6 May 2002
Children and Adolescents With Acute Alcohol Intoxication/Self-poisoning Presenting to the Emergency Department.
- Woolfenden S, Dossetor D, Williams K. Arch Pediatr Adolesc Med 2002; 156(4):345-348.
Correspondence: Sue Woolfenden, Department of Psychological Medicine, Children's Hospital at Westmead, Locked Bag 4001, Westmead 2145, New South Wales, Australia. susanw@chw.edu.au).
OBJECTIVE: To describe the presentations, characteristics, and follow-up care of children and adolescents aged 10 to 18 years who present to emergency departments (EDs) with acute alcohol intoxication/self-poisoning.
DESIGN: Retrospective medical record review. SETTING: Five EDs in Western Sydney, Australia. PARTICIPANTS: Patients aged 10 to 18 years who presented to EDs with acute alcohol intoxication/self-poisoning between January 1, 1996, and December 31, 2000. MAIN OUTCOME MEASURES: Frequency of presentations; presentation characteristics; psychosocial characteristics; and presence or absence of follow-up.
RESULTS: Two hundred twelve children and adolescents presented to EDs 216 times. Of the 212 patients, 49 (23%) were 14 years or younger, and the youngest was aged 10 years. The majority (82%) came after hours and were brought in by emergency services (77%). In 13% of presentations, verbal and/or physical aggression was present, and a threat of self-harm was present in 2% of cases. A mental health worker was consulted about the child or adolescent in only 6% of presentations. Most children and adolescents (85%) were discharged from the ED. Of concern, in 56% of presentations, a follow-up plan was not recorded. There was documentation of mental health follow-up in only 14% of presentations and follow-up from drug and alcohol services in only 1%. Forensic history, school functioning, and a history of past mental health problems were not documented in more than 60% of the medical records examined.
CONCLUSIONS: When children or adolescents present to an ED with acute alcohol intoxication/self-poisoning, their risk factors for psychosocial dysfunction appear to be inadequately assessed, documented, and followed up. Clear guidelines for assessment and referral pathways must be established in EDs.
Positive blood alcohol concentration and road accidents. A prospective study in an Italian emergency department.
- Fabbri A, Marchesini G, Morselli-Labate AM, Rossi F, Cicognani A, Dente M, Iervese T, Ruggeri S, Mengozzi U, Vandelli A. Emerg Med J 2002; 19(3): 210-214.
Correspondence: A Fabbri, Dipartimento Emergenza-Urgenza Accettazione, Ospedale GB Morgagni, Azienda USL di Forlė, 1, Ple Solieri, I-47100 Forlė, Italy (email: andfabbri@libero.it).
OBJECTIVES: To examine if a positive blood alcohol concentration (BAC) at the time of crash (>/=0.50 g/l), independently of any clinical evidence and laboratory results indicating acute alcohol intoxication, is associated with specific features of patients involved, specific types of injury, and characteristics of the accident.
METHODS: In this prospective cohort study, the BAC was measured in adult patients who had been injured and who were admitted to an Italian emergency department within four hours after a road accident. Altogether 2354 trauma patients were included between January to December 1998 out of 2856 eligible subjects.
RESULTS: BAC exceeded 0.50 g/l in 425 subjects (18.1%), but was in a toxic range (>1.00 g/l) in only 179 subjects (7.6%). BAC positivity was significantly more common in men, in young subjects, in subjects driving cars or trucks, and in persons involved in a crash during night time and at weekends. It was associated with higher trauma severity, but no differences were found in injury body distribution according to vehicle type. In multivariate logistic regression analysis, the risk of a positive BAC in injured patients at the time of crash was independently associated with night time (odds ratio: 3.48; 95% confidence intervals: 2.46 to 4.91), male sex (3.08 (2.36 to 4.01)), weekend nights (1.21 (1.05 to 1.41)), and age (0.92 (0.86 to 0.99) per decades).
CONCLUSIONS: In injured patients after a road accident, a BAC at the time of crash in a non-toxic range (>/=0.50 g/l) is associated with specific characteristics of crash, as well as increased risk of higher trauma severity. More careful monitoring is needed in young men during weekend nights for highest risk of BAC positivity after a road accident.
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World Trade Center Building Performance Study Data Collections, Preliminary Observations, and Recommendations.
