20 May 2002
State laws mandating or promoting training programs for alcohol servers and establishment managers: an assessment of statutory and administrative procedures.
- Mosher JF, Toomey TL, Good C, Harwood E, Wagenaar AC. J Public Health Policy 2002; 23(1):90-113.
Corrspondence: James F. Mosher, Marin Institute for the Prevention of Alcohol and Other Drug Problems, San Rafael, California 94901, USA.
We conducted a qualitative analysis of 23 state Responsible Beverage Service (RBS) laws to determine how effective the laws are in mandating or encouraging high-quality RBS programs. As of January, 2001, 12 states at least partially mandate RBS training for alcohol establishments and 11 states offer incentives to encourage participation in RBS training. We collected information regarding state RBS laws from two sources: (1) RBS statutes and associated regulatory provisions, and (2) telephone surveys of Alcoholic Beverage Control agency staff. We identified and evaluated five components of RBS laws: program requirements, administrative requirements, enforcement provisions, penalties for lack of compliance with law, and benefits for participation in training programs. Comprehensiveness of RBS laws varied by state; however, RBS legislation was weak across all states overall. While some states were strong in one or two of the RBS components, almost all states were weak in at least one component. (Copyright © 2002 Journal of Public Health Policy)
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No reports this week
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Validation of a Screening Instrument for Exposure to Violence in African American Children.
- Flowers A, Lanclos NF, Kelly ML. J Ped Psychology 2002; 27(4): 351-361.
Correspondence: Anise Flowers, Tarnow Center for Self-Management, 1001 West Loop South, #215, Houston, Texas 77027 USA (email: doctorflowers@email.com).
OBJECTIVE: To provide concurrent validity data for the KID-SAVE as a screening instrument for exposure to violence in African American children, to explore demographic differences in KID-SAVE scores, and to provide preliminary reliability data on a parent version of the KID-SAVE.
METHODS: Questionnaire data were collected regarding exposure to violence, children's behavior and symptoms, and family aggression. A sample of 182 children and their parents participated.
RESULTS: Both parent and child report of violence exposure was significantly related to the child's psychological adjustment as endorsed by both parents and children. Also, significant relationships were obtained between parent report of their child's exposure to violence and the presence of family violence.
CONCLUSIONS: The KID-SAVE appears to be a promising instrument for the assessment of exposure to violence, specifically in African American children, and may be applicable in a variety of clinical settings. (Copyright © 2002 Society of Pediatric Psychology)
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Heat wave morbidity and mortality, Milwaukee, Wis, 1999 vs 1995: an improved response?
- Weisskopf MG, Anderson HA, Foldy S, Hanrahan LP, Blair K, Torok TJ, Rumm PD. Am J Public Health 2002 May;92(5):830-833.
Correspondence: Marc Weisskopf, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115 USA (email: mweissko@hsph.harvard.edu).
OBJECTIVES: This study examined whether differences in heat alone, as opposed to public health interventions or other factors, accounted for the reduction in heat-related deaths and paramedic emergency medical service (EMS) runs between 1995 and 1999 during 2 heat waves occurring in Milwaukee, Wis.
METHODS: Two previously described prediction models were adapted to compare expected and observed heat-related morbidity and mortality in 1999 based on the city's 1995 experience.
RESULTS: Both models showed that heat-related deaths and EMS runs in 1999 were at least 49% lower than levels predicted by the 1995 relation between heat and heat-related deaths or EMS runs.
CONCLUSIONS: Reductions in heat-related morbidity and mortality in 1999 were not attributable to differences in heat levels alone. Changes in public health preparedness and response may also have contributed to these reductions. (Copyright © 2002 American Public Health Association)
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Application of a falls prevention program for older people to primary health care practice.
- Gardner MM, Robertson MC, McGee R, Campbell AJ. Prev Med 2002 May;34(5):546-553.
Correspondence: M. Clare Robertson Department of Preventive and Social Medicine, University of Otago Medical School, P.O. Box 913, Dunedin, New Zealand (email: clare.robertson@stonebow.otago.ac.nz).
BACKGROUND: Our research group has established the effectiveness of an individually tailored home exercise program to prevent falls and fall injuries in older people in four controlled trials. In one of these trials we evaluated the applicability of the exercise program to routine primary health care practice and the feasibility of nurses implementing the program.
METHODS: People aged 80 years and older, registered with general practices in three exercise (n = 330 participants) and four control centers (n = 120 participants) in New Zealand, were invited to take part by their doctor. We investigated program reach, uptake, and compliance. We carried out physical assessments at baseline and after 1 year to assess the impact of the program.
