13 May 2002
The effects of alcohol on head injury in the motor vehicle crash victim.
- Cunningham RM, Maio RF, Hill EM, Zink BJ. Alcohol Alcohol 2002; 37(3): 236-240.
Correspondence: Rebecca M. Cunningham, University of Michigan Medical Center, Department of Emergency Medicine, TC B134 1500 East Medical Center Drive, Ann Arbor MI 48109-0303, USA.
OBJECTIVE: To determine if alcohol potentiates the severity of traumatic brain injury (TBI) in motor vehicle crash (MVC) victims, controlling for crash severity characteristics.
METHODS: We evaluated severity of head injury by Marshall score [a classification scale of intracranial pathology on head computed axial tomogram (CT)], and blood-alcohol concentration (BAC), while controlling for crash characteristics [traffic accident deformity score (TAD) and belt use]. Marshall scores were determined from initial CT or autopsy reports, by a neurosurgeon, and were categorized into less severe injury (<3) and more severe (3). Logistic regression using this variable as the outcome parameter and crash characteristics, age and BAC as predictors was done, and the odds ratio (OR) and 0.95 confidence interval (0.95 CI) calculated.
RESULTS: Fifty-eight patients were analysed: 41% were BAC positive, 30% had a modified Marshall score of 3. Patients with positive BAC were 2.1-fold more likely to have a more severe head injury as measured on CT scan by the Marshall scores.
CONCLUSIONS: We suggest that alcohol potentiates severity of TBI as determined from head CT among MVC victims. Further research will be needed to substantiate this finding as well as to determine its long-term effect on clinical outcome. (Copyright © 2002 Medical Council on Alcohol)
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War on the roads: The public health community must intervene.
- Roberts I, Mohan D, Abbasi K. BMJ 2002; 324(7346): 1107-1108.
Correspondence: Ian Roberts, London School of Hygiene and Tropical Medicine, London WC1E 7HT UK (email: ian.roberts@lshtm.ac.uk).
Full text available online: ( Download Document ).
Summary of the editorial:
War is often waged by the powerful on the weak. In this case, the interests of pedestrians, cyclists, and other vulnerable road users are pitted against the powers that stand to profit from increasing global motorisation. And there are many millions of casualties. Every day about 3000 people die and 30 000 people are seriously injured on the world's roads. Over 85% of the deaths and 90% of disability adjusted life years lost from road traffic injuries are in low and middle income countries, with pedestrians, cyclists, and bus passengers bearing most of the burden. Most of the victims will never own a car, and many are children. Even in the high income countries, poor children are at greatest risk. Nevertheless, the prevention of traffic crashes is low on the list of public health priorities both in the United Kingdom and internationally, with record low levels of funding in research and development....
....As in other wars, propaganda is an important weapon. It is not in the interests of those who sell road transport to allow the private trouble of road death and injury to become a public issue. The idea that governments and the motor manufacturing industry have a major responsibility is not for public consumption. It is much more acceptable that the victims are held responsible....
The current preoccupation with educational programmes for pedestrians and road safety awareness campaigns might be another example of road safety propaganda. For example, writing on injuries in child pedestrians in low income countries, the Global Road Safety Partnership (led by the World Bank) argues that one reason why these accidents happen is that children do not have the necessary knowledge and skills that allow them to deal with the hostile traffic environment. On the basis of their systematic review of controlled trials of pedestrian education programmes, however, Duperrex and colleagues point out that there is no evidence that education programmes for pedestrians reduce the risk of motor vehicle collisions involving child pedestrians, and no trials have been conducted in low and middle income countries. But research in biomechanics has shown that changes in the design of vehicles could greatly reduce the frequency and severity of pedestrian injuries. Indeed, if vehicles complied with the recommendations of the European Enhanced Vehicle Safety Committee (EEVC), the estimated reductions in deaths among pedestrians could exceed 20%. The motor manufacturing industry vigorously opposes the introduction of this committee's recommendations for safety tests to benefit pedestrians. Trucks and buses hit a large number of pedestrians and bicyclists around the world, and it is possible to make the fronts of these vehicles safer.1 At present this issue is not on the agenda of any manufacturer or official safety agency....
By 2020 road traffic crashes will have moved from ninth to third place in the world ranking of the burden of disease and will be second place in developing countries. Connor and colleagues in New Zealand show that sleepiness among drivers may account for nearly a fifth of road traffic crashes. Similarly, if the international public health community continues to sleep through the global road trauma pandemic it will be accountable for many millions of avoidable deaths and injuries.
