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31 December 2001
We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.
Drinking and recreational boating fatalities: A population-based case-control study.
Smith GS, Keyl PM, Hadley JA, Bartley CL, Foss RL, Tolbert WG, McKnight J. JAMA 2001; 286(23):2974-2980.
Correspondence: Gordon S. Smith, Center for Safety Research, Liberty Mutual Research Center for Safety and Health, 71 Franklin Rd, Hopkinton, MA 01746 (e-mail: Gordon.Smith@LibertyMutual.com).
BACKGROUND: Alcohol is increasingly recognized as a factor in many boating fatalities, but the association between alcohol consumption and mortality among boaters has not been well quantified.
OBJECTIVES: To determine the association of alcohol use with passengers' and operators' estimated relative risk (RR) of dying while boating.
METHODS: Design, Setting, and Participants -- Case-control study of recreational boating deaths among persons aged 18 years or older from 1990-1998 in Maryland and North Carolina (n = 221), compared with control interviews obtained from a multistage probability sample of boaters in each state from 1997-1999 (n = 3943). Main Outcome Measure -- Estimated RR of fatality associated with different levels of blood alcohol concentration (BAC) among boaters.
RESULTS: Compared with the referent of a BAC of 0, the estimated RR of death increased even with a BAC of 10 mg/dL (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4). The OR was 52.4 (95% CI, 25.9-106.1) at a BAC of 250 mg/dL. The estimated RR associated with alcohol use was similar for passengers and operators and did not vary by boat type or whether the boat was moving or stationary.
CONCLUSIONS: Drinking increases the RR of dying while boating, which becomes apparent at low levels of BAC and increases as BAC increases. Prevention efforts targeted only at those operating a boat are ignoring many boaters at high risk. Countermeasures that reduce drinking by all boat occupants are therefore more likely to effectively reduce boating fatalities. -
Factors related to self-reported violent and accidental injuries.
McDonald S, Wells S. Drug Alcohol Rev 2001; 20(3): 299-307.
Correspondence: Scott MacDonald, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada M5S 2S1.
BACKGROUND: Alcohol and other drug use has been linked with violence and unintentional injuries.
OBJECTIVES: To gain a better understanding of the link between substance use and injuries.
METHODS: A secondary analysis was conducted on data from a randomized telephone survey of 10,385 Canadian residents. Three groups were compared using chi-square tests and logistic regression analyses: respondents who reported no injuries in the previous year, those with at least one accidental injury and those with at least one violent injury.
RESULTS: In the bivariate analyses, the violent injury group was significantly more likely than the accidental injury and non-injury groups to be single, widowed, separated or divorced, have more than five drinks on a usual drinking occasion, experience harmful effects of alcohol and to have used illicit drugs, such as cocaine and marijuana, and licit drugs, such as antidepressants and sleeping pills. The violent injury group was significantly more likely than those with non-violent injuries to report that the incident was related to either their own or someone else's alcohol or drug use.
Injury in the developing world.
Mock C. West J Med 2001; 175(6): 372-374.
Correspondence: Charles Mock, Departments of Surgery and Epidemiology, University of Washington School of Medicine, Seattle, WA 98195 (E-mail: cmock@u.washington.edu).
Injury is the commonest cause of death for children and young adults in developed and middle-income countries. In low-income countries, deaths in this age group are most often due to infectious disease, but there is a rising rate of deaths from injury. The Global Burden of Disease Study highlighted the overall toll from injury in the developing world. Injury-related causes account for 3 of the top 6 killers of older children and 4 of the top 6 killers of young adults. Road traffic accidents alone are second only to AIDS as a killer of young adults. Other major causes include nonintentional or accidental causes (such as drowning, fires and burns, poisoning, falls, and home injuries) and intentional causes (such as violence and suicide). In addition to mortality, disability is often due to injury, especially with the success of the global efforts to control polio. Injury is also a leading contributor to health-related economic losses.
