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22 October 2001
Disaster mitigation and preparedness: the case of NGOs in the Philippines.
Luna EM. Disasters 2001; 25(3):216-226.
Correspondence: E. M. Luna, Department of Community Development, College of Social Work and Community Development, University of the Philippines, Diliman, Quezon City, Philippines. lunakids@expert.net.ph
The Philippines is very vulnerable to natural disasters because of its natural setting, as well as its socio-economic, political and environmental context--especially its widespread poverty. The Philippines has a well-established institutional and legal framework for disaster management, including built-in mechanisms for participation of the people and NGOs in decision-making and programme implementation. The nature and extent of collaboration with government in disaster preparedness and mitigation issues varies greatly according to their roots, either in past confrontation and political struggles or traditional charity activities. The growing NGO involvement in disaster management has been influenced by this history. Some agencies work well with local government and there is an increasing trend for collaborative work in disaster mitigation and preparedness. Some NGOs, however, retain critical positions. These organisations tend to engage more in advocacy and legal support for communities facing increased risk because of development projects and environmental destruction. Entry points into disaster mitigation and preparedness vary as well. Development-oriented agencies are drawn into these issues when the community members with whom they work face disaster. Relief organisations, too, realise the need for community mobilisation, and are thus drawn towards development roles.
Hospitalizations for Pediatric Intoxication in Washington State, 1987-1997
Gauvin F, Bailey B, Bratton SL. Arch Pediatr Adolesc Med 2001; 155(10): 1105-1110.
Correspondence: France Gauvin, MD, Hôpital Ste-Justine, Department of Pediatrics, 3175 Côte Ste-Catherine, Montreal, Quebec, Canada H3T 1C5.
BACKGROUND: Intoxication (or poisoning) that necessitates hospitalization remains an important source of morbidity in children.
OBJECTIVES: To determine changes, during an 11-year period (1987-1997), in the incidence of hospitalization due to intoxication among children in Washington State and circumstances of ingestion, agents used, hospital length of stay, charges, and mortality.
METHODS: A computerized database of all hospital discharges (Comprehensive Hospital Abstract Reporting System [CHARS] database) in Washington was used. Cases included all children younger than 19 years with a primary or secondary diagnosis for an intoxication or with an external cause of injury code (E code) for an intoxication from 1987 to 1997.
RESULTS: There were 7322 hospitalizations (45 per 100 000 children per year); the annual rate significantly decreased during the study period. Most patients (75%) were teenagers. Sixty-five percent were female. Pharmaceutical agents were used in 80% of cases. Analgesics were the most commonly used (34%), followed by antidepressants (12%) and psychotropic drugs (8%). Nonpharmaceutical agents were more prevalent in children younger than 12 years than in teenagers. Self-inflicted intoxication was the most frequent cause identified by E codes (47%). Median length of stay was 1 day, and median hospital charges were $2096. Mortality was low (0.2%) and did not change significantly over time.
DISCUSSION: Acute intoxication continues to be an important cause of hospitalization in children. The type of agent involved did not change significantly over time. Teenage girls continue as the highest risk group for suicide attempt from ingestions. Self-inflicted intoxications were associated with higher costs, length of stay, and readmissions. Although preventive measures anddevelopment of poison centers have contributed to decrease mortality from acute intoxication in children in the last 50 years, efforts need to be targeted toward suicide prevention, especially among teenage girls.
Fetal Deaths Related to Maternal Injury
Weiss HB, Songer TJ, Fabio A. JAMA 2001; 286(15): 1863-1868.
Correspondence: Harold B. Weiss, PhD, MPH, MS, Center for Injury Research and Control, University of Pittsburgh, 200 Lothrop St, Suite B400, Pittsburgh, PA 15213 (e-mail: hweiss@injurycontrol.com).
BACKGROUND: Maternal and fetal trauma is an important cause of adverse fetal outcomes. However, systematic exclusion from US injury surveillance programs of even the most severe outcome, fetal/neonatal death, has led to a lack of understanding about frequency, causes, and prevention.