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No reports this week
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Heat waves in Madrid 1986-1997: effects on the health of the elderly.
- Diaz J, Jordan A, Garcia R, Lopez C, Alberdi JC, Hernandez E, Otero A. Int Arch Occup Environ Health 2002; 75(3): 163-170.
Correspondence: Julio Diaz, Centro Universitario de Salud Publica de Madrid, SPAIN (email: julio.diaz@uam.es).
OBJECTIVE: The objective of this paper is to analyse and quantify the effects exerted on summer mortality by extremes of heat, particularly among persons aged 65-74 and 75 years and over, groups in which mortality is higher.
METHODS: The study included the period from 1 January 1986 to 31 December 1997, for all people aged over 65 years resident in Madrid, based on mortality due to all causes except accidents (ICD-9 codes 1-799), and circulatory (390-459) and respiratory (460-487) causes. Meteorological variables analysed were: daily maximum temperature, daily minimum temperature and relative humidity. To control the effect of air pollution on mortality we considered the daily mean values of sulphur dioxide (SO2), total suspended particulate (TSP), nitric oxides (NOx), nitrogen dioxide (NO2) and tropospheric ozone (O3). Univariate and multivariate ARIMA models were used. Box-Jenkins pre-whitening was performed.
RESULTS: The results yielded by this study indicate a mortality increase up to 28.4% for every degree the temperature rises above 36.5 degrees C, with particular effect in women over the age of 75 years and circulatory-cause mortality. The first heat wave that leads to the greatest effects on mortality, due to the higher number of susceptible people and the duration of the heat wave, show an exponential growth in mortality. Furthermore, low relative humidity enhances the effects of high temperature, linking dryness to air pollutants, ozone in particular.
CONCLUSIONS: Since a warmer climate is predicted in the future, the incidence of heat wave should increase, and more comprehensive measures, both medical and social, should be adopted to prevent the effects of extreme heat on the population, particularly the elderly. (Copyright © 2002 Springer-Verlag)
The effects of terrorism on teens' perceptions of dying: the new world is riskier than ever.
- Halpern-Felsher BL, Millstein SG. J Adolesc Health 2002; 30(5): 308-311.
Correspondence: Bonnie L. Halpern-Felsher, Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA (email: yafa@itsa.ucsf.edu).
Adolescents assessed after the September 11, 2001 terrorist attacks perceived the risk of dying from general causes, a tornado, and an earthquake as dramatically higher than did adolescents assessed years before the attacks. Adolescents' heightened perceptions of vulnerability to death extended beyond the terrorist acts, and generalized to unrelated risks. (Copyright © 2002 Society for Adolescent Medicine)
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Color associations for Hong Kong Chinese.
- Chan AHS, Courtney AJ. 2001; 28(3-4): Int J Ind Ergonomics 165-170.
Correspondence: Alan Hoi Shou Chan, Department of Manufacturing Engineering and Engineering Management, City University of Hong Kong, Tat Chee Avenue, Hong Kong, HONG KONG (email: meachan@cityu.edu.hk).
Population stereotypes for color were tested with 117 Hong Kong Chinese subjects. They were asked to associate ten colors and sixteen concepts. Chi-square tests demonstrated significant color associations for all sixteen concepts. Although significant associations were demonstrated, they were not as strong as those found for Yunnan Chinese and US subjects obtained in previous studies. The three primary colors red, green, and blue had six, three, and one significant associations, respectively. The strongest associations found were red and stop (66.4%), red and danger (63.0%), and green and go (62.6%) which are associations that coincide with daily experiences of the subjects. Red had the highest percentage associations with six out of the sixteen concepts tested, viz. potential hazard, danger, radiation hazard, caution, stop, and strong, indicating that for Hong Kong Chinese there was no clear differentiation between caution and danger, and different types of hazards. Consensus between Chinese and US subjects was found for color associations with the concepts of safe, danger, go and stop. For the concept on, both green and red were highly associated. Some other differences for color associations were found between Hong Kong Chinese and other populations.
The nonconformity of the choice of colors with international standards and the divergence found in this experiment suggested that ergonomists and industrial designers must be prudent on equipment and facilities designed for the Chinese with appropriate research on applications of color associations. (Copyright © 2001 Elsevier Science B.V.)
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Safety education of pedestrians for injury prevention: a systematic review of randomised controlled trials.
- Duperrex O, Bunn F, Roberts I. BMJ 2002; 324(7346): 1129.