Injury has become a major health problem throughout the developing world, but there has been a disproportionately low policy response to the problem. However, many low cost-solutions could help to lower the burden of suffering from injury. International health organizations should increase their involvement with injury control or, in many cases, begin to address this problem.
A case series of biting dogs: Characteristics of the dogs, their behaviour, and their victims.
Guy NC, Luescher UA, Dohoo SE, Spangler E, Miller JB, Dohoo IR, Bate LA. Appl Animal Behav Sci 2001; 74(1): 2001, 43-57.
Correspondence: Norma Charlotte Guy, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PEI C1A 4P3, CANADA (E-Mail: nguy@upei.ca).
The characteristics of 227 biting dogs, their homes, and their victims were collected in a telephone survey of general veterinary clientele in 3 Canadian provinces. All of the dogs had bitten either someone living in the same household, or someone who was a frequent visitor and was well known to the dog. There were 117 male and 110 female dogs included in this study. Aggression which would traditionally be defined as dominant or possessive had been demonstrated by 75.6% of the dogs in at least one of 17 specific situations outlined in the questionnaire. Dogs with a history of this type of aggression were significantly older and of lower body weight when compared to the other dogs, and were more likely to be fearful of a variety of stimuli. The effect of fear in these dogs may be important in understanding the motivation for aggression problems. For what the owner considered to be the worst bite incident, 42.4% could be attributed to behavior which appeared to be characteristic of dominant or possessive aggression. If the reason for the worst bite incident was related to the commonly accepted criteria for dominance aggression, then the dogs were more often male and purebred. Adults were the most common victims of dog bites, and most injuries were to the hands and arms .
Risk factors for dog bites to owners in a general veterinary caseload.
Guy NC, Luescher UA, Dohoo SE, Spangler E, Miller JB, Dohoo IR, Bate LA. Appl Animal Behav Sci 2001; 74(1): 2001, 29-42.
Correspondence: Norma Charlotte Guy, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PEI C1A 4P3, CANADA (E-Mail: nguy@upei.ca).
Examined risk factors for biting (BT) behavior by dogs in a household setting. Interviews were completed with 515 individuals selected from a study population of 3,226 dogs by a random process. For risk factor analysis, 227 BT and 126 non-BT dogs were selected according to strict criteria to evaluate the association of potential risk factors with BT behavior. All dogs were at least 6 mo of age. Both the mean weight and age of BT dogs were significantly lower than that of non-BT dogs. Significant risk factors for an outcome of BT were: the dog being female, the presence of 1 or more teenagers in the home, a history of malodorous skin disorder which had received veterinary treatment, aggression over food in the first 2 mo of ownership, the dog having slept on someone's bed in the first 2 mo of ownership, and the dog having been given a significantly higher ranking for excitability based on its behavior in the first 2 mo of ownership. Small dogs were also determined to be at a higher risk of having bitten than large dogs when exposed to certain lifestyle and health factors, suggesting a relationship between body size and reactivity, or possibly greater owner tolerance of aggression in smaller dogs. BT dogs were more likely to have exhibited fear of children, men, and strangers. -
Determinants of acceptance of a community-based program for the prevention of falls and fractures among the elderly.
Larsen ER, Mosekilde L, Foldspang A. Prev Med 2001; 33(2): 115-119.
Correspondence: Erik Roj Larsen, Jr., Department of Orthopaedic Surgery, Randers Central Hospital, Randers, DENMARK (E-mail: erl@inet.uni2.dk).
BACKGROUND: Injuries resulting from falls are an important health problem among the elderly.
OBJECTIVES: To identify the determinants of acceptance in a community-based fall and fracture prevention program.
METHODS: The study population consisted of 7,543 66-103 yr old Danish residents. The residents participated in 1 of 3 intervention programs: (1) home safety inspection, evaluation of prescribed medicine and identification of possible health/food problems; (2) calcium and vitamin supplements combined with medicine evaluation; and (3) a combination of the 1st 2 programs. Acceptance was defined as willingness to receive an introductory nurse visit.