OBJECTIVES: To determine the rate of traumatic fetal deaths reported in state fetal death registries and the types of trauma and physiologic diagnoses associated with these deaths.
METHODS: The authors conducted a retrospective descriptive study of fetal death certificates from 1995 through 1997 obtained from 16 states, which accounted for 55% of US live births and approximately 15 000 fetal death registrations per year. The main outcome measure was the rate of fetal injury deaths, based on fetal death certificates coded with an underlying cause of death due to maternal injury at 20 weeks' gestation or later, by cause.
RESULTS: During the 3-year study period, 240 traumatic fetal injury deaths were identified (3.7 fetal deaths per 100 000 live births). Motor vehicle crashes were the leading trauma mechanism (82% of cases; 2.3 fetal deaths per 100 000 live births), followed by firearm injuries (6% of cases) and falls (3% of cases). In 3 states, reported crash-related fetal deaths exceeded that of crash-related infant deaths. Placental injury was mentioned in 100 cases (42%) and maternal death was noted in 27 cases (11%). A peak rate of 9.3 fetal deaths per 100 000 live births was observed among 15- to 19-year-old women.
DISCUSSION: Motor vehicle crashes are the leading cause of fetal deaths related to maternal trauma. Improved tracking of traumatic fetal injury deaths is important to stimulate and guide research and efforts to reduce the risks to women and fetuses from injury during pregnancy. Deer-vehicle crashes: Extensive peak at 1 hour after sunset.
Haikonen H, Heikki Summala H. Am J Prev Med 2001; 21(3): 209-213.
Correspondence: Heikki Summala, Traffic Research Unit, Department of Psychology, University of Helsinki, P.O. Box 13, 00014 Helsinki, Finland (email: heikki.summala@helsinki.fi).
BACKGROUND: On-road encounters with animals resulted in 231 fatalities in the United States in 1999, and the annual number of deer-vehicle crashes (DVCs) has been estimated to total more than 500,000. Previous studies suggest that the number of DVCs is highest during the hours of dusk and dawn. However, these studies have not adequately taken into account the synchronization of visibility and animal behavior with sunset and sunrise. The goal of this study was to determine the temporal variation in the crash risk, so that this variation could be better taken into account by road users.
METHODS: In Finland, the recorded times for 13,379 crashes with moose and 8191 crashes with white-tailed deer were adjusted to sunset and sunrise according to the location and date of occurrence. In addition, two sample distributions of traffic volume on public roads were adjusted to sunset. The DVC rate was computed as the proportion of number of crashes to traffic volume.
RESULTS: The highest crash peak occurred 1 hour after sunset for both species of deer. The relative risk peaked at 30 times the seasonal daytime level of the crash rate for white-tailed deer in the fall and at over 60 times for moose in the summer.
DISCUSSION: Drivers can effectively reduce their risk of DVCs by reducing speed and remaining alert for deer intrusions on the roadway during the most critical time of the day: after sunset.
Beyond screening for domestic violence: A systems model approach in a managed care setting.
McCaw B, Berman WH, Syme SL, Hunkeler EF. Am J Prev Med 2001; 21(3): 170-176.
Correspondence: Brigid McCaw, MD, c/o Kaiser Permanente Medical Center, 901 Nevin Avenue, Richmond, CA 94801 USA (email: brigid.mccaw@kp.org).
BACKGROUND: Implementation of screening guidelines for domestic violence has been challenging. The multifaceted ''systems model'' may provide an effective means to improve domestic violence screening, identification, and intervention in the healthcare setting.
METHODS: In a nonprofit, managed care facility in Richmond, California, the authors developed: (1) a systems model approach using tools for effective referral, evaluation, and reporting of domestic violence; (2) materials for distribution to female patients; (3) training for social service and mental health clinicians to provide domestic violence evaluation; and (4) strong links to the community. Staff and members of the managed care plan participated. Main outcome measures were (1) Increased screening for domestic violence by clinicians; (2) increased awareness of the healthcare facility as a resource for domestic violence assistance; and (3) increased member satisfaction with the health plan's efforts to address domestic violence.