Correspondence: Oliver Duperrex, Institut de Médecine Sociale et Préventive, CMU, CH-1211 Geneva 4, Switzerland (email: Olivier.Duperrex@imsp.unige.ch).
Available online: ( Download Document ).
BACKGROUND:Road traffic crashes are a leading cause of death and disablement, and pedestrians are particularly vulnerable road users. Several organisations strongly recommend road safety education.
As resources are limited, a key question concerns the relative effectiveness of different prevention strategies, including road safety education of pedestrians.
OBJECTIVES: To quantify the effectiveness of safety education of pedestrians.
METHODS: Design: Systematic review of randomised controlled trials of safety education programmes for pedestrians of all ages. Main outcome measures: Effect of safety education on pedestrians' injuries, behaviour, attitude, and knowledge and on pedestrian-motor vehicle collisions. Quality of trials: methods of randomisation; and numbers lost to follow up.
RESULTS: We identified 15 randomised controlled trials of safety education programmes for pedestrians. Fourteen trials targeted children, and one targeted institutionalised adults. None assessed the effect of safety education on the occurrence of pedestrian injury, but six trials assessed its effect on behaviour. The effect of pedestrian education on behaviour varied considerably across studies and outcomes.
CONCLUSIONS: Pedestrian safety education can change observed road crossing behaviour, but whether this reduces the risk of pedestrian injury in road traffic crashes is unknown. There is a lack of good evidence of effectiveness of safety education for adult pedestrians, specially elderly people. None of the trials was conducted in low or middle income countries. (Copyright © 2002 BMJ)
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See item 1 under Occupational Issues
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No reports this week
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See item 1 under Occupational Issues
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Surfing injuries.
- Nathanson A, Haynes P, Galanis D. Am J Emerg Med 2002; 20: 155-160.
Corrspondence: Andrew Nathanson, MD, Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 USA (email: Andrew_Nathanson@brown.edu).
The purpose of this study was to describe the relative frequency, pattern, and mechanism of surfing injuries. Descriptive data of surfing injuries was collected by using a Web site-based interactive multiple choice survey. Data was collected from May 1998 to August 1999. Completed surveys were obtained from 1,348 individuals reporting 1,237 acute injuries and 477 chronic injuries. Lacerations accounted for 42% of all acute injuries, contusions 13%, sprains/strains 12%, and fractures 8%. Thirty-seven percent of acute injuries were to the lower extremity, and 37% to the head and neck. Fifty-five percent of injuries resulted from contact with ones own board, 12% from another surfer's board, and 17% from the sea floor. Sixty-seven percent of acute surfing injuries are caused by board contact. Older surfers, more expert surfers, and those surfing large waves have a higher relative risk for significant injury. Equipment modifications are suggested that may decrease the risk for injury. (Copyright © 2002, Elsevier Science).
Does soccer ball heading cause retinal bleeding?
- Reed WF, Feldman KW, Weiss AH, Tencer AF. Arch Pediatr Adolesc Med 2002; 156(4): 337-40.
Correspondence: K.W. Feldman, 2101 E Yesler Way, Seattle, WA 98122 USA (email: kfeldman@u.washington.edu).
OBJECTIVES: To define forces of youth soccer ball heading (headers) and determine whether heading causes retinal hemorrhage.
METHODS: SETTING: Regional Children's Hospital, youth soccer camp. PATIENTS: Male and female soccer players, 13 to 16 years old, who regularly head soccer balls. MEASUREMENTS: Dilated retinal examination, after 2-week header diary, and accelerometer measurement of heading a lofted soccer ball.
RESULTS: Twenty-one youth soccer players, averaging 79 headers in the prior 2 weeks, and 3 players who did not submit header diaries lacked retinal hemorrhage. Thirty control subjects also lacked retinal hemorrhage. Seven subjects heading the ball experienced linear cranial accelerations of 3.7 +/- 1.3g. Rotational accelerations were negligible.
CONCLUSIONS: Headers, not associated with globe impact, are unlikely to cause retinal hemorrhage. Correctly executed headers did not cause significant rotational acceleration of the head, but incorrectly executed headers might. (Copyright © 2002 American Medical Association)
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Injury surveillance in the ED: Design, implementation, and analysis.
- Brenner RA, Scheidt PC, Rossi MW, Cheng TL, Overpeck MD, Boenning DA, Wright JL, Kavee JD, Boyle KE. Am J Emerg Med 2002; 20(3): 181-187.
Correspondence: Ruth A. Brenner, MD, MPH, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, 6100 Executive Blvd. Room 7B03, Bethesda, MD 20892 USA (email: BrennerR@nih.gov).
