14 January 2002
Geriatric trauma in the State of Illinois: Substance use and injury patterns.
- Zautcke JL, Coker SB Jr, Morris RW, Stein-Spencer L. Am J Emerg Med 2002 Jan;20(1):14-17.
Correspondence: John L. Zautcke,Department of Emergency Medicine, University of Illinois at Chicago, 808 S. Wood St. #471-D, Chicago, IL 60612. (email: zaut@uic.edu)
BACKGROUND: As the elderly population increases and they lead more active and healthy lifestyles, their exposure to the threats of injury multiply. Undoubtedly, the geriatric population will comprise a growing percentage of trauma patients. The role of alcohol and drug use in geriatric trauma has not been clearly defined.
OBJECTIVES: The purpose of this study is to determine the incidence of alcohol and illicit drug use in association with mechanism of injury in all elderly trauma patients presenting to level I and II trauma centers in the State of Illinois over 3 years.
METHODS: A retrospective analysis was performed on 3 years of data (January 1, 1994 to December 31, 1996), provided by the Illinois Department of Public Health as the Illinois Trauma Registry, which describes consecutive trauma patients presenting to level I and II trauma facilities in the State of Illinois.
RESULTS: During the study period, there were a total of 134,846 trauma patient entries. Of these 32,382 (24.0%) were for patients 65 years of age or older. In those patients 65 and older, 1699 (5.2%) were tested for the presence of alcohol and 845 (49.7%) tested positive. Of the elderly patients who tested positive for alcohol, 71.8% were considered intoxicated (BAC >80 mg/dL). Urine toxicology screens were performed on 1785 (5.5%) elderly trauma patients, and 208 (11.6%) were positive. Besides alcohol, benzodiazipines and opiates were the most frequently detected drugs. For elderly patients under the influence of alcohol falls (49.5%) and motor vehicle crashes (36.7%) were the most common mechanism of injury. For geriatric patients testing negative for alcohol, motor vehicle crashes were a much more common mechanism of injury than falls (65.0% v 25.1%). Falls were a much more common cause of injury in elderly patients using alcohol than in those not using alcohol. Alcohol and substance abuse are possibly significant factors in geriatric trauma. Although only 5% of elderly trauma patients were tested for alcohol, nearly half had alcohol present on presentation to a trauma center, and the majority of these patients were intoxicated.
CONCLUSIONS: Prospective studies are needed to determine the true incidence of alcohol use/abuse in the geriatric trauma population and the need for routine alcohol screening of these patients. Detection of alcohol abuse in elderly trauma patients could help identify individuals in need of counseling and rehabilitative treatment. It may also reduce future injuries in these patients.
See item 1 under Risk Factor Prevalence
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Explaining socio-economic differences in injury risks.
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Laflamme L. Injury Control Safety Promotion 2001; 8(3): 149-153.
Correspondence: Lucy Laflamme, Department of Public Health Science, Division of Social Medicine, Karolinska Institut, SE-17176 Stockholm, Sweden. (email: lucie.laflamme@phs.ki.se).
As is common in the public health arena in general, the literature concerned with social differences in injury risks is dominated by individual-level studies. Though numerous, theses studies are predominantly descriptive, mainly concerned with injury risk distribution across socio-economic groups (measured in terms of social class, education, income, occupation, or ethnicity) or with persons in various socioeconomic circumstances (e.g., the unemployed, single-parents, multi-child families).
There is a great need to improve our understanding of the mechanisms underlying social patterning of injury risks. Injury research still lacks explanatory models for and empirical evidence on how contextual and individual factors interact in injury causation. Such research may be of considerable help in understanding social differentials in injury risks and, perhaps most importantly, the differential benefits of prevention strategies.
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Rapid Assessment of Injuries Among Survivors of the Terrorist Attack on the World Trade Center --- New York City, September 2001.
- Boodram B, Torian L, Thomas P, Wilt S, Pollock D, Bell M, Budnitz D. MMWR 2002; 51(1): 1-5.
Full article available online: Download Document.
