1 April 2002
See item under Suicide
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Challenges in motor vehicle safety.
- Waller PF. Annu Rev Public Health 2002;23: 93-113..
Correspondence: Patricia F. Waller, Transportation Research Institute, University of Michigan, 1779 Crawford Dairy Road, Chapel Hill, North Carolina 17516 USA (email: pwaller@umich.edu).
Reductions in motor vehicle injury and death represent a major public health success. Since the advent of the federal program in highway safety in 1966, motor vehicle deaths have dropped dramatically, not only in rates per miles driven but also in absolute numbers. Key to this success has been the broad-based comprehensive approach promoted by the program's first administrator, a public health physician. The federal program provided leadership and coordination that leveraged national, state, and local programs to bring about safer vehicles, improved traffic records, more effective enforcement, enormously improved emergency medical services, more responsible judicial systems, and many other accomplishments. Although progress has been made on many fronts, major areas addressed here include federal motor vehicle safety standards, alcohol safety programs, occupant restraint laws and usage, and speed limits. The achievements in motor vehicle safety provide a model for other injury control efforts.
Socioeconimic inequalities in injury: Critical issues in design and analysis.
- Cubbin C, Smith GS. Annu Rev Public Health 2002;23:349-375.
Correspondence: Catherine Cubbin, Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, 1000 Welch Road, Palo Alto, California 94304-1825 USA (email: ccubbin@stanford.edu).
Injuries continue to place a tremendous burden on the public's health and rates vary widely among different groups in the population. Increasing attention has recently been given to the effects of socioeconomic status (SES) as a determinant of health among both individuals and communities. However, relatively few studies have focused on the influence of SES and injuries. Furthermore, those that have, and the other injury studies that have included measures of SES in their analysis, have varying degrees of conceptual and methodological rigor in their use of this measure. Recent advances in data linkage and analytic techniques have, however, provided new and improved methods to assess the relationship between SES and injuries. This review summarizes the relevant literature on SES and injuries, with particular attention to study design, and the measurement and interpretation of SES. We found that increasing SES has a strong inverse association with the risk of both homicide and fatal unintentional injuries, although the results for suicide were mixed. However, the relationship between SES and nonfatal injuries was less consistent than for fatal injuries. We offer potential explanatory mechanisms for the relationship between SES and injuries and make recommendations for future research in this area.
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Shopping trolley-related injuries to children in New Zealand, 1988-97.
- Parry ML, Morrison LGL, Chalmers DJ, Wright CS. J Paediatr Child Health 2002; 38(1):51-54.
Correspondence: David Chalmers, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (email: david.chalmers@ipru.otago.ac.nz).
OBJECTIVE: To describe the epidemiology of shopping trolley related injuries (fatalities and hospitalizations) to children in New Zealand prior to the introduction of a voluntary standard for shopping trolleys.
METHODS: To identify cases, a key word search was conducted of national mortality and hospitalization databases for the years 1988-97. Cases were limited to children under 15 years of age.
RESULTS: For the 10 year period investigated, 282 hospitalizations and no fatalities were identified. A significant increasing trend for hospitalizations was detected (chi sq = 17.6, 1 d.f.; P > 0.001). Ninety-two per cent of children hospitalized were aged under 5 years and two-thirds were aged 2 years or younger. Ninety per cent of injuries resulted from falls from trolleys, 84 percent of injuries were to the head or face and 22 percent were rated serious (AIS-3) on the Abbreviated Injury Scale.
CONCLUSIONS: The incidence of injuries associated with shopping trolleys increased between 1988 and 1997. Following the introduction of a voluntary standard for shopping trolleys in 1999, which included specifications for child harnesses, trends in injury should be monitored.
Lessons learned: Fires in the home care setting.
- Joint Commission on Accreditation of Healthcare Organizations. Sentinel Event Alert 2001; (17): 1-3.
