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23 July 2001
The Epidemiology of Pediatric Traumatic Brain Injury in Minnesota
Reid SR, Roesler JS, Gaichas AM; Tsai AK.
Arch Pedi Adol Med 2001; 155(7):784-789
Correspondence: Dr. Samuel R. Reid, Pediatric Emergency Medicine, Children's Hospitals and Clinics, 345 N Smith Ave, St Paul, MN 55102 USA (e-mail: krinandsam@aol.com).
The authors report the results of a study (population-based case series) to determine the epidemiology of pediatric traumatic brain injury (TBI) in Minnesota, USA and to examine differences between metropolitan and nonmetropolitan residents. Patients aged 0-19 years sustaining TBI in 1993 that resulted in hospitalization or death.Results Nine hundred seventy-seven patients met inclusion criteria. Incidence, mortality, and case-fatality rates were 73.5 per 100 000, 9.3 per 100 000, and 12.8 per 100, respectively. Higher median household incomes and percentages of adult high-school graduates in a patient's census block group correlated with lower incidence. Median length of stay was 2 days. Of those included in the study, 720 patients (74%) were discharged home with self-care. Three hundred fifty-seven patients met criteria for severe TBI; 346 (97%) were assigned Glasgow Outcome Scale scores, of which 161 (47%) had disabilities or died. Severe TBI was associated with nonmetropolitan residence, higher median household income, and certain injury mechanisms. Incidence was similar for metropolitan and nonmetropolitan residents. Median head-region Abbreviated Injury Score, Injury Severity Score, and mortality and case-fatality rates were higher for nonmetropolitan residents.
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Suicides and serious suicide attempts: two populations or one?
Beautrais AL. Psychol Med 2001; 31(5): 837-845.
Correspondence: Dr. Annette Beautrais, Canterbury Suicide Project, Christchurch School of Medicine, PO Box 4345, Christchurch, New Zealand (email: suicide@chmeds.ac.nz.)
The author compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour. Using case-control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction. Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior outpatient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR = 1.9, 95% CI 1.1, 3.2); older (OR = 1.03, 95% CI 1.02, 1.04); and to have a current diagnosis of non-affective psychosis (OR = 8.5, 95% CI 2.0, 35.9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR = 3.5, 95% CI 1.6, 7.8) and to be socially isolated (OR = 2.0, 95% CI 1.2, 3.5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-affective psychosis and anxiety disorder. The author concludes that suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.
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Relations among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study
McGwin G, Sims RV, Pulley L, Roseman JM. Am J Epidemiol 2000; 152(5): 424-431.
Correspondence: Dr.Gerald McGwin, Jr., Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, 700 S. 18th Street, Suite 609 EFH, Birmingham, AL, 35294-0009, USA (email: mcgwin@eyes.uab.edu).
Older drivers have elevated crash rates and are more likely to be injured or die if they have a crash. Medical conditions and medications have been hypothesized as determinants of crash involvement. This population-based case-control study sought to identify medical conditions and medications associated with risk of at-fault crashes among older drivers. A total of 901 drivers aged 65 years and older were selected in 1996 from Alabama Department of Public Safety driving records: 244 at-fault drivers involved in crashes; 182 not at-fault drivers involved in crashes; and 475 drivers not involved in crashes were enrolled. Information on demographic factors, chronic medical conditions, medications, driving habits, visual function, and cognitive status was collected. Older drivers with heart disease (odds ratio (OR) = 1.5, 95% confidence interval (CI): 1.0, 2.2) or stroke (OR = 1.9, 95% CI: 0.9, 3.9) were more likely to be involved in at-fault automobile crashes. Arthritis was also associated with an increased risk among females (OR =1.8, 95% CI: 1.1, 2.9). Use of nonsteroidal antiinflammatory drugs (OR = 1.7, 95% CI 1.0, 2.6), angiotensin converting enzyme inhibitors (OR = 1.6, 95 CI: 1.0, 2.7), and anticoagulants (OR = 2.6, 95% CI: 1.0, 73) was associated with an increased risk of at-fault involvement in crashes. Benzodiazepine use (OR = 5.2, 95% CI: 0.9, 30.0) was also associated with an increased risk. Calcium channel blockers (OR = 0.5, 95% CI: 0.2, 0.9) and vasodilators (OR = 0.3, 95% CI: 0.1, 1.0) were associated with a reduced risk of crash involvement. The identification of medical conditions and medications associated with risk of crashes is important for enhancing the safety and mobility of older drivers.