On September 11, 2001, a jet aircraft crashed into the north tower of the World Trade Center (WTC) in lower Manhattan. Minutes later, a second aircraft crashed into the south tower. The impact, fires, and subsequent collapse of the buildings resulted in the deaths of thousands of persons. The precise number and causes of deaths could not be assessed in the immediate aftermath of the attack; however, data were available on the frequency and type of injuries among survivors (Figure 1). In previous disasters, such information assisted in characterizing type and severity of injuries and the health-care services needed by survivors (1). To assess injuries and use of health-care services by survivors, the New York City Department of Health (NYCDOH) conducted a field investigation to review emergency department (ED) and inpatient medical records at the four hospitals closest to the crash site and a fifth hospital that served as a burn referral center. This report summarizes findings of that assessment, which indicated that the arrival of injured persons to this sample of hospitals began within minutes of the attack and peaked 2 to 3 hours later. Among 790 injured survivors treated within 48 hours, approximately 50% received care within 7 hours of the attack, most for inhalation or ocular injuries; 18% were hospitalized. Comprehensive surveillance of disaster-related health effects is an integral part of effective disaster planning and response.
See report on avalanche injuries under Recreation
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Hand injuries in young children from contact with vacuum cleaners.
- Macgregor D. Emerg Med J 2002; 19(1):80-81.
Correspondence: Diana MacGregor, Royal Aberdeen Children's Hospital, Cornhill Road, Aberdeen AB25 2ZG, UK; (email: dianamacgregor@yahoo.com).
OBJECTIVES: To assess the incidence of injuries to young children sustained by contact with a domestic vacuum cleaner and to highlight the potential for significant injury. An increase in public awareness of these risks might result in a reduction in morbidity.
METHODS: Over a period of one year, all children attending with an injury sustained because of contact with a domestic vacuum cleaner had review of their case notes by the author.
RESULTS: Four children were identified as having sustained friction burns to a hand after contact with a vacuum cleaner. All required treatment and several review appointments before satisfactory resolution was achieved.
CONCLUSIONS: Although the number of cases seen was small, the potential for significant injury must be emphasized and public awareness increased in an attempt to reduce morbidity.
Children and mini-magnets: an almost fatal attraction.
- McCormick S, Brennan1 P, Yassa1 J, Shawis R. Emerg Med J 2002; 19(1):71-73.
Correspondence: Simon McCormick, Northern General Hospital, Herries Rd, Sheffield S5 7AU, UK;
(email: simon@mc-cormick.freeserve.co.uk).
Children imitating adults often appear to indulge in harmless fun, however at times these activities have more serious implications. The recent fashion of body piercing among adults has encouraged children to have similar procedures or imitate them by applying small magnets to sustain the jewellery used in piercing in position. This paper describes a series of 24 cases presented to the Sheffield Children's Hospital over a period of eight weeks. The children imitated body piercing by using small powerful magnets across parts of their body including nose, ears, penis, and tongue. Some swallowed the magnets while attempting to use them, resulting in one near fatal surgical complication.
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Rural work-related accidents in Pelotas, Rio Grande do Sul State, Brazil: a population-based cross-sectional study.
- Fehlberg MF, Santos IS, Tomasi E. Cad Saude Publica 2001; 17(6):1375-1381.
Correspondence: Marta Fernanda Fehlberg, Centro de Controle de Zoonoses, Faculdade de Veterinaria, Universidade Federal de Pelotas, Pelotas, RS, 96010-900, Brazil. (email: mbauer@ufpel.tche.br).
Epidemiological literature on occupational accidents among rural workers is scarce in Brazil. This population-based cross-sectional study was designed to investigate the characteristics of farming accidents occurring in the rural area of Pelotas, Southern Brazil. A multi-stage sampling scheme was used to select a representative sample of farms. From January to April 1996, a total of 258 rural families were visited, and all 580 rural workers identified in these families answered a standardized questionnaire. Sixty-three rural workers (11%) reported at least one work-related accident in the previous twelve months. There were 82 accidents during the study period, mainly related to the use of hand farm tools (29%) and handling farm animals (27%). The main types of injuries were cuts (50%), bruises (13%), and burns (9%). The body areas most frequently involved were hands (34%), feet (29%), and legs (18%). Among the injured rural workers, only 32% used health services to treat the resulting lesions (46% went to primary health care facilities and 36% to emergency services).
Injuries among female army recruits: a conflict of legislation.
- Gemmell IM. J R Soc Med 2002; 95(1):23-27.
Correspondence: Ian M M Gemmell, Army Personnel Centre, Brown Street, Glasgow G2 8EX, Scotland, UK. (email: unavailable).