Comprehensive, population-based surveillance for nonfatal injuries requires uniform methods for data collection from multiple hospitals. To show issues related to design and implementation of multihospital, emergency department (ED), injury surveillance, a city-wide system in the United States is discussed. From October 1, 1995 to September 30, 1996 all injury-related ED visits among District of Columbia residents <3 years of age were ascertained at the 10 hospitals where city children routinely sought care. Information was abstracted from 2,938 injury-related, ED visits (132.7 visits/1,000 person-years). Based on this experience, suggestions to facilitate design of multihospital, injury surveillance in other locations are offered. Importantly, injury-related visits were reliably ascertained from ED logs, and for most variables, a systematic sample of injury-related visits was representative of the total injured population. However, there is a need for more complete documentation of circumstances surrounding injuries and for standardization of data elements on ED logs and treatment records. (This is a US government work. There are no copyright restrictions on its use.)
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Cross sectional survey of socioeconomic variations in severity and mechanism of childhood injuries in Trent 1992-1997.
- Hippisley-Cox J, Groom L, Kendrick D, Coupland C, Webber E, Savelyich B. BMJ 2002; 324(7346):1132
Correspondence: Julia Hippisley-Cox Division of General Practice, Tower Building University Park, Nottingham NG7 2RD UK (email: julia.hippisley-cox@nottingham.ac.uk).
Available online: ( Download Document ).
OBJECTIVE: To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years.
METHODS: Design: Cross sectional survey of routinely collected hospital admission data for injury 1992-7. Setting: 862 electoral wards in Trent Region. Subjects: 21 587 injury related hospital admissions for children aged 0-4 years and 35 042 admissions for children aged 5-14. Main outcome measures: Rate ratios for hospital admission for all injuries, all injuries involving long bone fracture, and all injuries involving long bone fracture requiring an operation; rate ratios for hospital admission for six types of injury mechanism divided by quintiles of the electoral wards' Townsend scores for deprivation. Rate ratios calculated by Poisson regression, with adjustment for distance from nearest hospital admitting patients with injuries, rurality, ethnicity, and percentage of males in each electoral ward.
RESULTS: : Both total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation. These gradients were more marked for 0-4 year old children than 5-14 year olds. In terms of injury mechanisms, the steepest socioeconomic gradients (where the rate for the fifth of electoral wards with the highest deprivation scores was >/=3 times that of the fifth with the lowest scores) were for pedestrian injuries (adjusted rate ratio 3.65 (95% confidence interval 2.94 to 4.54)), burns and scalds (adjusted rate ratio 3.49 (2.81 to 4.34)), and poisoning (adjusted rate ratio 2.98 (2.65 to 3.34)).
CONCLUSIONS: There are steep socioeconomic gradients for injury morbidity including the most common mechanisms of injury. This has implications for targeting injury prevention interventions and resources. (Copyright © 2002 BMJ)
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No reports this week
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No reports this week
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Firearm-related suicide among young African-American males.
- Joe S, Kaplan MS. Psychiatr Serv 2002; 53(3): 332-334.
Correspondence: Sean Joe, Center for Intervention and Practice Research, School of Social Work, University of Pennsylvania, 4200 Pine Street, Philadelphia, Pennsylvania 19104 USA (e-mail: sjoe@ssw.upenn.edu).
National trends in firearm-related suicides among African-American and white males in the age groups 15 to 19 years and 20 to 24 years from 1979 to 1997 were examined. The rates and percentages of suicide by firearms increased significantly more among African-American males than among white males. During the 19-year period, firearms accounted for about 70 percent and 64 percent of all suicides among males aged 15 to 19 years and 20 to 24 years, respectively. The results support the Surgeon General's 1999 call for greater awareness of the suicide risk among African-American males. (Copyright © 2002 American Psychiatric Association)
College students' perceptions of suicide: the role of empathy on attitudes, evaluation, and responsiveness.
- Mueller MA, Waas GA. Death Stud 2002; 26(4): 325-341.
Correspondence: Michaele A. Mueller, Department of Psychology, Northern Illinois University, Dekalb, Illinois, 60115 USA (email: mmueller@niu.edu).