RESULTS: Most (85%) doctors agreed to take part and they approved 71% of patients to undertake the exercise program. Overall 47% of people invited agreed to participate and 70% of the exercise participants remained exercising at 1 year. Balance score and chair stand time improved by a similar amount in each exercise center compared with the control centers.
CONCLUSIONS: This falls prevention program is acceptable to older people and their doctors. Nurses trained by a physiotherapist can deliver the home exercise program effectively in routine primary health care practice. (Copyright © 2002 American Health Foundation and Elsevier Science)
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Fire and flame related events with multiple occupational injury fatalities in the United States, 1980-1995.
- Biddle EA, Hartley D. Injury Control and Safety Promotion 2002; 9(1): 9-18.
Correspondence: Elyce Anne Biddle, National Institute for Occupational Safety and Health, Analysis and Field Evaluations Branch, Division of Safety Research, Morgantown, USA.
The National Traumatic Occupational Fatalities surveillance system recorded 1587 fire and flame related occupational fatalities among the civilian workforce in the United States between 1980 and 1995. Of these fatalities, 433 resulted from 127 incidents that involved two or more victims. For purposes of this study, these victims were categorized into one of three cause-of-death classifications: burns, inhalation or other traumatic injury. The classification "Burns" accounted for 232 or just over one-half of the fatalities and an additional 172 cases were coded as inhalation. Other traumatic injury was named as the cause of death for another 23 fatalities or five percent of the multiple victims. The cause of death for the remaining six fatalities could not be determined from the death certificates. This study revealed the similarities and disparities of the demographic and employment characteristics associated with these three cause-of-death classifications. (Copyright © 2002 © Swets & Zeitlinger)
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Why teenagers owning a bicycle helmet do not use their helmets.
- Lajunen T, Rasanen M. J Safety Res 2001 32(3): 323-332.
Correspondence: Timo Lajunen, Department of Psychology, Middle East Technical University, ODTU 06531, Ankra, Turkey (email: timo@metu.edu.tr).
BACKGROUND: Recent reports about bicycle helmet wearing indicate that the number of helmet users is still very small among teenagers.
OBJECTIVE: The objective of this prevalence survey was to investigate why teenagers do not use a bicycle helmet even if they have one.
METHODS: Data were collected at two schools in Helsinki, Finland. High school students (N=965) completed a questionnaire about their cycling habits and bicycle helmet use.
RESULTS: A student's parents' positive attitude to bicycle helmet use was the strongest predictor of having a helmet. Analyses of responses given by bicycle helmet owners showed that having friends who use a bicycle helmet is strongly related to a student's decision to wear a helmet. In addition, parents' positive opinion to helmet wearing predicted helmet use frequency. Other factors accounted only for a small proportion of variance in helmet wearing frequency.
CONCLUSIONS: The present study shows that the most efficient way of increasing bicycle helmet-wearing rate among students is to influence peer opinions and to inform students' parents about the safety benefits of bicycle helmets, which should be taken into account when planning bicycle helmet-wearing campaigns and other countermeasures. (Copyright © 2001 National Safety Council and Elsevier Science)
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No reports this week
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No reports this week
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Reduced risk of sudden death from chest wall blows (commotio cordis) with safety baseballs.
- Link MS, Maron BJ, Wang PJ, Pandian NG, VanderBrink BA, Estes NA 3rd. Pediatrics 2002; 109(5): 873-877.
Correspondence: Mark S. Link, Center for the Cardiovascular Evaluation of Athletes, the Cardiac Arrhythmia Center, New England Medical Center, 750 Washington St., Boston, Massachusetts 02111, USA (email: mlink@lifespan.org).
BACKGROUND: Sudden cardiac death can occur after chest wall impact with a baseball (commotio cordis). Whether softer-than-standard (safety) baseballs reduce the risk of sudden death is unresolved from the available human data. In a juvenile swine model, ventricular fibrillation (VF) has been shown to be induced reproducibly by precordial impact with a 30-mph baseball 10 to 30 ms before the T-wave peak, and this likelihood was reduced with the softest safety baseballs (T-balls). To further test whether safety baseballs would reduce the risk of sudden death at velocities more relevant to youth sports competition, we used our swine model of commotio cordis to test baseballs propelled at the 40-mph velocity commonly attained in that sport.
OBJECTIVES: In an experimental model of sudden death from baseball chest wall impact (commotio cordis), we sought to determine if sudden death by baseball impact could be reduced with safety baseballs.
METHODS: Forty animals received up to 3 chest wall impacts at 40 mph during the vulnerable period of repolarization for VF with 1 of 3 different safety baseballs of varying hardness, and also by a standard baseball.