BACKGROUND: In the final decade of the 20th century, the British Armed Forces came under intense pressure to open up traditionally male roles to female recruits. For training, women were initially given lower entry and exit standards, but it became apparent that many did not possess the strength necessary for their work. This 'gender fair' policy was therefore changed to a 'gender free' policy, whereby identical physical fitness tests were used for selection of male and female recruits and the training program made no allowances for gender differences.
OBJECTIVES: To determine the effects of this policy change.
METHODS: Data from medical discharges were examined for the periods before and after implementation, with reference to musculoskeletal injuries of the lower limbs. In the first cohort there were 5697 men and 791 women, in the second 6228 men and 592 women.
RESULTS: The cross-gender (F/M) odds ratio for discharges because of overuse injury rose from 4.0 (95% CI 2.8 to 5.7) under the gender-fair system to 7.5 (5.8 to 9.7) under the gender-free system (P=0.001).
CONCLUSIONS: Despite reducing the number of women selected, the gender-free policy led to higher losses from overuse injuries. This study confirms and quantifies the excess risk for women when they undertake the same arduous training as male recruits, and highlights the conflict between health and safety legislation and equal opportunities legislation.
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Protecting the child's abdomen: a retractable bicycle handlebar.
- Arbogast KB, Cohen J, Otoya L, Winston FK. Accid Anal Prev 2001; 33(6): 753-757.
Correspondence: Kristy B. Arbogast The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, 3535 TraumaLink 10th Floor, Philadelphia, PA 19104, USA (email: arbogast@email.chop.edu).
A surveillance system in the Emergency Department of a level 1 pediatric trauma center previously identified minor bicycle crashes as a cause of serious child abdominal injury. A discordancy exists between the apparently minor circumstances and serious injuries sustained by child bicyclists who impact bicycle handlebars. The objective of this work was to redesign the bicycle handlebar to reduce the forces transmitted to the child's abdomen during an impact with the handlebars. A retractable handlebar consisting of a spring-mass-damper system was designed to retract and absorb the majority of energy at impact (Patent pending). Because the child remains in contact with the bar after impact, the retracting system also includes a mechanism to damp the outward motion of the handlebar. This prototype will reduce the forces at impact by ~50% in a collision similar to those discussed above. A unique methodology of translating research findings into product design produced a novel handlebar that absorbs significant energy that otherwise would be transferred to the child's abdomen when impacting the handlebar.
Child pedestrian injury in an urban setting: descriptive epidemiology.
- DiMaggio C, Durkin M. Acad Emerg Med 2002; 9(1):54-62.
Correspondence: Charles DiMaggio, Department of Emergency Medicine, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, USA; (email: cjd11@columbia.edu).
OBJECTIVES: To describe the epidemiology of pedestrian injuries to children and adolescents (ages <20 years) in an urban setting, providing analyses of environmental and pedestrian variables.
METHODS: Anonymous data were obtained for all motor vehicle crashes occurring in New York City over a seven-year period (1991-1997).
RESULTS: Among 693,283 crashes, 97,245 resulted in injuries to 100,261 pedestrians, of whom 32,578 were under the age of 20. Using census counts for the denominator, the overall incidence of pediatric pedestrian injuries was 246/100,000 per year, and the case fatality rate was 0.6%. Incidence rates peaked in the 6-14-year age group, and showed a modest annual decline during the study period. Younger children were more likely to be struck mid-block and during daylight hours, whereas adolescents were more likely to be struck at intersections and at night. For younger children, there was a sharp peak in incidence during the summer months. Road and weather conditions did not appear to affect injury risk.
CONCLUSIONS: These results help identify priorities for child pedestrian injury prevention and education, inform public health policy, and direct emergency medical health services resource allocation.
Pedestrian road traffic collisions in South Africa.
- Brysiewicz P. Accid Emerg Nurs 2001; 9(3):194-197.
Correspondence: Petra Brysiewicz, School of Nursing, University of Natal, Durban 4041, South Africa; (email: brysiewiczp@nu.ac.za).
Pedestrian road traffic collisions continue to account for a large number of the clients attending the accident and emergency units in South Africa. These victims include both adults and children, and can lead to serious lifelong consequences for the victims and their families. A pilot study was carried out in Durban, KwaZulu-Natal in order to investigate the injuries sustained by pedestrian pediatric clients who were involved in road traffic collisions in South Africa. The findings of the study reflecting the age, gender distribution and the injuries and their severity are discussed.
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Amusement park injuries and deaths.
- Braksiek RJ, Roberts DJ. Ann Emerg Med 2002; 39(1):65-72.