RESULTS: Acceptance of program 1 was 50%; for program 2, 56%; and for program 3, 45%. Acceptance was associated with gender (females 53%, males 47%) and did not change from ages 66-84, but decreased significantly after age 85. Widows aged 66-84 had the highest acceptance (57%) and never married males the lowest (30%). An important determinant was the individual social service center that communicated the specific program. Acceptance varied from 39-66% between the centers.
CONCLUSIONS: Acceptance of a fall and fracture prevention program varies with intervention type; with gender, age, and social status of the target population; and with the motivation and attitude of the health workers involved in the implementation of the program.
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School Health Guidelines to Prevent Unintentional Injuries and Violence.
Centers for Disease Control and Prevention. MMWR 2001, 50(RR22): 1-46.
The guidelines and report are available free online HERE.
Approximately two thirds of all deaths among children and adolescents aged 5--19 years result from injury-related causes: motor-vehicle crashes, all other unintentional injuries, homicide, and suicide. Schools have a responsibility to prevent injuries from occurring on school property and at school-sponsored events. In addition, schools can teach students the skills needed to promote safety and prevent unintentional injuries, violence, and suicide while at home, at work, at play, in the community, and throughout their lives.
This report summarizes school health recommendations for preventing unintentional injury, violence, and suicide among young persons. These guidelines were developed by CDC in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in unintentional injury, violence, and suicide prevention; health education; and public health. Every recommendation is not appropriate or feasible for every school to implement. Schools should determine which recommendations have the highest priority based on the needs of the school and available resources.
The guidelines include recommendations related to the following eight aspects of school health efforts to prevent unintentional injury, violence, and suicide:
- a social environment that promotes safety;
- a safe physical environment;
- health education curricula and instruction;
- safe physical education, sports, and recreational activities;
- health, counseling, psychological, and social services for students;
- appropriate crisis and emergency response;
- involvement of families and communities; and
- staff development to promote safety and prevent unintentional injuries, violence, and suicide.
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Effectiveness of barriers at suicide jumping sites: a case study.
Beautrais AL. Aust NZ J Psychiatry 2001;35(5): 557-562.
Correspondence: Annette Beautrais, Dept of Psychological Medicine, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand (E-mail: suicide@chmeds.ac.nz).
OBJECTIVES: Suicide safety barriers were removed from a central city bridge in an Australasian metropolitan area in 1996 after having been in place for 60 years. The bridge is a known suicide site and is located adjacent to the region’s largest hospital, which includes an acute inpatient psychiatric unit. This paper examines the impact of the removal of these barriers on suicide rates.
METHODS: Data for suicide deaths by jumping from the bridge in question, from 1992 to 2000, were obtained from the regional City Police Inquest Office. Data for suicide deaths by jumping from other sites in the metropolitan area in question, from 1992 to 1998, were obtained from the national health statistics database. Case history data about each suicide death by jumping in the metropolitan area in question, from 1994 to 1998, were abstracted from coronial files held by a national database.
RESULTS: Removal of safety barriers led to an immediate and substantial increase in both the numbers and rate of suicide by jumping from the bridge in question. In the 4 years following the removal of the barriers (compared with the previous 4 years) the number of suicides increased substantially, from three to 15 (c2 = 8, df = 1, p < 0.01); the rate of such deaths increased also (c2 = 6.6, df = 1, p < 0.01). The majority of those who died by jumping from the bridge following the removal of the safety barriers were young male psychiatric patients, with psychotic illnesses. Following the removal of the barriers from the bridge the rate of suicide by jumping in the metropolitan area in question did not change but the pattern of suicides by jumping in the city changed significantly with more suicides from the bridge in question and fewer at other sites.
CONCLUSIONS: Removal of safety barriers from a known suicide site led to a substantial increase in the numbers of suicide deaths by jumping from that site. These findings appear to strengthen the case for installation of safety barriers at suicide sites in efforts to prevent suicide deaths, and also suggest the need for extreme caution about the removal of barriers from known jumping sites.
Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the adverse childhood experiences study.
Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH. JAMA 2001; 286(24):3089-3096.
Correspondence: Shanta R. Dube, MPH, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, 4770 Buford Hwy NE, MS K-45, Atlanta, GA 30341-3717 (E-mail: skd7@cdc.gov).
BACKGROUND: Suicide is a leading cause of death in the United States, but identifying persons at risk is difficult. Thus, the US surgeon general has made suicide prevention a national priority. An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including attempted suicide among adolescents and adults.
OBJECTIVES: To examine the relationship between the risk of suicide attempts and adverse childhood experiences and the number of such experiences (adverse childhood experiences [ACE] score).
METHODS: Design, Setting, and Participants- A retrospective cohort study of 17 337 adult health maintenance organization members (54% female; mean [SD] age, 57 [15.3] years) who attended a primary care clinic in San Diego, California, within a 3-year period (1995-1997) and completed a survey about childhood abuse and household dysfunction, suicide attempts (including age at first attempt), and multiple other health-related issues. Main Outcome Measure- Self-reported suicide attempts, compared by number of adverse childhood experiences, including emotional, physical, and sexual abuse; household substance abuse, mental illness, and incarceration; and parental domestic violence, separation, or divorce.
RESULTS: The lifetime prevalence of having at least 1 suicide attempt was 3.8%. Adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood (P<.001). Compared with persons with no such experiences (prevalence of attempted suicide, 1.1%), the adjusted odds ratio of ever attempting suicide among persons with 7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1). Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts, suggesting partial mediation of the adverse childhood experience–suicide attempt relationship by these factors. The population-attributable risk fractions for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and childhood/adolescent suicide attempts, respectively.
CONCLUSIONS: A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship. Because estimates of the attributable risk fraction caused by these experiences were large, prevention of these experiences and the treatment of persons affected by them may lead to progress in suicide prevention.
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Increasing motorist compliance and caution at stop signs.
Van Houten R, Retting RA. J Applied Behav Analysis 2001; 34(2): 185-193.
Correspondence: Ron Van Houten, Center for Education and Research in Safety, 17 John Breton Drive, Dartmouth, Nova Scotia B2X 2V5 (E-mail: rvh@cers-safety.com).
BACKGROUND: Stop signs are used at intersections to separate potentially conflicting traffic movements and thus prevent crashes. Drivers who fail to stop or, after stopping, proceed with insufficient caution create a substantial crash risk.
OBJECTIVES: To evaluate a strategy to improve motorist compliance at stop signs.
METHODS: The researchers evaluated strategies to improve motorist compliance and caution at 3 stop sign-controlled intersections with a history of motor vehicle crashes. The primary intervention was a light-emitting diode (LED) sign that featured animated eyes scanning left and right to prompt drivers to look left and right for approaching traffic. Data were scored from videotape on the percentage of drivers coming to a complete stop and the percentage of drivers looking right before entering the intersection. Observational data were collected on the percentage of right-angle conflicts (defined as braking suddenly or swerving from the path to avoid an intersection crash).
RESULTS: The introduction of the LED sign according to a multiple baseline across the 3 intersections was associated with an increase in the percentage of vehicles coming to a complete stop at all 3 intersections and a small increase in the percentage of drivers looking right before entering the intersections. Conflicts between vehicles on the major and minor road were also reduced following the introduction of the animated eyes prompt. View a photograph of the animated eyes sign.
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Kentucky's graduated driver licensing program for young drivers: barriers to effective local implementation.
Steenbergen LC, Kidd PS, Pollak S, McCoy C, Pigman JG, Agent KR. Injury Prev 2001; 7(4): 286-291.
Correspondence: Lorena Steenbergen, Kentucky Injury Prevention Research Center, 333 Waller Avenue, Suite 202, Lexington KY 40504-2915, USA (E-mail: flsteen@scrtc.com).
BACKGROUND: The motor vehicle crash death rate for teenaged drivers in Kentucky is three times the rate for other licensed drivers. Thirty-two states have attempted to address this problem through some sort of graduated driver licensing (GDL) program.
