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May 28, 2001
Elders:
Risk factors for falls and injuries in a long-term care facility in Ontario.
Krueger PD, Brazil K, Lohfeld LH. Can J Public Health 2001; 92(2):117-120
Correspondence: Dr. Krueger, St. Joseph's Health Care System Research Network, Father Sean O'Sullivan Research Centre, Hamilton, ON, Canada. kruegerp@mcmaster.ca
The authors conducted a case-control study of 335 among seniors living in a long-term care facility to identify risk factors for falls and injuries. Cases were defined as residents who fell between July 1, 1996 and June 30, 1997; controls were those who did not fall. The most important risk factors for falls included: having fallen in the past three months; residing in a secured unit; living in the facility for two or more years; having the potential to cause injury to others; and having an illness, disease or behavior that may cause a fall. The most important risk factor for injury among those who fell was altered mental state.
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Drowning --- Louisiana, 1998
Kohn M, Duthu R, Flood H, Hall G, Wiley J, Kutinec H, and staff at the National Center for Injury Prevention and Control. MMWR 2001; 50(20)413-414.
Correspondence: Giesle A. Hall, Injury Research and Prevention Section, Louisiana Office of Public Health, 325 Loyola, New Orleans, Louisiana, 70112, USA.
The complete text, including references and an editorial note are available at online at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5020a5.htm
Drowning is the third leading cause of death from unintentional injuries in Louisiana. In 1998, the fatality rate from drowning for Louisiana residents was 3.1 per 100,000 population, higher than the U.S. rate of 1.9 per 100,000, and more than twice the 2000 national target of 1.3 per 100,000 population. This report describes the demographics and risk factors associated with drownings in Louisiana in 1998. Findings indicate that alcohol or illicit drug use was found in approximately 60% of tested victims aged >13 years and that none of the victims of boating-related drowning were correctly wearing a personal flotation device (PFD).
Of the 137 drowning cases, 115 (84%) occurred among males. The rate of drowning among blacks was more than twice the rate of whites, 4.8 per 100,000 and 2.3 per 100,000, respectively. The median age of drowned persons was 32 years (range: 10 months--94 years). The highest drowning rate was among persons aged 25--35 years (3.8 per 100,000). Children aged <4 years accounted for 10% of the total deaths and had the second highest rate (3.5 per 100,000). Among those cases in which the manner of death could be determined, 122 (95%) were classified as unintentional and the remaining seven (5%) were classified as suicide. Twelve (9%) drowning deaths were work-related.
Among the 19 deaths that occurred in a swimming pool, 11 (58%) were in children aged <14 years. Children aged <4 years died in swimming pools at the highest rate (1.3 per 100,000). The presence or absence of fences was noted in eight (42%) deaths. Six pools had and two did not have fencing. (The authors did not indicate the if swimming pools where the fatalities occurred were at private residences or more public settings. The type of fencing -- 4-sided isolation or 3-sided perimeter with the home as the fourth side -- was not specified and probably not available.)
Coroner and LDWF reports indicated that 35 (31%) of 114 deaths occurred during boating-related activities: 11 (31%) involved a fall from the boat, seven (20%) occurred when the boat capsized, and six (17%) involved a collision. Five (14%) persons who drowned had entered the water voluntarily, and six (17%) had entered the water for unknown reasons. PFD use was recorded for 22 (63%) boating-related drownings; only one decedent had been wearing a PFD and it was unfastened. Among persons aged >13 years, 34 drownings occurred; 13 (48%) tested positive for alcohol or illicit drugs.
Application of the induced exposure method to compare risks of traffic crashes among different types of drivers under different environmental conditions.
Redondo-Calderon JL, de Luna-del-Castillo J, Jimenez-Moleon JJ, Garcia-Martin M, Lardelli-Claret P, Galvez-Vargas R. Am J Epidemiol 2001; 153(9):882-891.
Correspondence: José Luis Redondo-Calderón1, Delegacion Provincial de Salud, E-14004 Cordoba, Spain.