RESULTS: Safety baseballs propelled at 40 mph significantly reduced the risk for VF. The softest safety baseballs triggered VF in only 11% of impacts, compared with 19% and 22% with safety baseballs of intermediate hardness, and 69% with standard baseballs. CONCLUSION: In this experimental model of low-energy chest wall impact, safety baseballs reduced (but did not abolish) the risk of sudden cardiac death. More universal use of these safety baseballs may decrease the risk of sudden death on the playing field for young athletes. (Copyright © 2002 American Academy of Pediatrics)
Snow sports injuries in Scotland: a case-control study.
- Langran M, Selvaraj S. Br J Sports Med 2002; 36(2): 135-140.
Correspondence: Michael Langran, Aviemore Medical Practice, Aviemore, Inverness-shire PH22 1SY, Scotland, UK (email: doc_mike@hotmail.com).
OBJECTIVES: To examine the incidence and patterns of snow sports injuries at the three largest commercial ski areas in Scotland and to identify factors associated with injury risk.
METHODS: A prospective case-control study of all injured people at Cairngorm, Glenshee, and Nevis Range ski areas during the 1999-2000 winter season. Personal details, snow sports related variables, diagnosis, and treatment were recorded. Control data were collected at random from uninjured people at all three areas. Random counts were performed to analyse the composition of the on slope population.
RESULTS: A total of 732 injuries were recorded in 674 people. Control data were collected from 336 people. The injury rate for the study was 3.7 injuries per 1000 skier days. Alpine skiers comprised 67% of the on slope population, snowboarders 26%, skiboarders 4%, and telemark skiers 2%. Lower limb injuries and sprains were the commonest injuries in alpine skiers and skiboarders. Snowboarders sustained more injuries to the upper limb and axial areas. Skiboarders and snowboarders had a higher incidence of fractures. After adjustment for other variables, three factors were all independently associated with injury: snowboarding (odds ratio (OR) 4.07, 95% confidence interval (CI) 1.65 to 10.08), alpine skiing (OR 3.82, CI 1.6 to 9.13), and age <16 years (OR 1.9, CI 1.14 to 3.17). More than five days of experience in the current season and at least one week of experience in total had a protective effect against injury.
CONCLUSIONS: Despite a change in the composition of the alpine population at Scottish ski areas, the overall rate and pattern of injury are similar to those reported previously in comparable studies. Several factors are associated with an increased risk of injury and should be targeted in future injury prevention campaigns. (Copyright © 2002 British Journal of Sports Medicine)
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No reports this week
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Prevalence of traumatic brain injury in an ED population.
- Boswell JE, McErlean M, Verdile VP. Am J Emerg Med 2002;20:177-180.
Correspondence: Mara McErlean, MD, Albany Medical College, Department of Emergency Medicine MC-139, 47 New Scotland Avenue, Albany, NY 12208 USA (email: Mcerlem@mail.amc.edu).
The objective of this study was to determine prevalence of traumatic brain injury (TBI) in an emergency department (ED) population. Questionnaires were administered to patients in an urban, university, trauma center ED. All respondents provided demographics; patients reporting TBI were asked age at injury, if they experienced loss of consciousness (LOC), mechanism, or if medical attention was sought. Five hundred one patients completed the survey. Forty-one percent reported TBI; 23% had TBI with LOC. Mean age at injury was 21.5 years. Mechanism was evenly distributed among sports, assaults, falls, and motor vehicle crashes (MVC). Medical attention was sought for 61% of injuries. Men were more likely to report TBI (P < .001). Medical attention was more likely if MVC or LOC and less likely in sports-injured patients (all P < .01). Twenty-five percent of patients with TBI sustained repeat injury by the same mechanism. Prevalence of TBI in this population is high. Many occur by mechanisms that potentially are preventable. (Copyright © 2002, Elsevier Science)
Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes.
- Newgard CD, Lewis RJ, Jolly BT. Ann Emerg Med 2002; 39(5): 481-491.
Correspondence: Craig D. Newgard, MD, MPH, Department of Emergency Medicine, Harbor-UCLA Medical Center, Box 21, 1000 West Carson Street, Torrance, CA 90509; 310-222-3666, fax 310-782-1763 USA (email: newgard@emedharbor.edu).
OBJECTIVES: We sought to create a clinical decision rule, on the basis of variables available to out-of-hospital personnel, that could be used to accurately predict severe injury in pediatric patients involved in motor vehicle crashes as occupants.