- McAllister T, ed. Washington DC: US Federal Emergency Management Agency, 2002.
Full report available online: ( Download Document ).
Following the September 11, 2001 attacks on New York City's World Trade Center (WTC), the Federal Emergency Management Agency and the Structural Engineering Institute of the American Society of Civil Engineers, in association with New York City and several other Federal agencies and professional organizations, deployed a team of civil, structural, and fire protection engineers to study the performance of buildings at the WTC site.
The purpose of this study was to examine the damage caused by these events, collect data, develop an understanding of the response of each affected building, identify the causes of observed behavior, and identify studies that should be performed. The immediate effects of the aircraft impacts on each tower, the spread of fires following the crashes, the fire-induced reduction of structural strength, and the mechanism that led to the collapse of each tower were studied. Additionally, the performance of buildings in the immediate vicinity of the towers was studied to determine the effects of damage from falling debris and fires. Recommendations are presented. The report contains 238+ pages.
Tropical Storm Allison Rapid Needs Assessment --- Houston, Texas, June 2001
- Waring SC, desVignes-Kendrick M, Arafat RR, Reynolds KM, D'Souza G, Bishop SA, Perrotta DM, Cruz M, Batts-Osborne D, Winterton BS. MMWR 2002; 51(17): 365-369.
Full text available online: ( Download Document ).
On June 5, 2001, Tropical Storm Allison made landfall on Galveston Island, Texas. During the next 2 days, the system soaked much of southeast Texas and south-central Louisiana with more than 10 inches of rain as it moved slowly northward. On June 7, the storm made a clockwise loop back to the southwest, bringing even more rain to already drenched areas. The record rainfall caused billions of dollars in flood-related damage and approximately 25 deaths and led to a presidential disaster declaration covering 31 Texas counties and 28 Louisiana parishes. Harris County, Texas (2000 population: 3,400,578), center of the Houston metropolitan area, was among the hardest hit with some areas receiving up to 37 inches of rain in 24 hours. To evaluate the community's immediate public health needs, the City of Houston Department of Health and Human Services conducted a rapid needs assessment in the areas most affected by flooding. This report summarizes assessment results, which identified increased illness in persons living in flooded homes, suggesting a need for rapid resolution of flood-related damage and the possibility that residents should seek temporary housing during clean-up and repair. The findings underscore the usefulness of rapid needs assessment as a tool to minimize misinformation, identify actual health threats, and ensure delivery of resources to those with the greatest and most immediate need.
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Is Soccer Bad for Children's Heads?: Summary of the IOM Workshop on Neuropsychological Consequences of Head Impact in Youth Soccer
- Patlak M, Joy JE. Washington, DC: Institute of Medicine / National Academy Press, 2002.
Full text available online: ( Download Document ).
Soccer is one of the most rapidly growing team sports in the United States, especially for girls and women. The growing popularity of soccer among youths combined with reports in the medical literature that soccer players may be at increased risk for brain injury has fostered concern that children who play soccer may not be adequately protected from head injury.
This report presents the results of a study by experts in head injury, sports medicine, pediatrics, and bioengineering to explore whether soccer playing puts youth at risk for lasting brain damage.
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Ergonomics, loss management, and occupational injury and illness surveillance. Part 1: elements of loss management and surveillance. A review.
- Amell TK, Kumara S, Rosserb BWJ. Int J Indust Ergonomics 2001; 28(2): 69-84.
Correspondence: Taylor Amell, Ergonomics Research Laboratory, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta, T6G 2G4 CANADA (email: tamell@ualberta.ca).
This paper discusses ergonomic design principles and programs in terms of a practical, comprehensive corporation-wide loss management viewpoint. Comprehensive loss management may be novel to some individuals in the field of ergonomics, and hence its basic premises are introduced and discussed. One key component of any comprehensive ergonomic program and inherently the loss management program employing ergonomic strategies is the need for thorough and integrated information concerning Occupational Injury and Illness within the organization. These data are utilized to identity and justify the need for an ergonomic design intervention as well as serve as a means of evaluating the efficacy of the intervention. The Occupational Injury and Illness surveillance system model employed by a mid-sized industrial organization is reviewed in Part 1 of this paper. Part 2 of this paper presents the complete Occupational Injury and Illness profile of the mid-sized industrial corporation based upon a comprehensive loss management system model.