Since April 1997, 11 sentinel events have been received and reviewed by the Joint Commission related to home health care patients who were either injured or killed as a result of a fire in the home. These home care patients were receiving supplemental oxygen service and in each case, the patient was over the age of 65. Several risk factors for home care related fires have been identified through an intensive analysis of these sentinel events; these risk factors include 1) living alone, 2) lack of smoke detectors or presence of non-functional smoke detectors, 3) cognitive impairment, 4) an identified history of smoking while oxygen is running, and 5) flammable clothing. These home care sentinel events resulted in the death of seven patients and the loss of function or permanent disfigurement for four other patients. Cigarette smoking was determined to be a contributing factor in each of these cases.
Side bias and accidents in Japan and India.
- Ida Y, Dutta T, Mandal MK. Int J Neurosci 2001; 111(1-2): 89-98.
Correspondence: Y Ida, Faculty of International Studies, Osaka Gakuin University, 2-36-1 Kishibe-Minami,Suita-shi, Osaka 564-8511, Japan.
The purpose of this study was to examine (a) the incidence of leftward bias for paired organs (hand, foot, eye, and ear) in India (n = 418) and Japan (n = 697), and (b) the incidence of accident amongst individuals with leftward, rightward, and no bias across countries. The impetus for the study was obtained from a speculation that individuals with leftward bias commit more accidents than their counterparts. Data were collected with the help of a questionnaire on side bias, along with a check-list on accidents (included in the questionnaire). Results showed that participants from these two countries did not differ in terms of leftwardness for any of these forms of side bias. Left-handers were found to commit more accidents in India but not in Japan. Reanalysis of data in terms of left-, mixed-, and right-handedness indicated that mixed handers committed more accidents than extreme (left- + right-) handers in Japan but not in India.
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Fatal work-related inhalation of harmful substances in the United States.
- Valent F, McGwin G Jr, Bovenzi M, Barbone F. Chest 2002; 121(3): 969-975.
Correspondence: Gerald McGwin, Jr., MS, PhD, Center for Injury Sciences, 120 Kracke Building, 1922 7th Ave South, University of Alabama at Birmingham, Birmingham, AL 35294-0016 USA (email: gerald.mcgwin@ccc.uab.edu).
BACKGROUND: Inhalation of harmful substances is common in the workplace.
OBJECTIVES: The purpose of this study was to describe the epidemiology of fatal occupational inhalations in the United States.
METHODS: Data from the Census of Fatal Occupational Injuries from 1992 to 1998 were analyzed. Information on demographic characteristics, occupation, and industry was used to calculate specific mortality rates, and the inhaled substances were identified.
RESULTS: Nationwide, there were 523 cases of fatal occupational inhalation, with a mortality rate of 0.56 deaths per 1,000,000 worker-years. The rate of death was greater for men (1.01/1,000,000) than for women (0.03/1,000,000), and workers greater-than-or-equal 65 years of age had the highest mortality. Mining was the industry with the highest mortality rate (6.64/1,000,000). The occupations with the highest rate were firefighters (3.54/1,000,000) and farming, forestry, and fishing occupations (2.84/1,000,000). Nearly half of the inhalation victims were constructing, repairing, cleaning, inspecting, or painting when the injury occurred. Overall, carbon monoxide was the most frequently inhaled substance (33.5%). The incidence of fatal carbon monoxide inhalations was twice as high in the winter as in the summer. The proportion of workers killed by carbon monoxide poisoning increased with increasing age.
CONCLUSIONS: Work-related inhalations cause more deaths than any other mode of exposure to harmful substances. Recognizing those circumstances that pose a higher risk for maintenance and repair workers, as well as upgrading carbon monoxide poisoning prevention programs, could have a major impact in reducing fatal work-related inhalation injuries.
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Scooter injuries in children.
- Chapman S, Webber C, O'Meara M. J Paediatr Child Health 2001; 37(6):567-570.
Department of Emergency Medicine, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia.
OBJECTIVES: To study the causes, patterns of injury and use of safety equipment in children presenting with 'push/kick' scooter-related injuries. To draw comparisons with in-line skate, skateboard and bicycle injuries and to suggest strategies for injury prevention.