RESULTS: The number of clinician referrals and patient self-referrals to an on-site domestic violence evaluator increased more than twofold. A pre-intervention and post-intervention phone survey of members seen for routine checkup showed an increase in member recall of being asked about domestic violence. After intervention, statistically significant increases were seen in members' perception that the health plan was concerned about the health effects of domestic violence (p <0.0001) and about members' satisfaction with the health plan's efforts to address this issue (p <0.0001).
DISCUSSION: A systems model approach improved domestic violence services in a managed care health setting within 1 year and affected clinicians' behavior as well as health plan members' experience. This successful implementation makes it possible to address critical research questions about the impact of a healthcare intervention for victims of domestic violence in a managed healthcare setting. Firearm Prevalence and Social Capital
Hemenway D, Kennedy BP, Kawachi I, Putnam RD. Ann Epidemiol 2001; 11(7): 484-490.
Correspondence: David Hemenway, PhD, Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA (email: hemenway@hsph.harvard.edu).
BACKGROUND: The United States is the most heavily armed nation in the developed world. Social capital is a broad sociologic concept describing the connection among individuals. It involves those social aspects of our daily lives that often matter the most¯¯good will, fellowship, sympathy, and social intercourse. Social capital is typically measured by the amount of mutual trust and civic engagement among community members. Previous studies have shown a correlation between measures of social capital and morbidity, mortality, and violent crime. This article examines the association across U.S. states between social capital (as measured by mutual trust and civic engagement) and firearm availability.
METHODS: The study is a cross-sectional ecological study of U.S. states. The dependent variables are measures of mutual trust among community members and civic engagement. The analysis uses ordinary least squares regression to determine degrees of association across U.S. states. Measures of mutual trust come from responses to questions on the U.S. General Social Survey that "you can't be too careful in dealing with people," and most people "would try to take advantage of you." Measures of formal civic engagement come from responses to Lifestyle Survey questions concerning times volunteered, club meetings attended, community projects worked on, and church services attended. Informal civic engagement measures come from responses to number of times bowled, played cards, entertained at home, and gave or attended dinner parties, and number of greeting cards sent. The Lifestyle Survey also asked whether respondent believed whether "most people are honest." The percentage of suicides from firearms, and the average percentage of suicides and homicides from firearms, are used as proxies for state firearm ownership rates. Control variables are the degree of urbanization, the rates of poverty, and the percentage of nonwhites in the state.
RESULTS: Across the U.S. states, higher levels of firearm ownership are associated with significantly lower levels of mutual trust and civic engagement.
DISCUSSION: This cross-sectional study does not provide evidence about whether or not an armed society is a polite society. It does suggest, however, that an armed community may not be a very sociable or trusting one. While the analysis cannot show causation, states with heavily armed civilians are also states with low levels of social capital. Social control in a school setting: Evaluating a school-based boot camp.
Trulson C, Triplett R, Snell C. Crime & Delinquency 2001; 47(4): 573-609.
Correspondence: Chad R. Trulson, George J. Beto College of Criminal Justice, Sam Houston State University, Huntsville, TX 77341 (email: icc_jwm@shsu.edu).
BACKGROUND: In the past few years, several dramatic incidents have spurred renewed efforts to control violence and prevent crime in schools. Although it has yet to become a matter of much public discussion, what is particularly notable about many of these efforts is the increased collaboration of criminal and juvenile justice agencies with schools in their capacity as formal agents of control.
METHODS: In the present study, the authors evaluate one program that embodies this type of collaboration—Specialized Treatment and Rehabilitation (STAR). STAR is an innovative juvenile boot camp program, based in a public school setting that is operated through the combined efforts of the school, the juvenile court, and the juvenile probation department.
RESULTS: Recidivism analysis revealed that STAR participants, despite less serious beginnings, offended more times for more serious offenses in a 6- and 12-month postrelease follow-up when compared to Intensive Supervision Probation participants. Survey responses obtained from STAR participants, their parents, and their teachers indicated that STAR was perceived as favorable in almost every aspect.
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