An integral component in determining whether or not an ergonomic intervention is required as well as a means of evaluating the intervention is the Occupational Injury and Illness surveillance program in place within the organization. Without adequate and accurate information pertaining to the Occupational Injury and Illness characteristics of the workforce, a comprehensive ergonomic intervention cannot be successfully implemented.
Ergonomics, loss management, and occupational injury and illness surveillance. Part 2: injury and illness incident profile. Sample data.
- Amell TK, Kumara S, Rosserb BWJ. Int J Indust Ergonomics 2002; 29(4): 199-210.
Correspondence: Taylor Amell, Ergonomics Research Laboratory, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alta, T6G 2G4 CANADA (email: tamell@ualberta.ca).
This paper supports the information found in the first part of this two-part article. The Occupational Injury And Illness surveillance data contained herein were extracted from an integrated loss control reporting system. This paper describes the incidents reported over a 10-yr period at a mid-sized industrial organization in terms of the occupational injury or illness (incident character, body part injured, nature of injury) and the cause of the incident (basic cause, substandard actions and conditions, contributing factors and remedial work to control efforts). These data are presented for the express purpose of justifying the usefulness of loss management data for the targeting and evaluation of ergonomic programs and initiatives. The 10-yr data capture revealed that during this time frame over 14,000 incidents were recorded. The most common types of incidents involved being struck by objects and overexertions while the most commonly injured body parts were the fingers, back, head and eyes. The most common nature of injury were sprains, bruises and cuts. Low work standards and inadequate job/task/tool design were frequently noted as the basic cause while the most common substandard actions contributing to the incident were workers being inattentive to ambient job hazards and utilizing unsafe work positions. Trying to avoid extra effort was consistently cited as a major contributing factor. Design improvements were cited as remedial action in up to 13% of incidents.
In order to be of utility to an organization, ergonomic programs and initiatives must have a sound method of targeting the most appropriate area for intervention as well as an accurate and timely method of evaluation. The loss control reporting system employed by advocates loss management is just such a tool. The elements of the loss control reporting system pertinent to ergonomic programs as well as examples of the data they provide are presented in the second part of this two-part article.
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See item 2 under Suicide & Self Harm
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Utah youth suicide study, phase I: government agency contact before death.
- Gray D, Achilles J, Keller T, Tate D, Haggard L, Rolfs R, Cazier C, Workman J, McMahon WM. J Am Acad Child Adolesc Psychiatry 2002; 41(4):427-434.
Correspondence: Doug Gray, University of Utah Department of Psychiatry, Division of Child and Adolescent Psychiatry, ARUP Building, Suite 457, 546 South Chipeta Way, Salt Lake City, UT 84108 USA (email: Douglas.gray@hsc.utah.edu).
OBJECTIVE: To delineate the probability of contact between government agencies and youths who complete suicide, to investigate the nature of those contacts, and to identify new risk factors for suicide.
METHOD: A descriptive epidemiological analysis of data from multiple Utah government agencies on consecutive youth suicides (n = 151) between August 1, 1996, and June 6, 1999, aged 13-21 years. Data were collected from four government agencies: Office of the Medical Examiner, Juvenile Justice, Department of Human Services, and the Department of Education.
RESULTS: Utah descriptive data were similar to national statistics, with the majority of completers being male (89%) and firearms the most common method of suicide (58%). The data demonstrated an association between youth suicide and contact with Juvenile Justice. Sixty-three percent of youths who completed suicide in Utah had contact with Juvenile Justice, and there was a direct correlation between number of referrals and increased suicide risk. Suicide completers had multiple minor offenses over many years. A significant minority of school-age subjects could not be located within the school system. Few suicide completers had evidence of active psychiatric treatment.
CONCLUSIONS: Juvenile Justice is identified as a novel site for the screening and identification of youths at risk for suicide.
Suicide in Australian farming, 1988-1997.
- Page AN, Fragar LJ. Aust N Z J Psychiatry 2002; 36(1):81-85.
Correspondence: A.N. Page, Department of Public Health and Community Medicine, Edward Ford Building, A27, The University of Sydney, Sydney, New South Wales 2066, Australia (email: apage@health.usyd.edu.au).
OBJECTIVES: To identify and describe suicide data for occupational classifications relating to farm managers and agricultural labourers for Australia for the period 1988 to 1997, and to relate resultant suicide rates to farmers' terms of trade.