METHODS: A retrospective review of medical data was undertaken for 12 consecutive months to September 2000. All children aged < 15 years who had attended the Sydney Children's Hospital with scooter, in-line skate (rollerblade), skateboard or bicycle injuries were identified. Children with scooter injuries for the latter 6 month period were contacted by telephone and interviewed, together with their parents, using a structured questionnaire.
RESULTS: There was a marked rise in the number of scooter injuries from October 1999 to September 2000. Sixty-one per cent of these injuries occurred during the final 3 months of the study period, making scooters the most common cause of injury in the studied groups for this period. Forty-two per cent of scooter injuries were fractures. Only 3% of children used safety equipment at the time of injury, despite 86% owning some form of safety equipment. Children were less likely to use safety equipment with a scooter than with any other form of activity studied. (Chi-squared P=0.000).
CONCLUSIONS: Scooters are a common cause of childhood injury, resulting in injury patterns similar to those caused by in-line skates, skateboards and bicycles. Safety equipment is rarely worn when scooters are ridden. Injury patterns and riding styles suggest that if existing guidelines for in-line skating, skateboarding and bicycling are modified and applied to scooters, a reduction in injury numbers may be achieved.
Effect of legislation on the use of bicycle helmets.
- Leblanc JC, Beattie TL, Culligan C. Canadian Med Assn J 2002; 166(5):592-595.
Correspondence: John C. LeBlanc, IWK Health Centre, 5850 University Ave., PO Box 3070, Halifax NS B3J 3G9 CANADA.
BACKGROUND: About 50 Canadian children and adolescents die each year from bicycle-related injuries, and 75% of all bicycle-related deaths are due to head injuries. Although the use of helmets can reduce the risk of head injury by 85%, the rate of voluntary helmet use continues to be low in many North American jurisdictions.
METHODS: We measured compliance before, during and after 1997, when legislation making the use of helmets mandatory for cyclists was enacted in Nova Scotia. In the summers and autumns of 1995 through 1999, trained observers who had a direct view of oncoming bicycle traffic recorded helmet use, sex and age group of cyclists in Halifax on arterial, residential and recreational roads. Sampling was done during peak traffic times of sunny days. We abstracted data from the Canadian Hospitals Injury Reporting and Prevention Program database on bicycle-related injuries treated during the same period at the Emergency Department of the IWK Health Centre, Halifax.
RESULTS: The rate of helmet use rose dramatically after legislation was enacted, from 36% in 1995 and 38% in 1996, to 75% in 1997, 86% in 1998 and 84% in 1999. The proportion of injured cyclists with head injuries in 1998/99 was half that in 1995/96 (7/443 [1.6%] v. 15/416 [3.6%]) (p = 0.06). Police carried out regular education and enforcement. There were no helmet-promoting mass media education campaigns after 1997.
CONCLUSIONS: Rates of helmet use rose rapidly following the introduction of legislation mandating the use of helmets while bicycling. The increased rates were sustained for 2 years afterward, with regular education and enforcement by police.
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Childhood poisoning in Queensland: an analysis of presentation and admission rates.
- Reith D M, Pitt W R, Hockey R. J Paediatr Child Health 2001; 37(5): 446-450.
Correspondence: D. Reith, Mater Chidren's Hospital, South Brisbane, Queensland, Australia (EMAIL: D.Reith@medicine.uq.edu.au).
OBJECTIVES: To determine the presentation rates for paediatric poisoning by ingestion and the determinants of hospital admission.
METHODS: Cross-sectional survey using an injury surveillance database from emergency departments in South Brisbane, Mackay and Mt Isa, Queensland, from January 1998 to December 1999. There were 1516 children aged 0-14 years who presented following ingestional poisoning.
RESULTS: The presentation rates for poisoning were 690, 40 and 67 per 100000 population aged 0-4, 5-9 and 10-14 years, respectively. The admission rates to hospital for poisoning were 144, 14 and 22 per 100000 population aged 0-4, 5-9 and 10-14 years, respectively. Although presentation rates for poisoning were higher in the rural centres the admission rates were disproportionately high for the 0-4 years age group. The agents most frequently ingested were paracetamol, Dimetapp, rodenticides and essential oils.