A total of 334 college-age students (18719 years) participated in a study investigating the role of empathy in perceptions of and responsiveness toward a hypothetical friend exhibiting symptoms associated with suicide risk. High-empathy participants viewed both affective and behavioral characteristics associated with suicide risk as more serious, and they were more likely to provide direct assistance and talk with the troubled peer.Gender of participant and type of symptom displayed also emerged as important factors in participants' evaluations.These findings underscore the importance of considering social-cognitive factors that may influence perceptions of at-risk behaviors.The implications of these findings for the development of primary prevention intervention efforts are discussed. (Copyright © 2002 Brunner-Routledge -- Taylor and Francis Group).
Mass suicide: historical and psychodynamic considerations.
- Mancinelli I, Comparelli A, Girardi P, Tatarelli R. Suicide Life Threat Behav 2002; 32(1):91-100.
Correspondence: Roberto Tatarelli, Department of Psychiatric Sciences and Psychological Medicine, University La Sapienza, Via Panama 68/70, 00198 Rome, ITALY ( email: tatarellipsichiatria@libero.it).
Mass suicide can be defined as the simultaneous suicide of all the members of a social group and is closely linked to the human dimension of existence, although the social and cultural context may vary. In fact, the term mass suicide can also be used to describe situations in which a particular population has reacted to oppression by denying all normal activities of sustenance, with the intention of bringing about a traumatic metamorphosis in a cultural context (colonization, exploitation by other populations), thus transforming a catastrophe in which a passive role is played into one constructed actively. Therefore, mass suicides can be subdivided into two categories: (a) hetero-induced, typical of defeated and colonized populations forced to escape from a reality that does not acknowledge their human dignity and (b) self-induced, in which the motivation is related to a distorted evaluation of reality, without there being either an intolerable situation or a real risk of death. The mass suicides that have taken place in the last 20 years are all related to the establishment of religious sects; the mystic delirium created within the sect leads to the self-destruction of the group as being interpreted as an act of self-assertiveness.
Association between physical illness and suicide among the elderly.
- Quan H, Arboleda-Flórez J, Fick GH, Stuart HL, Love EJ. Soc Psychiatry Psychiatr Epidemiol 2002; 37(4): 190-197.
Correspondence: Hude Quan, Department of Community Health Sciences, University of Calgary, 3330 Hospital Dr. N. W., Calgary, Alberta T2N 4N1, CANADA (email: hquan@ucalgary.ca).
BACKGROUND: Only a few small studies have explored the association between various physical illnesses and suicide in the elderly and they have produced inconsistent results.
OBJECTIVES: We undertook this larger study to more definitively assess the association between elderly suicide and physical illness.
METHODS: This case-control study compared the proportion with physical illnesses among 822 cases who committed suicide with that among 944 controls who died due to motor vehicle accident at age 55 years or over in Alberta, Canada.
RESULTS: Compared to the motor vehicle accident deaths, the elderly who committed suicide were more likely to have cancer, ischemic heart disease, chronic pulmonary disease, peptic ulcer, prostatic disorder, depression and other psychiatric illnesses. There was no significant difference in the proportion of cerebrovascular disease and diabetes mellitus between the case and control groups before adjustment of demographic and clinical characteristics. After adjustment of these variables, the elderly with any of the following illnesses were more likely to die by suicide than those without the illness: cancer (adjusted odds ratio [95 % confidence interval]: 1.73 [1.16-2.58]), prostatic disorder (excluding prostatic cancer, 1.70 [1.16-2.49]), chronic pulmonary disease among the married (1.86 [1.22-2.83]), depression (6.70 [4.72-9.50]) or other psychiatric illness (2.16 [1.68-2.76]). There was no evidence that ischemic heart disease, cerebrovascular disease, peptic ulcer and diabetes mellitus might be associated with suicide in the elderly.
CONCLUSIONS: Cancer, prostatic disorder, chronic pulmonary disease among the married and psychiatric illness appear to be associated with suicide among the elderly. (Copyright © 2002 Steinkopff Verlag)
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Association of driver air bags with driver fatality: a matched cohort study.
- Cummings P, McKnight B, Rivara FP, Grossman DC. BMJ 2002; 324(7346):1119-1122.
Correspondence to: Peter Cummings Harborview Injury Prevention and Research Center, 325 Ninth Avenue, Box 359960, Seattle, WA 98104-2499, USA (email: peterc@u.washington.edu).
Text available free onine: ( Download Document ).
BACKGROUND:Studies have estimated that driver air bags reduce the risk of death in a road vehicle crash by 10-14%. These studies disagree as to whether benefit is greater for drivers wearing a seat belt or for unbelted drivers.
OBJECTIVE: To estimate the association of driver air bag presence with driver fatality in road traffic crashes.
