5.7% of the adolescents surveyed have had a physician talk with them about guns. However, if approached by their physician, 63.8% said that they would discuss the issue with them.
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