CONCLUSIONS: There is a need to design and implement interventions aimed at reducing poison exposures and unnecessary hospital admissions in the 0-4 years age group.
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Knowledge and attitudes about school bullying in trainee teachers.
- Nicolaides S, Toda Y, Smith PK. Br J Educ Psychol 2002; 72(Pt 1): 105-118.
Correspondence: Peter K. Smith, Goldsmiths College, University of London, UK (email pss01pks@gold.ac.uk).
BACKGROUND: Recent research has highlighted the issue of bullying in schools. However, little attention has been paid to the knowledge and beliefs of trainee teachers, who will hold a key position in reducing the problem of bullying in schools.
OBJECTIVES: To determine (i) trainee teachers' beliefs about some aspects of school bullying; (ii) their recommended strategies for pupils to cope; (iii) their confidence in dealing with bullying issues as future teachers; (iv) the value of specific aspects of training; (v) the importance for these of sex, and primary/secondary training.
METHODS: Questionnaire completed and returned within a 2-week period. This comprised 270 students enrolled on either a one-year postgraduate Certificate in Education (PGCE) course (N =197) or a four-year degree in education (BEd) course (N =73). Age ranged from 18-51 years (mean=28 years).
RESULTS: Bullying was seen as an important issue. Some aspects of trainee teachers' knowledge of bullying were accurate, others less so. Telling teachers, and parents, were the strategies most highly recommended to pupils. The great majority were in favour of teacher training courses incorporating information regarding ways of combating bullying. However, they had less confidence about their ability to deal with bullying. Respondents expressed more confidence when dealing with victims rather than bullies and working with the parents of victims rather than the parents of bullies.
CONCLUSION: It is important that teacher-training programmes incorporate information about school bullying, and are designed to take account of existing knowledge, and areas in which trainee teachers may feel less confident.
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Suicide attempts in a Nigerian military setting.
- Okulate GT. East Afr Med J 2001; 78(9):493-496.
Correspondence: G.T. Okulate, Military Hospital, Yaba, P.O. Box 8869, Shomolu, Lagos State, Nigeria.
OBJECTIVES: To describe the characteristics of patients who attempted suicide in a military setting and to examine the differences between the suicide attempters and a group of non-suicide, affective disorder patients.
METHODS: DESIGN: Fifty one consecutive cases of suicide attempts were studied using a questionnaire which inquired about demographic characteristics and suicide related issues such as method of attempt used and giving a notice. The suicide attempt group was then compared with a control group who had no history of attempted suicide. SETTING: Department of Psychiatry, Military Hospital, Yaba, Lagos, Nigeria, which is a 500-bed military general hospital. SUBJECTS: Fifty one attempted suicide patients. Intervention reports on intervention methods applied were not within the scope of this report. MAIN OUTCOME MEASURES: These were also not within the scope of the present study.
RESULTS: Suicide attempt patients constituted 0.37% of all admissions during a five-year period, and 60.8% of them were under the age of 30 years. The numbers of male and female patients were approximately the same. Depression and acute stress reaction were the commonest diagnoses. While military dependents most commonly ingested substances in their suicide attempts, military personnel most often used more violent methods including hanging and self-stabbing, but none used firearms. Compared with non suicide patients, suicide attempt ones were more likely to be unmarried and to have a family history of mental disorder but less likely to have lost a parent through death before the age of 18 years.
CONCLUSIONS: The need for a more controlled access to substances capable of being used for self-destruction was highlighted. The need for emergency room doctors to become more skilfull in the identification and assessment of suicide attempt patients was also emphasized.
A study of suicides of older people in Sydney.
- Snowdon J, Baume P. Int J Geriatr Psychiatry 2002; 17(3):261-269.
Correspondence: John Snowden, Department of Psychological Medicine, University of Sydney, Australia (email: jsnowdon@mail.usyd.edu.au).