METHODS: We analyzed the National Automotive Sampling System database, a national probability sample, using pediatric patients up to 15 years old (occupants only) involved in motor vehicle crashes from January 1993 to December 1999. The National Automotive Sampling System database includes patients from regions throughout the country, weighted to represent a nationwide sample. Twelve out-of-hospital variables were used in classification and regression tree analysis to create a decision rule separating children with severe injuries (Injury Severity Score [ISS] 16) from those with minor injuries (ISS<16). Misclassification costs and complexity parameters were selected to yield a decision tree with appropriate sensitivity and specificity for the identification of severely injured patients, while also being simple and practical for out-of-hospital use. Probability weights were used throughout the analysis to account for the sampling design and sampling weights.
RESULTS: Using a sample size of 8,392 children, we constructed a decision rule using 3 out-of-hospital variables (Glasgow Coma Scale score, passenger space intrusion 6 in [15 cm], and restraint use) to predict those patients with an ISS of 16 or more. Internal cross-validation was used to determine the sensitivity and specificity, yielding values of 92% and 73%, respectively, for the prediction of patients with an ISS of 16 or more.
CONCLUSIONS: Out-of-hospital variables available to field personnel could be used to effectively triage pediatric motor vehicle crash patients using the decision rule developed here. Prospective trials would be needed to test this decision rule in actual use.
[Newgard CD, Lewis RJ, Jolly BT. Use of out-of-hospital variables to predict severity of injury in pediatric patients involved in motor vehicle crashes. (Copyright © 2002 American College of Emergency Physicians)
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No reports this week
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See abstract on hazing under Violence
See abstract on gatekeepers under Suicide
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The Protective Role of Parental Involvement in Adolescent Suicide.
- Flouri E, Buchanan A. Crisis 2002; 23(1):17-22.
Correspondence: Eirini Flouri, Department of Social Policy and Social Work, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK; (email: eirini.flouri@socres.ox.ac.uk).
This study of 2722 adolescents aged 14-18 years explored whether parental involvement can protect against adolescent suicide attempts. Compared to their counterparts suicide attempters were more likely to have been in trouble with the police, to report lower levels of parental interest and academic motivation, and to report suicidal ideation and using alcohol or an illegal drug when they feel stressed. They were also less likely to reside with both parents. The association between parental involvement and suicidal behaviour was not stronger for sons than for daughters or for adolescents who had experienced family disruption than for those who grew up in two-parent families. (Copyright © 2002 International Association for Suicide Prevention and Hogrefe & Huber Publishers)
Prevention of youth suicide: how well informed are the potential gatekeepers of adolescents in distress?
- Scouller KM, Smith DI. Suicide Life Threat Behav 2002; 32(1): 67-79.
Correspondence: David I. Smith, Department of Psychology, RMIT University, Plenty Road, Bundora AUSTRALIA 3083 (email: david.smith@rmit.edu.au).
Australia has one of the higher rates of suicide among young people. Although a role for doctors and teachers in the prevention of youth suicide has been suggested, no prior Australian study has assessed adequately the level of suicide knowledge held by these professionals. Knowledge about adolescent suicide was investigated using the Adolescent Suicide Behaviour Questionnaire, a 39-item instrument developed for the purpose. The stratified random sample comprised 404 general practitioners and 481 teachers from 56 secondary schools. General practitioners and teachers scored, on average, 71% and 59% of the questionnaire items correct, respectively. There was wide individual variability: The number of items correct ranged from 4 to 38 for general practitioners and 0 to 34 for teachers. Strengths and deficits in knowledge across the two professions are discussed in terms of the potential gatekeeping role of these professionals in suicide prevention. (Copyright © 2002 The American Associan of Suicidology)
Assault victimization and suicidal ideation or behavior within a national sample of U.S. adults.
- Simon TR, Anderso M, Thompson MP, Crosby A, Sacks JJ. Suicide Life Threat Behav 2002 Spring;32(1):42-50.
Correspondence: Thomas Simon, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, MS- K-60, Atlanta, GA 30341-3724, USA (email: tsimon@cdc.gov).
Data from a nationally representative sample of 5,238 U.S. adults were used to examine the extent to which physical assault victimization was associated with suicidal ideation or behavior (SIB). The results from multivariable logistic regression analyses indicate that physical assault victimization was positively associated with SIB after adjusting for sociodemographic characteristics and alcohol use (OR = 3.6; 95% CI = 2.4-5.5). Those who were injured during the most recent physical assault (OR = 2.7; 95% CI = 1.2-6.0) and those who were assaulted by a relative (OR = 3.4; 95% CI= 1.0-11.0) or intimate partner (OR = 7.7; 95% CI = 2.7-22.5) were significantly more like to report SIB than victims who were not injured or were assaulted by a stranger. Also, those who were victimized but not injured (OR = 5.6; 95% CI = 3.8-8.2) and those who were victimized by a stranger (OR = 2.9; 95% CI = 1.4-6.0) were more likely to report SIB than non-victims. These results highlight the need for legal, medical, mental health, and social service providers to address the co-occurrence of violent victimization and suicidal ideation, particularly, but not exclusively, victimization by family members and intimates. (Copyright © 2002 The American Associan of Suicidology)
A case control study of suicide and attempted suicide in older adults.