Correspondence: Robert J. Braksiek, Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415 USA; email: robertbraksiek@hotmail.com).
Media coverage of amusement park injuries has increased over the past several years, raising concern that amusement rides may be dangerous. Amusement park fatalities and increases in reported injuries have prompted proposed legislation to regulate the industry. Since 1979, the medical literature has published reports of 4 subdural hematomas, 4 internal carotid artery dissections, 2 vertebral artery dissections, 2 subarachnoid hemorrhages, 1 intraparenchymal hemorrhage, and 1 carotid artery thrombosis with stroke, all related to roller coaster rides. In this article, we review reports of amusement park injuries in the medical literature and Consumer Product Safety Commission data on the overall risk of injury. We also discuss the physics and the physiologic effects of roller coasters that may influence the type and severity of injuries. Although the risk of injury is low, emergency physicians are advised to include participation on thrill rides as part of their history, particularly when evaluating patients presenting with neurologic symptoms.
Snowboarding injuries in children.
- Drkulec JA, Letts M. Can J Surg 2001; 44(6): 435-439.
Correspondence: Mervyn Letts, Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1, CANADA; (email: unavailable).
OBJECTIVES: To study injury patterns of snowboarding trauma in children.
METHODS: Design- A retrospective case series. Setting- A major pediatric trauma centre. Patients A cohort of 113 children (97 boys, 16 girls), mean age 13.9 years, who sustained 118 injuries secondary to snowboarding. Interventions- All fractures were treated by immobilization in a cast; 19 children required a closed reduction. Outcome Measures- Sex and age of patients, mechanism of injury, injury sustained, treatments and complications.
RESULTS: Falls on the outstretched hand from a loss of balance accounted for 66 (57%) of the injuries, uncontrolled falls for 42 (36%) and collisions for 5 (4%). Seventy-nine percent of the injuries were to the upper extremity, whereas 7% were to the lower extremity.
CONCLUSIONS: The predominance of snowboarding injuries of the upper extremity seen in children differs significantly from those in adults in whom lower extremity injuries are more common.
Avalanche trauma and closed head injury: adding insult to injury.
- Johnson SM, Johnson AC, Barton RG. Wilderness Environ Med 2001; 12(4):244-247.
Correspondence: Sidney Morris Johnson, Department of Surgery, University of Utah School of Medicine, Salt Lake City, USA; (email: johnson_sid@yahoo.com).
OBJECTIVES: The incidence of fatal closed head injury (CHI) and nonfatal CHI causing an altered level of consciousness in avalanche victims is unknown. The purpose of this study was to assess the incidence and potential significance of CHI in avalanche-related deaths.
METHODS: The records of the state medical examiner and hospital records of all victims killed in avalanches in the state of Utah from October 1, 1992 through April 30, 1999 were reviewed for a cause of death and for the presence of CHI. Closed head injury was described as "present" or "severe," depending on whether the degree of CHI was sufficient to have caused or directly contributed to death, as determined by the medical examiner.
RESULTS: In this review, 28 avalanche-related deaths were identified, of which 22 (79%) were due to asphyxia. Seventeen victims (61%) had evidence of some degree of CHI. Six victims (21%) had evidence of severe CHI. One of 7 snowmobile riders sustained a severe CHI, whereas 4 of 16 skiers or snowboarders sustained a severe CHI (P = not significant).
CONCLUSIONS: Although asphyxiation was the cause of death in most avalanche victims, evidence of CHI was present in 61% of the cases studied. While avalanche-associated CHI may not be sufficient to cause death in many cases, a depressed level of consciousness might render a victim incapable of self-rescue and predispose to asphyxia. Helmet use may help prevent avalanche-associated CHI and thus be a useful safety adjunct.
The role of the mouthguard in the prevention of sports-related dental injuries: a review.
- Newsome PR, Tran DC, Cooke MS. Int J Paediatr Dent 2001; 11(6):396-404.
Correspondence: Philip RH Newsome, Oral Diagnosis, Faculty of Dentistry, The University of Hong Kong. (email: newsome@hkucc.hku.hk).
OBJECTIVES: This paper examines the literature dealing with oral-facial injuries received during participation in sport and the possibilities open to athletes for their prevention. In particular, the paper examines five different aspects of this topic: the risk of dental injury while playing sports, the role of the mouthguard in preventing injury, types of athletic mouthguard, implications for patients undergoing orthodontic treatment and behavioural aspects of mouthguard wear.