BACKGROUND: Reports based on studies of coroner's files show that suicides in old age are commonly related to depression, but that in a majority of cases disability or ill-health is also a major factor. The aim of this study was to try to understand more clearly the precipitant causes of suicide in an older population.
METHODS: An Australian metropolitan coroner's office provided data concerning suicides in 1994-1998 of persons aged over 65 years.
RESULTS: Of 210 elderly people who killed themselves, 160 (76%) were clearly depressed, including a majority of the 24% deemed to have understandable reasons for suicide. Physical ill-health or disability was the major factor leading to suicide in 34% and appeared to contribute to suicidal ideation in another 24% of those who died; they had usually not been seen by psychiatrists.
CONCLUSION: Because depression is often treatable, even when associated with depressing circumstances, there is potential for further reduction of old age suicide rates by recognising and appropriately responding to symptoms of depression and distress. Copyright 2002 John Wiley and Sons, Ltd.
Drug use and suicide attempts: the role of personality factors.
- Bolognini M, Laget J, Plancherel B, Stephan P, Corcos M, Halfon O. Subst Use Misuse 2002; 37(3):337-356.
Correspondence: M. Bolognini, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Lausanne, Switzerland (email: mbologni@inst.hospvd.ch).
This study on suicide attempts is part of a large research project on dependent behavior in adolescents and young adults. 228 subjects aged 14-25 (107 "drug abusers," 121 controls) from the French speaking part of Switzerland were evaluated on the basis of a semi-structured interview (Mini International Neuropsychiatric Interview), enabling a DSM-IV diagnosis, and self-reports (SSS by Zuckermann, MMPI-2, IDI by Hirschfeld). 31.5% of "drug abuser" males and 41.2% of "drug abuser" females committed one or more suicide attempts. The results of a logistic regression show that the significant factor explaining suicide attempts in drug users is emotional reliance for males and experience-seeking for females.
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The perceptual reality of synesthetic colors
- Palmeri TJ, Blake R, Marois R, Whetsell, Jr. W. Proc National Acad Sci 2002; 99 (6): 4127-4131.
Correspondence: Thomas J. Palmeri, Department of Psychology, Center for Integrative and Cognitive Neuroscience, 301 Wilson Hall, Vanderbilt University, Nashville, TN 37240 USA (email: thomas.j.palmeri@vanderbilt.edu).
Synesthesia is a remarkable, rare condition where an individual has multimodal perceptual experiences from a unimodal sensory event. We have studied such an individual, an adult male for whom achromatic words and alphanumeric characters are seen in vivid, reliable colors. We used a variety of perceptual tasks to document the perceptual reality of synesthetic colors and to begin to localize the stage of visual processing where this anomalous binding of externally specified form and internally generated color may take place. Synesthetic colors were elicited by forms defined solely by binocular cues or solely by motion cues, which implies a central locus of visual processing for synesthetic binding of form and color. Also included among our measurements was a difficult visual search task on which non-synesthetic subjects required an effortful search through the visual display. Our subject, in contrast to non-synesthetic subjects, accomplished the task with relative ease because the target of the search had a different synesthetic color from the distractors. Thus, synesthetic experiences appear to originate from a binding of color and form that takes place within central stages of visual processing.
Collisions with wildlife: the rising toll.
Running over or hitting animals with a vehicle is such a common occurrence it rarely receives notice or mention. The Humane Society of the United States reports that more than a million animals are struck by vehicles on US roadways each day.1 These collisions are almost inevitably fatal for the animals. The risk to humans is much lower, but it increases with factors such as the size of the animal hit and the likelihood of a secondary collision while trying to avoid the animal. These accidents also carry a growing price tag. In Manitoba, collisions between vehicles and wildlife cost the provincial auto insurance agency $16.2 million in 2000, with 200 people injured in the 8200 collisions that were reported.