METHODS: Descriptive and linear regression analysis of aggregated mortality data.
RESULTS: In the period 1988 to 1997, 921 suicides were identified. The majority of these suicides were farm managers (67.4%). Farm manager suicides occurred predominantly in older age groups (55 + years). In comparison agricultural labourer suicides were younger, with the majority of suicides occurring in the 15-39 years age group. The most common methods for both groups were firearms (particularly hunting rifles and shot guns), hanging and motor vehicle exhaust gas. These methods accounted for approximately 81% of all male farm suicides. Firearms accounted for 51% of male farm suicide, in comparison to 23% for the wider Australian male population for the same period. Estimated age standardized rates per 100 000 for male farm managers for the 10-year period ranged from 24.8 to 51.4. For male agricultural labourers these rates ranged from 23.5 to 41.9. Analyses also revealed a negative correlation (r = -0.75, p < 0.01) between farm manager suicide rates and farmers' terms of trade.
CONCLUSION: Male farm manager and agricultural labourer suicide rates are higher than male national rates and rates in the wider rural population, particularly in the later years of the period investigated. Firearms prefigure as the most common method of suicide, despite decreases in this method in the wider rural population. Establishing more accurate denominator data for the farming community is a priority, as is preventative action that accounts for unique aspects of farm life.
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Accidents in patients with insulin-treated diabetes: increased risk of low-impact falls but not motor vehicle crashes--a prospective register-based study.
- Kennedy RL, Henry J, Chapman AJ, Nayar R, Grant P, Morris AD. J Trauma 2002 Apr;52(4):660-666.
Correspondence: Lee Kennedy, City Hospital Sunderland, University of Sunderland, Sunderland, United Kingdom (email: lee.kennedy1@sunderland.ac.uk).
BACKGROUND: Patients with diabetes mellitus may be at increased risk of accidents, mainly because of hypoglycemia. A variety of approaches have been adopted in an attempt to quantify this risk, but there has not been, to date, a systematic study using a national trauma register. In this study, we report findings from the Scottish Trauma Audit Group database.
METHODS: The database includes all patients admitted to hospital for 3 or more days, or who died in hospital as a result of their accident. The study includes 11,244 cases aged 15 years or over entered into the database between July 1996 and June 1998. This included 151 patients with insulin-treated diabetes. Using detailed prescribing information from one representative region, we have calculated the rates of different types of accidents for patients treated with insulin and compared this with the control population. We have analyzed information on the mechanism and severity of injury, outcome, and length of hospital stay.
RESULTS: Overall, the rate of accidents for insulin-treated patients was estimated at 291.2 per 100,000 population per year compared with 148.4 for the control population (p < 0.001; relative risk, 1.97; 95% confidence interval, 1.68-2.32). Insulin-treated patients were, on average, older (p < 0.005), more likely to be women (p < 0.02), and had longer stay in hospital (p < 0.001). The major excess of injuries related to low falls (< 2 m), which accounted for 62.3% of the injuries in the insulin-treated group compared with 47.1% in the remainder (p < 0.01). Low falls in the insulin-treated group (n = 94) were examined in detail: compared with the control population, there was no difference in age and sex, Injury Severity Score, Revised Trauma Score (a measure of the severity of physiologic disturbance), or calculated probability of survival (TRISS). Length of inpatient stay was higher in the insulin-treated low-fall patients (10 vs. 7 days, p < 0.01). Of the 151 catalogued injuries, the vast majority were fractures at peripheral sites. Only 23 insulin-treated individuals were admitted after a motor vehicle crash during the study period. This represents a slight but not significant increase above the rate for the background population.
CONCLUSION: This study confirms that patients taking insulin are at increased risk of accidents. Among the different types of injury, only low-impact falls were significantly increased. This is most likely related to an increased tendency for insulin-treated patients to fall during a hypoglycemic episode. However, patients with diabetes may also be at higher risk of sustaining a fracture after a fall. The number of car crashes involving drivers with insulin-dependent diabetes is small, and the rate is not significantly greater than that of the background population. Further study of the causes and consequences of falls in diabetic patients is warranted.
Sleepy driving: Accidents and injury.
- Powell NB, Schechtman KB, Riley RW, Li K, Guilleminault C. Otolaryngol Head Neck Surg 2002; 126(3):217-227.