RESULTS: It is clear from this review that participation in a number of sports does carry a considerable risk of sustaining dental injury, not only in the so-called contact sports such as rugby and hockey, but also in less obviously dangerous sports such as basketball. Although some evidence exists to the contrary, the majority of studies have found the mouthguard to be the most effective way of preventing such injuries. It is also clear that the custom-fabricated mouthguard, in particular the pressure-laminated variety, is seen to afford most protection. Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances. The fabrication of mouthguards for these patients is also problematic and the literature covering this is reviewed. As with other preventive measures, mouthguard usage is often less than the dental profession would like; the reasons for this are explored in a small number of studies.
CONCLUSION: While much progress has been made in this area, the profession could do much more to promote the greater use of mouthguards.
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Accuracy of external cause of injury codes reported in Washington State hospital discharge records.
- LeMier M, Cummings P, West TA. Inj Prev 2001; 7(4): 334-338.
Correspondence: Mary LeMier, Washington State Department of Health, Injury Prevention Program, Olympia, USA; (email: mary.lemier@doh.wa.gov).
OBJECTIVES: To evaluate the accuracy of external cause of injury codes (E codes) reported in computerized hospital discharge records.
METHODS: All civilian hospitals in Washington State submit computerized data for each hospital discharge to a file maintained by the Department of Health. In 1996, 32 hospitals accounted for 80% of the injury related discharges in this file; from these hospitals, we sampled 1,260 computerized records for injured patients in a stratified, but random, manner. An expert coder then visited the 32 study hospitals, reviewed the medical records that corresponded to each computerized record, and assigned an E code for that hospitalization. The computerized E code information was compared with codes provided by the expert reviewer.
RESULTS: The incidence of hospitalization for injury based upon computerized hospital discharge data was very similar to that based upon chart review: incidence rate ratio 1.0 (95% confidence interval 1.00 to 1.02). Computerized hospital discharge data correctly ranked injuries in regard to both mechanism and intent. Overall agreement on coding was 87% for mechanism of injury, 95% for intent of injury, and 66% for the complete E code. The sensitivity of computerized hospital discharge data for identification of falls, motor vehicle traffic injuries, poisonings, and firearm injuries was 91% or better. The predictive value positive of coding for these four categories of injury ranged from 88% for motor vehicle traffic injuries to 94% for poisonings. The amount of agreement for intent coding ranged from 84% for firearm injuries to 99% for falls. Agreement on coding of the complete E code ranged from 57% for firearm injuries to 72% for poisonings.
CONCLUSIONS: Computerized hospital discharge data can be used with confidence to determine how many injuries are treated in a hospital setting and the relative magnitude of various categories of injury. E codes reported in hospital discharge data are a reliable source of information on the types of information most often used for injury related analyses and priority setting. The detail codes (complete E codes) reported in hospital discharge codes are less reliable and must be used with caution.
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Epidemiology of traumatic brain injuries in India.
- Gururaj G. Neurol Res 2002; 24(1):24-28.
Correspondence: G. Gururaj, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India. (email: guru@nimhans.kar.nic.in).
Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, disability and socioeconomic losses in India and other developing countries. Specific topics addressed in this paper include magnitude of the problem, causes, context of injury occurrence, risk factors, severity, outcome and impact of TBIs on rapidly transforming societies. It is estimated that nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%-25%) and violence (10%). Alcohol involvement is known to be present among 15%-20% of TBIs at the time of injury. The rehabilitation needs of brain injured persons are significantly high and increasing from year to year. India and other developing countries face the major challenges of prevention, pre-hospital care and rehabilitation in their rapidly changing environments to reduce the burden of TBIs.
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See report under Occupational Issues
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- See reports under Suicide
- See reports under Violence
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Confidential death to prevent suicidal contagion: an accepted, but never implemented, nineteenth-century idea.
- Leonard EC Jr. Suicide Life Threat Behav 2001; 31(4):460-466.
E.C. Leonard, Jr., Friends Hospital, Philadelphia, PA 19124-2399, USA. (email: ecleonard@pol.net).