OBJECTIVES: To examine the implementation of GDL in Kentucky and to use the data collected to recommend actions to enhance the effectiveness of the GDL program.
METHODS: Data were acquired from surveys of 700 law enforcement officers and more than 40 judges and from interviews with 100 persons who implement or are affected by Kentucky's GDL program -- for example, traffic court judges, licensing clerks, insurance agents, driving instructors, parents, and employers of teens. Transcripts from the interviews were examined using QRS NU*DIST, a qualitative data analysis program.
RESULTS: Participants noted a widespread lack of awareness of the night-time driving restriction and a substantial number of young drivers receiving little driving time during the learner permit phase. It appeared that specific GDL provisions can be difficult for judges and law officers to enforce and that the penalty of license suspension after several traffic violations may not be a sufficient deterrent.
CONCLUSIONS: Efforts are needed to increase parental awareness of GDL provisions, GDL purpose, and their teen's traffic violations; and to increase parental enforcement of restrictions that are difficult for law enforcement agencies to monitor, such as night-time driving restriction and the adult supervision requirement.
Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study.
Hiroeh U, Appleby L, Mortensen PB, Dunn G. Lancet 2001; 358: 2110-2112.
Correspondence: Louis Appleby, School of Psychiatry and Behavioural Sciences, University of Manchester, University Hospital of South Manchester, Manchester M20 8LR, UK (E-mail: Louis.Appleby@man.ac.uk).
BACKGROUND: People with mental illness are at great risk of suicide, but little is known about their risk of death from other unnatural causes. No study has commented on their risk of being victims of homicide; public concern is pre-occupied with their role as perpetrators. We aimed to calculate standardized mortality ratios (SMRs) and directly standardized rate ratios for death by homicide, suicide, and accident in people admitted to hospital because of mental illness.
METHODS: The researchers performed a population-based study in which they linked the data for 72 208 individuals listed in the Danish Psychiatric Case Register between 1973 and 1993, and who died before Dec 31, 1993, with data in the Danish National Register of Causes of Death.
RESULTS: 17 892 (25%) patients died from unnatural causes. Our results show raised SMRs for homicide, suicide, and accident for most psychiatric diagnoses irrespective of sex. The all-diagnosis SMRs for women and men, respectively, were: 632 (95% CI 517-773) and 609 (493-753) for homicide, 1356 (1322-1391) and 1212 (1184-1241) for suicide, and 318 (305-332) and 466 (448-484) for accident. We recorded an increased risk of dying by homicide in men with schizophrenia and in individuals with affective psychosis. The highest risks of death by homicide and accident were in alcoholism and drug use, whereas the highest risks of suicide were in drug use.
CONCLUSIONS: People with mental disorders, including severe mental illness, are at increased risk of death by homicide. Strategies to reduce mortality in the mentally ill are correct to emphasize the high risk of suicide, but they should also focus on other unnatural causes of death. -
Risk factors for physical injury among women assaulted by current or former spouses.
Thompson MP, Saltzman LE, Johnson H. Violence Against Women 2001 7(8): 886-899.
Correspondence: Martie P. Thompson, National Center for Injury Prevention and Control, Mailstop K65,
4770 Buford Highway NE, Atlanta, GA 30341-3724, USA (E-mail: mgt8@cdc.gov).
This study examined risk factors for physical injuries resulting from partner violence using data from 1,946 women who participated in the Canadian Violence Against Women Survey. Multivariate results indicate that experiencing violence before the union, having a partner who was drinking at the time of the assault, having children who witnessed the assault, experiencing previous violence by the same partner, fearing one's life was in danger, and experiencing high levels of emotional abuse were related to an increased risk of both minor and severe injuries. Both models had good predictive value: 80% concordance rate when predicting minor injuries and 90% concordance rate when predicting severe injuries. It is concluded that knowledge of a woman's status on these risk factors would allow public health practitioners to intervene with battered women more effectively to prevent injuries.
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