Although the problem is serious, there is little epidemiologic evidence about injury patterns and effective prevention. Data on collisions resulting from close encounters with foxes, turtles, porcupines, badgers and the like are virtually nonexistent. Most of the information comes from police reports and medical records, and is limited to collisions with larger animals that result in injury or property damage. Data on these accidents are also incomplete; one jurisdiction estimated that reported collisions accounted for only about 54% of the deer killed by motor vehicles in the area. The available data suggest that between 10% and 30% of collisions with moose and 1% to 3% of collisions with deer result in injury requiring medical attention.
The risk of fatality from either is lower -- of 661 moose-related accidents reported in Newfoundland over a 2-year period, 130 people were injured and 3 were killed. In Alberta, 3 members of one family died in February after their truck hit a moose and then veered into the path of another vehicle. Common injury sites are the head, face or neck. Occupants of the car may be cut by flying glass, and unusual axial-load-type injuries to the cervical spine of front-seat occupants are a common result of moose-automobile collisions.
Risks increase according to the time of day and the season, with dawn, dusk, spring and early summer being prime times to drive with wildlife in mind. Moose hits occur most often between April, when road salt attracts them, and October, the mating season. Deer hits occur most frequently during the fourth quarter of the year. The risk of hitting deer 1 hour after sunset is 30 times greater than the risk of hitting them during the day. The incidence of moose and deer collisions is increasing in many vicinities because of revitalized herds, increased traffic, lost habitat and expanded motorways.
Several inventive strategies to modify the behaviour of the agent (the animal), the host (the vehicle occupant) and the environment (the car and road) have been adopted by different jurisdictions, but many have not been rigorously evaluated. Reducing the population of animals through recreational hunting and outfitting deer with reflectors are examples of agent modification. Road modifications include the introduction of animal overpasses and underpasses, walls, culverts, fencing, and roadside mirrors and reflectors (to deflect headlight beams toward the side of the road to alert animals). Vehicles can also be outfitted with devices that catch wind currents and emit a high-pitched signal to frighten animals, although there is debate about their usefulness. Shatter-proof windshields and strengthened A-pillars and roofs have also been recommended. Animal-crossing signs that inform drivers about high-risk periods ("black spots") and advise them to reduce their speeds and be watchful during these periods can also reduce injuries, provided drivers comply.(Copyright 2002 Canadian Medical Association)
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Television viewing and aggressive behavior during adolescence and adulthood.
- Johnson JG, Cohen P, Smailes EM, Kasen S, Brook JS. Science 2002; 295(5564):2468-2471.
Correspondence: Jeffrey G. Johnson, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA (email: jjohnso@pi.cpmc.columbia.edu).
Television viewing and aggressive behavior were assessed over a 17-year interval in a community sample of 707 individuals. There was a significant association between the amount of time spent watching television during adolescence and early adulthood and the likelihood of subsequent aggressive acts against others. This association remained significant after previous aggressive behavior, childhood neglect, family income, neighborhood violence, parental education, and psychiatric disorders were controlled statistically.
Barriers to disclosure of abuse among rural women.
- Kershner M, Anderson JE. Minn Med 2002; 85(3):32-37.
Correspondence: Jon E. Anderson, Division of Science and Mathematics, University of Minnesota-Morris, USA (email: jonander@umn.edu).
The purposes of this study were to examine the prevalence of abuse (physical, emotional, and sexual) in women seeking care in rural medical clinics and WIC voucher pick-up sites, and to discover ways of improving the response of health care providers to violence. Data were collected in 8 medical clinics and 17 WIC supplemental food program sites in 9 counties of west central Minnesota during January and February 1997. Fifteen percent of respondents reported having had a discussion about abuse with a health care provider. Six of the 8 symptoms and injuries most associated with abuse indicate diminished emotional health. A series of barriers are identified as substantial obstacles to obtaining help and revealing abuse to health care providers. The most frequently reported barriers were self-reliance, reliance on God, and reliance on friends and family. These findings show that a large percentage of rural women experience abuse and that their health is adversely affected. The barriers to disclosure of abuse reported in this study illustrate the complexity of disclosing abusive relationships in rural and other settings. Low screening levels suggest that rural health care providers can develop additional opportunities to discuss abuse with their patients.
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