Nineteenth-century medical literature often admonished the popular press to limit reports of suicide, because of a belief that knowledge of another's suicide could stimulate some persons to kill themselves. An 1837 case report (perhaps the earliest attempt at a psychological autopsy in an American medical journal) is discussed, because it presciently clarifies the concept of psychological sensitization. Its study leads to documentation of two examples of falsified death certificates. The power to prevent publicity of suicide by not reporting it may have diminished efforts for newspaper restraint, as did editorial resistance and later acceptance of Emile Durkheim's (1897/1951) strongly expressed belief that reports of suicide did not cause an overall increase in suicide. Despite lack of success over the past two centuries, efforts to keep reports of self-inflicted death confidential continue to flow from concern about suicidal contagion. Today, uncensored websites and books advocating suicide may limit the benefit of the U. S. Surgeon General's 'call to action' to prevent suicide, which again supports voluntary media restraint in reporting suicide.
Correlates of recent suicide attempts in a triethnic group of adolescents.
- Rew L, Thomas N, Horner SD, Resnick MD, Beuhring T. J Nurs Scholarsh 2001; 33(4): 361-367.
Correspondence:Donna Lynn Rew, University of Texas at Austin School of Nursing, (Campus Mail Code: D0100) Austin, TX 78712, USA; (email: ellerew@mail.utexas.edu).
OBJECTIVES: To describe recent self-reported suicide attempts in a triethnic group of adolescents, to analyze differences in the correlates of attempts by ethnicity and gender, and to explore theoretical correlates of recent suicide attempts using a resilience framework.
METHODS: Quantitative data were collected from 10,059 students in 7th, 9th, and 11th grades in Connecticut in 1996. Secondary analysis was done to compare respondents of African American, Hispanic Latino, and Caucasian ethnicities. Data were analyzed using bivariate and multivariate procedures. Logistic regression was used to identify the best set of explanatory variables for recent suicide attempts.
RESULTS: The percentage of suicide attempts was significantly higher among Hispanic Latina girls (19.3%) than in any other ethnic-gender group. Significant relationships were found between recent suicide attempts and (a) family history of suicide attempt, (b) friend's history of suicide attempt, (c) history of sexual abuse, (d) history of physical abuse, and (e) environmental stress. The significant set of explanatory variables for recent suicide attempts for the three ethnic groups combined were stress, internalizing and externalizing behaviors, physical and sexual abuse, family and friend attempted suicide, social connectedness, and religious influence.
CONCLUSIONS: Findings support use of a resilience model for suicide attempts among three ethnic groups. The finding of a significantly higher percentage of recent suicide attempts by Hispanic girls compared to girls in other ethnic-gender groups warrants further investigation along with development and testing of culturally sensitive preventive interventions.
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(9299): 2110-2112.
Correspondence: Louis Appleby, School of Psychiatry and Behavioural Sciences, University of Manchester, University Hospital of South Manchester, M20 8LR, Manchester, UK; (email: 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.
OBJECTIVES: 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: We did a population-based study in which we linked the data for 72208 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: 17892 (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.
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Vehicles reversing or rolling backwards: an underestimated hazard.
- Mayr JM, Eder C, Wernig J, Zebedin D, Berghold A, Corkum SH. Inj Prev 2001; 7(4): 327-328.
Correspondence: Johannes Mayr, Department of Pediatric Surgery, University of Graz, Austria; (email: johannes.mayr@kfunigraz.ac.at).
OBJECTIVES: A retrospective analysis of injuries caused by vehicles that were reversing or rolling backwards to establish guidelines for prevention was performed.
METHODS: Medical records and questionnaires completed by parents for 32 children admitted to the Department of Pediatric Surgery, Graz, within the past eight years, were analyzed.
RESULTS: The median age was 2.1 years (1.0-14.0 years). Fourteen of 32 of the cars were driven by family members (43.8%); three were rolling backwards without a driver (9.4%). The median injury severity score was 3 (1-27) and the most common injuries were contusions (40.6%), fractures (31.3%), and lacerations/burns (21.9%). Most incidents occurred in driveways (37.5%) or farmyards (21.9%). Altogether 70.3% of children sustained "run-over" injuries, 29.6% were hit by the rear bumper or injured by a breaking window.
CONCLUSIONS: Toddlers playing in driveways or farmyards are at risk of a injury caused by reversing vehicles/vehicles rolling backwards.
Children in crashes: mechanisms of injury and restraint systems.
- Lapner PC, McKay M, Howard A, Gardner B, German A, Letts M. Can J Surg 2001; 44(6):445-449.
Correspondence: Peter Lapner, Department of Surgery, University of Ottawa, ON, CANADA (email: PLAPN031@uottawa.ca).