METHODS: Design: Matched pair cohort study. Setting: All passenger vehicle crashes in the United States during 1990-2000 inclusive. Subjects: 51 031 driver-passenger pairs in the same vehicle.
Main outcome measures: Relative risk of death within 30 days of a crash.
RESULTS: Drivers with an air bag were less likely to die than drivers without an air bag (adjusted relative risk 0.92 (95% confidence interval 0.88 to 0.96)). This estimate was nearly the same whether drivers wore a seat belt (adjusted relative risk 0.93) or not (0.91). Air bags were associated with more protection for women (0.88 (0.82 to 0.93)), than for men (0.94 (0.90 to 0.99)). Drivers wearing a seat belt were less likely to die than unbelted drivers (0.35 (0.33 to 0.36)). Belted drivers with an air bag were less likely to die than unbelted drivers without an air bag (0.32 (0.30 to 0.34)).
CONCLUSIONS: If the associations are causal the average risk of driver death was reduced 8% (95% confidence interval 4% to 12%) by an air bag. Benefit was similar for belted and unbelted drivers and was slightly greater for women. However, seat belts offered much more protection than air bags. (Copyright © 2002 BMJ)
Are seat belt restraints as effective in school age children as in adults? A prospective crash study.
- Halman SI, Chipman M, Parkin PC, Wright JG. BMJ 2002; 324:1123.
Correspondence: James G Wright, Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, CANADA (email: jim.wright@sickkids.ca).
Available online: ( Download Document ).
BACKGROUND: Although child restraints protect young children in road vehicle crashes, it is not known whether standard seat belts used by school age children work as well. School age children are often unbelted in cars.
OBJECTIVE: To study effectiveness of seat belts for protecting school age children in road vehicle crashes.
METHODS: Design: Crash examinations by trained investigators.
Setting: Ten Canadian university based crash investigation centres. Subjects: 470 children aged 4-14 years, with 168 selected for detailed analysis, and 1301 adults. Main outcomes measures: Use of seat belts by vehicle occupants; severity of injury adjusted for age and crash severity.
RESULTS: Overall, 40% (189/470) of children were unbelted. Of the 335 children in cars driven by belted adults, 73 (22%) were unbelted. The odds of sustaining fatal or moderately severe injury (injury severity score 4) for children in the front passenger seat was more than nine times higher for unbelted children than for belted ones (odds ratio 9.8 (95% confidence interval 2.4 to 39.4)) and for those in the rear left seat was more than two times higher for unbelted than for belted children (2.6 (1.1 to 5.9)). The protection afforded by seat belts compared favourably with the results for adults in the same seat positions (odds ratios for unbelted v belted adults of 2.4 and 2.7 for front and rear seat passengers respectively).
CONCLUSIONS: Seat belts helped to protect school age children from injury in road vehicle crashes. However, 40% of children were unbelted. Despite standard seat belts being designed for adults, school age children were at least as well protected as adults. (Copyright © 2002 BMJ)
Driver sleepiness and risk of serious injury to car occupants: population based case control study.
- Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, Bailey J, Jackson R. BMJ 2002; 324(7346):1125.
Correspondence to: Jennie Connor, Division of Community Health, University of Auckland, Private Bag 92019, Auckland, New Zealand (email: j.connor@auckland.ac.nz).
Available online: ( Download Document ).
BACKGROUND:Driver sleepiness is considered a potentially important risk factor for car crashes and related injuries but the association has not been reliably quantified. Published estimates of the proportion of car crashes attributable to driver sleepiness vary from about 3% to 30%.
OBJECTIVES: To estimate the contribution of driver sleepiness to the causes of car crash injuries.
METHODS: Design: Population based case control study. Setting: Auckland region of New Zealand, April 1998 to July 1999. Participants: 571 car drivers involved in crashes where at least one occupant was admitted to hospital or killed ("injury crash"); 588 car drivers recruited while driving on public roads (controls), representative of all time spent driving in the study region during the study period. Main outcome measures: Relative risk for injury crash associated with driver characteristics related to sleep, and the population attributable risk for driver sleepiness.
RESULTS: There was a strong association between measures of acute sleepiness and the risk of an injury crash. After adjustment for major confounders significantly increased risk was associated with drivers who identified themselves as sleepy (Stanford sleepiness score 4-7 v 1-3; odds ratio 8.2, 95% confidence interval 3.4 to 19.7); with drivers who reported five hours or less of sleep in the previous 24 hours compared with more than five hours (2.7, 1.4 to 5.4); and with driving between 2 am and 5 am compared with other times of day (5.6, 1.4 to 22.7). No increase in risk was associated with measures of chronic sleepiness. The population attributable risk for driving with one or more of the acute sleepiness risk factors was 19% (15% to 25%).