There are important denominator problems when calculating the risk of motor vehicle injury. This problem arises because the level of exposure is usually unknown when making comparisons by age group, sex, time of day and day of week, or driver physical and psychological condition. The authors analyzed traffic crashes recorded by the Spanish Direccion General de Trafico to assess the usefulness of the induced exposure method and to compare proportions of drivers in different age/sex categories who were involved in single-vehicle and multi-vehicle crashes under different psychological and physical conditions. Crash risk was 1.42- to 2.35-fold greater in men than in women, depending on driver category and environmental factors. Risk was also significantly higher in the 18- to 24-year-old age group (1.75- to 2.87-fold greater than in drivers aged 25-49 years) and under abnormal psychological-physical conditions (1.69- to 4.10-fold greater among drivers under the influence of alcohol). Twilight and night driving, driving in urban areas, and driving on weekends and legal holidays were also associated, though nonsignificantly, with a slightly higher traffic crash risk. These findings are consistent with earlier reports, and they support the usefulness of the induced exposure method as an easy and economical tool with which to analyze data contained in traffic crash records.
Validation of an injury surveillance epidemiological data system used with emergency departments.
Stokes M, Ozanne-Smith J, Harrison J, Steenkamp K. Injury Control and Safety Promotion 2000; 7(4):219-232.
Correspondence: Mark Sinclair-Stokes, Victorian Injury Surveillance System, Monash University Accident Research Centre, Clayton, Victoria, Australia Mark.Stokes@general.monash.edu.au
OBJECTIVES: To establish ascertainment rates, validity, and the presence of bias within the Victorian Emergency Minimum Data set (VEMD). METHODS: Experienced researchers conducted interviews using a paper-based instrument to collect injury details. These data were obtained in parallel with the routine electronic collection of injury data within four of the 25 VEMD hospitals. Data were matched using the unique data and time of presentation, as well as the birth date. Interviews were conducted with 481 injured persons. RESULTS: Electronic and paper records were successfully matched in 382 cases. A high mean capture rate (82.5%) across hospitals was found when the interview data and VEMD data were compared. Data were mostly coded with some inaccuracy, 82% of the cases had at least one error, yet when compared with interview descriptions, the coded injury and incident data were usually valid (83.9%). However, narrative data provided information beyond coded data for only 14.1% of the cases. CONCLUSIONS: These results suggest that the VEMD is a reliable and valid computerized data set, but that the case narratives require attention.
Offender and offense characteristics of a non-random sample of adolescent mass murderers.
Meloy JR, Hempel AG, Mohandie K, Shiva AA, Gray BT. J Am Acad Child Adolesc Psychiatry 2001; 40(6): 719-728.
Correspondence: J. Reid Meloy, Department of Psychiatry, University of California at San Diego, 964 5th Avenue, Suite 409, San Diego, CA 92101, USA, jrmeloy@cts.com
The authors searched multiple sources to identify cases of an individual 19 years old or younger who killed at least three victims in a single incident. After case identification data was obtained from court testimony; video- and audio-tapes of perpetrators, family members, survivors, or witnesses; and interviews with law enforcement officers involved with the case. Twenty-seven cases were identified. These occurred between 1958 and 1999. The authors state their belief that this represents all such incidents within that time period. The 27 cases involved 34 perpetrators who acted alone or in pairs. Most were described as 'loners' and abused alcohol or drugs. Almost half were bullied by others, preoccupied with violent fantasy, and had a history of violence. Although 23% had a psychiatric history (typically depression), only 6% were judged to have been psychotic at the time of the time of the incident. There was a precipitating event (perceived failure in love or school) in 66.6% of the cases. A threatening statement was made to third parties in 46.7% of the cases. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits.
Katon W, Sullivan M, Walker E. Ann Intern Med 2001; 134(9 Pt 2):917-925
Correspondence: Dr. Wayne J. Katon, Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, 1959 NE Pacific Street, Seattle, WA 98195-6560, USA. wkaton@u.washington.edu
The investigators examined the association of stressful life events, psychological distress, and depressive and anxiety disorders with 1) a range of medical symptoms without identified pathology, 2) increased health care utilization, and 3) increased costs. In both primary care and medical specialty samples, patients who have syndromes with ill-defined pathologic mechanisms (such as the irritable bowel syndrome and fibromyalgia) have been shown to have significantly higher rates of anxiety and depressive disorders than do patients with comparable, well-defined medical diseases and similar symptoms. Other studies show that after adjustment for severity of medical illness, patients with depression or anxiety and comorbid medical disease have significantly more medical symptoms without identified pathology than do patients with a similar medical disease alone. Both childhood maltreatment and psychological trauma in adulthood have been associated with increased vulnerability to psychiatric illness and more medical symptoms without identified pathology.
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