OBJECTIVES: To explore the levels of protection offered to children involved in motor vehicle collisions.
METHODS: A joint study by the Children's Hospital of Eastern Ontario (CHEO) and Transport Canada, Ottawa, conducted in 2 phases: retrospective from 1990 to 1997 and prospective from 1998 to 2000. Setting- CHEO, a university affiliated tertiary care center. Patients- Children admitted to CHEO between 1990 and 2000 with spinal trauma due to motor vehicle crashes (MVCs). Phase I of the study involved analysis, in a series of 45 children after MVCs, by location of spinal injury versus belt type. Phase 2 was a prospective study of 22 children injured in 15 MVCs. Intervention- A biomechanical assessment of the vehicle and its influence on the injuries sustained. OUtcome Measures- The nature and extent of the injuries sustained, and the vehicle dynamics and associated occupant kinematics.
RESULTS: The odds ratio of sustaining a spinal injury while wearing a 2-point belt versus a 3-point belt was 24 (95% confidence interval 2.0-245.0), indicating a much higher incidence with a lap belt than a shoulder strap.
CONCLUSIONS: Proper seat-belt restraint reduces the morbidity in children involved in MVCs. Children under the age of 12 years should not be front-seat passengers until the sensitivity of air bags has been improved. Three-point pediatric seat belts should be available for family automobiles to reduce childhood trauma in MVCs.
Rear seating and risk of injury to child occupants by vehicle type.
- Winston FK, Durbin DR, Kallan MJ, Elliott MR. Proc Assoc Adv Automot Med Conf 2001; 45:51-60. (Conference Proceedings available from The Association for the Advancement of Automotive Medicine.)
Correspondence: Flaura K. Winston, TraumaLink and the Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine.
The safety of rear-seated child passengers was evaluated across vehicle types. 113,887 children under age 16 in crashes were enrolled as part of an on-going crash surveillance system which links insurance claims data to telephone survey and crash investigation data. Children in the second row suffered less significant injuries than those in the front in all vehicle types except compact extended cab pickup trucks in which the risk for children in the rear was 13% as compared to 2.8% for front-seated occupants. Further research is needed to identify the child and vehicle characteristics which might explain this increased injury risk.
A nationwide survey of self-reported red light running: measuring prevalence, predictors, and perceived consequences.
- Porter BE, Berry TD. Accid Anal Prev 2001; 33(6): 735-741.
Correspondence: Bryan E. Porter, Department of Psychology, Old Dominion University, Mills Godwin Building, Room 250, Norfolk, VA 23529-0267, USA; (email: bporter@odu.edu).
A United States probability sample of 880 licensed drivers participated in a telephone survey of red light running perceptions and behaviors. Despite most drivers believing red light running was problematic and dangerous, approximately one in five respondents reported running one or more red lights when entering the last ten signalized intersections. Among several demographic and attitude variables, only age group predicted recent red light running. Specifically, younger respondents were more likely to be violators. Drivers also reported being more likely to run red lights when alone, and were typically in a hurry when speeding up to be beat red lights. Contrary to expectations, frustration was not as important for predicting red light running as it was for other driving behaviors, such as speeding, tailgating, weaving, and gesturing angrily at others. Additionally, drivers perceived and received few consequences for running red lights. Less than 6% had received a traffic ticket for red light running and most believed that police would catch less than 20% of violators. Slightly more than one in ten had been involved in a red light running crash. Respondents most commonly suggested legal initiatives to reduce red light running. Accordingly, we recommend traffic safety experts pursue interventions that apply immediate and consistent negative consequences to violators to change the public's red light running perceptions and behavior.
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Pediatric violence-related injuries in Boston: results of a city-wide emergency department surveillance program.
- Sege RD, Kharasch S, Perron C, Supran S, O'Malley P, Li W, Stone D. Arch Pediatr Adolesc Med 2002; 156(1):73-76.
Correspondence: Pediatric and Adolescent Health Research Center, the Floating Hospital for Children's National Medical Center, New England Medical Center, Boston, MA, USA. rsege@lifespan.org).
BACKGROUND: Violence-related injuries among children are common, but age-based incidence data are not easily available.
OBJECTIVES: To describe injuries due to violence in a population-based case series of children and to estimate injury incidence.