Correspondence: N.B. Powell, Department of Psychiatry and Behavioral Science, Stanford University Medical School, and the Stanford Sleep Disorders and Research Center, Stanford.
OBJECTIVE: The study goals were to evaluate the associated risks of driving and to assess predictors of accidents and injury due to sleepiness.
METHODS: A cross-sectional Internet-linked survey was designed to elicit data on driving habits, sleepiness, accidents, and injuries during the preceding 3 years. Statistical analysis included logistic models with covariate-adjusted P values of <0.01 (odds ratios and 95% confidence intervals or limits). Independent accident predictors were sought.
RESULTS: Responses from 10,870 drivers were evaluated. The mean +/- SD age was 36.9 +/- 13 years; 61% were women and 85% were white. The Epworth Sleepiness Scale overall baseline score was 7.4 +/- 4.2 (for drivers with no accidents) and ranged to 12.7 +/- 7.2 (for drivers with >/= 4 accidents) (P = < 0.0001). Twenty-three percent of all respondents experienced >/= 1 accident. Among respondents who reported >/= 4 accidents, a strong association existed for the most recent accident to include injury (P < 0.0001). Sleep disorders were reported by 22.5% of all respondents, with a significantly higher prevalence (35%, P = 0.002) for drivers who had been involved in >/= 3 accidents.
CONCLUSION: Factors of sleepiness were strongly associated with a greater risk of automobile accidents. Predictors were identified that may contribute to accidents and injury when associated with sleepiness and driving.
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Firearm availability and female homicide victimization rates among 25 populous high-income countries.
- David Hemenway D, Shinoda-Tagawa T, Miller M. J Am Med Women Assn 2002; 57(2): 100-104.
Correspondence: David Hemenway, Department of Health Policy and Management, 677 Huntington Ave., Boston, MA 02115 USA (email: dheminway@hsph.harvard.edu).
Objective: to determine the association between firearm availability and female homicide victimization among high-income countries.
Methods: Data were assembled for the most recent available year (1994-1999) from the official reports of the ministries of health for those countries that had more than 2 million inhabitants and were classified as high income by the World Bank. Twenty-five nations provided sufficient information for the analysis. Rates of female victimization from homicide, firearm homicide, and nonfirearm homicide were compared with a validated proxy for household firearm ownership (the percentage of total national suicides that are committed with firearms). Possible confounding variables included in the analysis were the percentage of the population living in urban areas and income inequality.
Results: The United States is an outlier. It had the highest level of household firearm ownership and the highest female homicide rate. The United States accounted for 32% of the female population in these high-income countries, but for 70% of all female homicides and 84% of all female firearm homicides. Female homicide victimization rates were significantly associated with firearm availability largely because of the United States.
Conclusion: Among high-income countries, where firearms are more available, more women are homicide victims. Women in the United States are at higher risk of homicide victimization than are women in any other high-income country.
Violence-inflicted injuries: reporting laws in the fifty states.
- Houry D, Sachs CJ, Feldhaus KM, Linden J. Ann Emerg Med 2002; 39(1):56-60.
Correspondence: Deborah Houry, Emergency Medicine Residency, Denver Health Medical Center, Denver, CO 80204, USA (email: dhoury@aol.com).
OBJECTIVE: 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. 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.
CONCLUSION: 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.
Teaching firearm safety to children: failure of a program.
- Hardy MS. J Dev Behav Pediatr 2002; 23(2): 71-76.
Correspondence: M.S. Hardy, Department of Psychology, Eckerd College, St. Petersburg, Florida 33711, USA (email: hardyms@eckerd.edu).
The present study investigated the effectiveness of a skills-based firearm safety program on reducing children's play with firearms. In a randomized control study, 34 children aged 4 to 7 years participated in a week-long firearm safety program; the Control Group was composed of 36 children. After the program, pairs of children were observed playing in a structured setting in which they had access to a semiautomatic pistol. A total of 53% of the pairs played with the gun, and there was no difference in gun-play behavior between those children who did and did not receive the intervention. Interview data revealed significant discrepancies in parent and child reports of parental gun ownership and inaccurate parental predictions of their children's interest in guns. The results of the current study cast doubt on the potential effectiveness of skills-based gun safety programs for children.
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