CONCLUSIONS: Acute sleepiness in car drivers significantly increases the risk of a crash in which a car occupant is injured or killed. Reductions in road traffic injuries may be achieved if fewer people drive when they are sleepy or have been deprived of sleep or drive between 2 am and 5 am. (Copyright © 2002 BMJ)
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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: Debora Houry, Emergency Medicine Residency, Denver Health Medical Center, 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.
OBJECTIVE: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. (Copyright © 2002 American College of Emergency Physicians).
Keeping Battered Women Safe During Welfare Reform: New Challenges.
- Raphael J. J Am Med Women Assn 2002; 57(1): 32-35.
Jody Raphael, Center for Impact Research, 926 N. Wolcott, Chicago, IL 60622 USA (email: jodycir@cs.com).
Available online: ( Download Document ).
This paper reviews the growing body of research literature on the relationship of domestic violence to welfare. Not only do women on welfare suffer from domestic violence in far greater numbers than women in the general population, but their abusers, threatened by the women's efforts at education, training, or work, also use violence and threats of violence to sabotage these efforts at economic self-sufficiency. For this reason, welfare reform exacerbates domestic violence in the lives of many low-income women. As a result of the federal Family Violence Option, most state welfare plans allow battered women on welfare more time and specialized services before mandating work in order to keep them and their children safe. Recent research and monitoring have shown, however, that the majority of battered women on welfare do not tell their welfare workers about the violence. Ending the isolation of these battered women and helping them with domestic violence services pose difficult challenges. Women's health providers may be in a better position to accomplish this task than welfare department personnel. (Copyright © 2002 American Medical Women's Association)
Prevalence and patterns of intimate partner violence among adolescent mothers during the postpartum period.
- Harrykissoon SD, Rickert VI, Wiemann CM. Arch Pediatr Adolesc Med 2002; 156(4):325-330.
Correspondence: Constance M. Wiemann, Department of Pediatrics, Section of Adolescent and Sports Medicine, Baylor College of Medicine, 6621 Fannin St, CC610.01, Houston, TX 77030-2399 USA (email: cwiemann@bcm.tmc.edu).
OBJECTIVE: To examine prevalence, frequency, severity, and patterns of intimate partner violence (IPV) during the first 24 months' post partum within a multiethnic cohort of adolescents.
METHODS: DESIGN: A prospective study of adolescent girls followed up for 24 months into the postpartum period. Follow-up surveys were completed at 3, 6, 12, 18, and 24 months' post partum. Overall, 74% completed at least 4 of the 5 follow-up surveys. SETTING: Postpartum unit at a university teaching hospital in Galveston, Tex. PARTICIPANTS: A total of 570 adolescents (18 years or younger; 219 Mexican Americans, 182 African Americans, and 169 European Americans) completed face-to-face interviews within 48 hours of delivery and returned at least 4 of 5 follow-up surveys. MAIN OUTCOME MEASURES: Prevalence of IPV and frequent and severe IPV.
RESULTS: Prevalence of IPV was highest at 3 months' post partum (21%) and lowest at 24 months (13%). The percentage of assaulted mothers who experienced severe IPV increased from 40% to 62% across this period. Seventy-five percent of mothers reporting IPV during pregnancy also reported IPV within 24 months following delivery. Of importance, 78% who experienced IPV during the first 3 postpartum months had not reported IPV before delivery. Ethnic differences in IPV were observed at 3, 6, and 18 months' post partum.
CONCLUSIONS: Adolescents are at high risk for experiencing IPV during the postpartum period. Frequent screening for IPV by health care practitioners is critical to maximize detection. (Copyright © 2002 American Medical Association)
A statewide survey of domestic violence screening behaviors among pediatricians and family physicians.
- Lapidus G, Cooke MB, Gelven E, Sherman K, Duncan M, Banco L. Arch Pediatr Adolesc Med 2002; 156(4):332-336.
Correspondence: Gary Lapidus, Injury Prevention Center, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106 USA (email: glapidu@ccmckids.org).
OBJECTIVE: To assess rates of previous domestic violence (DV) training, current screening practices, and barriers to screening among Connecticut pediatric primary care physicians. DESIGN: Self-administered mail survey.
METHODS: SETTING: State of Connecticut. PARTICIPANTS: Pediatricians and pediatric care-providing family practice physicians (N = 903).