Predictive validity of a screen for partner violence against women
Koziol-McLain J, Coates CJ, Lowenstein SR. Am J Prev Med 2001; 21(2): 93-100.
Correspondence: Jane Koziol-McLain, School of Nursing, Johns Hopkins University, 525 N. Wolfe Street,
Baltimore, MD 21205-2110, USA (email: jkoziol-mclain@son.jhmi.edu).
While public health leaders recommend screening for partner violence, the predictive value of this practice is unknown. The purpose of this study was to test the ability of a brief three-question violence screen to predict violence against women in the ensuing months. The authors conducted a prospective cohort study of adult women participating in the Colorado Behavioral Risk Factor Surveillance System (BRFSS), a population-based, random-digit-dialing telephone survey. During 8 monthly cohorts, 695 women participated in the BRFSS; 409 women participated in follow-up telephone interviews approximately 4 months later. Violent events during the follow-up period, measured using a modified 28-item Conflict Tactics Scale, were compared between women who initially screened positive and those who screened negative. Among BRFSS respondents, 8.4% (95% confidence interval [CI]=6.3%-10.5%) had an initial positive screen. During the follow-up period, women who screened positive were 46.5 times (5.4-405) more likely to experience severe physical violence, 11.7 times (5.0- 27.3) more likely to experience physical violence, 3.6 (2.4-5.2) times more likely to experience verbal aggression, and 2.5 times (1.2-5.1) more likely to experience sexual coercion. In a multivariate model, separation from one's spouse and a positive screen were significant independent predictors of physical violence. Firearm storage practices of officers in a law enforcement agency in the south
Coyne-Beasley T, Johnson RM, Charles LE, Schoenbach VJ. Am J Prev Med 2001; 21(2): 118-123.
Correspondence: Tamera Coyne-Beasley. Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA (email: unavailable)
The authors conducted an anonymous, self-administered survey of law enforcement officers in an agency in the southern United States concerning firearm ownership, storage practices, and opinions. The 207 respondents (response rate=71%) were primarily white (60%) and male (89%). The proportions of respondents with (55%) and without (45%) children were similar. Eighty percent of the officers had firearms in addition to the one they were issued for work. Most stored firearms unlocked (59%) and loaded (68%); almost half (44%) reported storing firearms both unlocked and loaded. Eighty-five percent indicated that they felt an added need to protect themselves and family because of their job. Those who reported having firearms for self-protection were less likely than those who had firearms for recreation to store firearms securely. As compared to those without children, law enforcement officers with children were more likely to store firearms safely, and were especially likely to store firearms locked up (chi sq =12.72, p<0.0001). Respondents favored background checks, mandatory safety training, and enforcement of storage laws. Three quarters approved of government safety regulations for handguns. Despite the law enforcement officers' prominent role in firearm safety promotion and support for initiatives that limit unauthorized access, the authors found that many do not practice safe storage. Apparently, many officers keep their firearms stored unlocked and loaded for the purpose of protecting themselves and their families. Addressing concerns about personal safety is a necessary step in promoting safe storage to law enforcement officers.
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The Invention of Television as a Cause of Homicide: The Reification of a Spurious Relationship
Jensen GF. Homicide Studies, 2001; 5(2): 114-130.
Correspondence: Gary F. Jensen, Department of Sociology, Vanderbilt University, 319 Garland Hall (Box 1811 Sta B), Nashville, TN 37235 USA (email: jensengf@ctrvax.vanderbilt.edu).
Among the studies cited by several medical associations as a guide for warning parents about the pernicious effects of television is Brandon Centerwall's (1992) analysis of the effect of the invention and distribution of television on homicide rates. Centerwall claims that the introduction of television substantially increased homicide rates in the United States and Canada and that they remained relatively stable in South Africa until the ban on television was lifted. This article reports the results of a multivariate time-series analysis testing the alternative hypothesis that relationships involving primary groups are more important for understanding variations in homicide over time than the spread of television in a society. This hypothesis is supported in all three societies, with the significant positive effect of television reduced to insignificance after incorporating marriage-divorce ratios, divorce rates, and other variables. The author claims that his findings constitute a serious challenge to Centerwall's thesis but continue to support traditional sociological perspectives.
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