METHODS: Design- Prospective surveillance of children residing in Boston, Mass, who received pediatric emergency department treatment for violence-related injury during a 4-year period beginning April 15, 1995. Setting- Pediatric emergency departments in Boston. Patients- Children aged 3 through 18 years who came to a hospital emergency department between April 1995 and April 1999. Violence-related injuries were defined as those resulting from a situation of conflict involving 2 or more persons with intent to harm, as assessed by health care personnel caring for the patients. Self-inflicted injuries and injuries caused by child abuse (including any injury resulting from a conflict with a parent or guardian) were excluded. Homicides of Boston children aged 3 through 18 years who were killed during the study period were included based on police data. Main Outcome Measure- Population-based violence-related injury rates.
RESULTS: There were 2035 injury-related visits caused by violence, which reflects a rate of 52.7 (95% confidence interval, 50.5-54.9) per 10 000 person-years. Most injuries were relatively minor; 6.4% of visits resulted in admission. The youth violence-related injury rate in Boston declined at an average rate of 12% annually during the period studied.
CONCLUSIONS: Pediatric emergency department monitoring of violence-related injury in Boston suggests that childhood injuries due to violence declined during the late 1990s.
Violence-inflicted injuries: Reporting laws in the fifty states.
- Houry D, Sachs CJ, Feldhaus KM, Linden J. Ann Emerg Med 2002; 39(1):55-60.
Correspondence: Debra Houry, Denver Health Medical Center, Emergency Medicine Residency, 601 Broadway, Mailcode 0108, Denver, CO 80204, USA (email: dhoury@aol.com).
BACKGROUND: Physicians have an important role in the diagnosis, treatment, and documentation of violence-inflicted injuries. Physicians may also be legally mandated to report these assault-related injuries to law enforcement. Previous studies have shown that physicians may not be aware of the reporting laws in their state.
OBJECTIVES: The objective of this study was to review the reporting laws for violence-inflicted injuries in adults in the 50 states and the District of Columbia, with particular emphasis on domestic violence.
METHODS: Members of a domestic violence research interest group contacted individual state legislatures regarding mandated reporting by health providers of violence-inflicted injuries in adults. This information was then verified by each state's domestic violence coalition. Statutes regarding child abuse or sexual assault and statutes concerning injuries in incapacitated adults were not included in this study.
RESULTS: Five states (Alabama, New Mexico, South Carolina, Washington, and Wyoming) have no specific reporting requirements for health providers treating patients with assault-related injuries. Forty-two states have reporting requirements for injuries resulting from firearms, knives, or other weapons. Twenty-three states have reporting requirements for injuries resulting from crimes. Seven states have statutes that specifically require health providers to report injuries resulting from domestic violence.
CONCLUSIONS: Forty-five states have laws that mandate physician reports of injuries caused by weapons, crimes, or domestic violence. Physicians need to be aware of the existence of these laws and of their state's specific requirements.
Prevalence of child psychological, physical, emotional, and ritualistic abuse among high school students in Mpumalanga Province, South Africa.
- Madu SN. Psychol Rep 2001; 89(2):431-444.
Correspondence: S.N. Madu, Department of Psychology, University of the North, Private Bag X1106, Sovenga 0727, Pietersburg, South Africa; (email: madus@unin.unorth.ac.za).
Based on self-reports the prevalence during childhood of psychological, physical, emotional, and ritualistic abuse among 559 high school students in Standards 7, 8, 9, and 10 of three high schools in the Mpumalanga Province of South Africa was examined. The questionnaire asked for the demographic information and experiences of psychological, physical, and emotional abuse by their parents or adult caretakers as well as ritualistic abusive experiences before they were 17 years of age plus an estimate of self-perceived abuse during childhood and an overall rating of their own childhood. Analysis showed the self-reported prevalence rates to be as follows: 70.7% psychologically abused (but 14.4% for extreme cases), 27.0% physically abused, 35.3% emotionally abused, and 10.0% ritualistically abused. 13.4% of those who reported themselves as psychologically abused, 20.7% of the physically abused, 19.3% of the emotionally abused, and 35.8% of the ritualistically abused perceive themselves as not abused in any form during childhood. Yet, of the psychologically abused 23.4%, of the physically abused 18.2%, of the emotionally abused 22.0%, and of the ritualistically abused 28.3% rated their childhood as 'very unhappy'. It appears these various forms of abuse are experienced by the participants as widespread, suggesting that a much more serious problem may exist than has been recognized. More research into those forms of child abuse in this Province and elsewhere is needed for a clear appreciation of the problems and the effects of such abuse in children's behavior.
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