RESULTS: The response rate was 49% (n = 438). The demographic characteristics of the response sample were as follows: 70% male, 76% older than 40 years, 84% white, 87% in private practice, and 64% in suburban practice. Only 12% of the physicians reported routinely screening for DV at all well-child care visits, 61% reported screening only selective patients, and 30% said they did not screen for DV at all. Sixteen percent of the physicians reported having an office protocol for dealing with victims of DV. Respondents practicing in an urban setting were significantly more likely to screen routinely for DV than those practicing in a suburban setting (odds ratio, 1.77; 95% confidence interval, 1.12-2.79). Prior DV training was the strongest predictor of routine screening (odds ratio, 5.17; 95% confidence interval, 3.13-8.56). In fact, respondents with previous training made up 64% of those who routinely screened for DV.
CONCLUSIONS: Only a minority of Connecticut pediatric care physicians routinely screen mothers for DV. Primary care physicians with education and training about DV are screening at higher rates than physicians with no education and training. Pediatric physicians need training, protocols, and best-practice models on how to identify and intervene with families experiencing DV. (Copyright © 2002 American Medical Association)
Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of vermont and massachusetts high school students.
- Robin L, Brener ND, Donahue SF, Hack T, Hale K, Goodenow C. Arch Pediatr Adolesc Med 2002; 156(4):349-355.
Correspondence: Leah Robin, MS K-33, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341 USA (email: ler7@cdc.gov).
OBJECTIVE: To examine associations between health risk behaviors and sexual experience with opposite-, same-, or both-sex partners in representative samples of high school students.
METHODS: DESIGN: We used 1995 and 1997 data from the Vermont and Massachusetts Youth Risk Behavior Surveys. Logistic regression and multiple regression analyses were used to compare health risk behaviors among students who reported sex with opposite-sex partners only (opposite-sex students), with same-sex partners only (same-sex students), and with both male and female sexual partners (both-sex students). SETTING: Public high schools in Vermont and Massachusetts. PARTICIPANTS: Representative, population-based samples of high school students. The combined samples had 14 623 Vermont students and 8141 Massachusetts students. MAIN OUTCOME MEASURE: Violence, harassment, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices.
RESULTS: In both states, both-sex students were significantly more likely to report health risk behaviors than were opposite-sex students. For example, both-sex students had odds 3 to 6 times greater than opposite-sex students of being threatened or injured with a weapon at school, making a suicide attempt requiring medical attention, using cocaine, or vomiting or using laxatives to control their weight. In both states, same-sex students were as likely as opposite-sex students to report most health risk behaviors.
CONCLUSION: Relative to opposite- and same-sex students, both-sex students may be at elevated risk of injury, disease, and death by experiencing serious harassment and engaging in violence, suicidal behavior, alcohol and other drug use, and unhealthy weight control practices. (Copyright © 2002 American Medical Association)
US hate crime legislation : a legal model to avoid in Australia.
- Morgan J. J Sociology 2002; 38(1): 25-48.
Jo Morgan, Department of Social Work, Social Policy and Sociology, University of Sydney, Sydney NSW 2006 Australia.
Analysis of US hate crime legislation reveals a significant overall trend involving: (1) the inclusion of a notion of hate motivation on the part of the offender; (2) the provision for enhanced penalties; and (3) the identification of particular victimized groups who are listed in state and federal hate crime statutes. Whether or not a person is recognized as a hate crime victim in US statutes has been shown to be heavily influenced by the strength of social movements based on politicized identities. It is argued that this alignment problematizes the position of victims who are the targets of hate crimes yet who fail to organize on the basis of identity politics, lack political clout, have insufficient moral status, or who see hate crime legislation as an ineffective way of dealing with their particular concerns. This paper examines the barriers to achieving hate crime victim status for persons who are targeted because of their occupations or sexual orientation. The specific examples I will use are doctors and other workers in abortion clinics, sex workers and paedophiles. These widely disparate groups have been selected as examples to highlight some of the moral status, politicized identity and social movement and lobbying strength issues that are currently involved in being recognized as a victim of hate in the US. It is argued that Australia should not proceed down the track of introducing hate crime legislation. Hate crime legislation is the source of serious social disquiet and acrimony in the US. There are inequities built into the alignment between proving hate intent and the enhanced penalty approach that involve giving higher symbolic status to some bodies and not others. As the experience in the US shows, this has a dangerous potential to undermine social cohesion and community faith in equality before the law as well as creating a breeding ground of resentment. (Copyright © 2002 Australian Sociological Association)
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