- Beautrais AL. Suicide Life Threat Behav 2002 Spring;32(1):1-9.
Correspondence: Annette L. Beautras, Canterbury Suicide Project, Christchurch School of Medicine, P.O. Box 4345, Christchurch, New Zealand (email: suicide@chmeds.ac.nz).
Risk factors for serious suicidal behavior among older adults were examined in a case control study of 53 adults aged 55 and older who died by suicide or made medically serious suicide attempts and who were compared with 269 randomly selected comparison subjects. Multivariate analyses suggested that risk of serious suicidal behavior was elevated among those with current mood disorders (OR = 179, CI = 52.8-607.6), psychiatric hospital admission within the previous year (OR = 24.4, CI = 1.9-318.7), limited social network (OR = 4.5, CI = 1.4-14.6). The predominant role of mood disorders was confirmed by population attributable risk (PAR) estimates (73.6%), suggesting that the improved detection, treatment and management of mood disorders should be the primary focus of suicide prevention strategies for older adults. (Copyright © 2002 The American Associan of Suicidology)
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Previous convictions or accidents and the risk of subsequent accidents of older drivers.
- Daigneault G, Joly P, Frigon JY. Accid Anal Prev 2002; 34(2):257-261.
Correspondence: G. Daigneault, Reseau de Sante Richelieu-Yamaska, Departement des Soins longues durees, St. Hyacinthe, Quebec, CANADA (email: gedaigneault@hotmail.com).
The over-involvement of elderly drivers in collisions has a potentially adverse effect on highway safety. The question for most experts in traffic research is whether we can predict the individual risk of accidents and which variables are the best predictors, especially for this population. For a better understanding of the elderly drivers' problems, this study aimed to describe the most common types of accidents in the elderly population of drivers living in Quebec (> or = 65 years of age). The second objective of the study was to analyse the relationship between previous accidents or convictions and the risk of subsequent accidents. The results show that: (1) elderly drivers are characterised by error accidents involving more than one car, especially at intersections, (2) prior accidents are a better predictor for accident risk than prior convictions and (3) these trends steadily increase with each age group (drivers 65 years old to 80 years or more). The results are discussed in relation to the literature on risk behaviour of the elderly drivers.
Evaluating the crash and citation rates of Utah drivers licensed with medical conditions, 1992-1996.
- Vernon DD, Diller EM, Cook LJ, Reading JC, Suruda AJ, Dean JM. Accid Anal Prev 2002 Mar;34(2):237-246.
Correspondence: Donald D. Vernon, University of Utah School of Medicine, Salt Lake City 84108, USA (email: don.vernon@hsc.utah.edu).
BACKGROUND: Medical problems may affect the ability to drive motor vehicles, and programs that control the issuing of driver licenses to individuals with medical conditions exist in most states. The main activity of these programs is the imposition of restrictions upon the driving privileges of individuals with medical conditions that are deemed to pose some risk to public safety. However, little is known about the effectiveness of these licensing programs.
OBJECTIVE: The objective of this study was to compare the rates of adverse driving events (crash, at-fault crash and citations) experienced by drivers licensed with medical conditions to those of age-, sex- and location-matched controls. Separate comparisons were made for drivers reporting medical conditions licensed with full driving privileges, and those with restricted driving privileges (e.g. speed, area and time of day).
METHODS: DESIGN: Retrospective case-control. METHODS: The study population was all drivers licensed in the state of Utah who reported a medical condition on their driver license application, over the 5-year period 1992-1996. Drivers enter the program by self-reporting their medical problems. Control drivers were chosen from the entire population of drivers licensed in Utah for the same period. Information on driver license status, participation in the medical conditions program, citations, involvement in crashes, and death certificate data was obtained from the relevant state agencies. Probabilistic linkage methodology was used to link the records in these disparate databases for eventual analysis. Rates of citation, crashes and at-fault crashes, expressed as events per 10000 license days, were calculated separately for program drivers and their corresponding control groups for each medical condition category and restriction status. These data were used to determine an estimate of relative risk (RR) and 95% confidence intervals.
RESULTS: As a group, medical conditions drivers had modestly elevated rates of adverse driving events compared with control drivers (RR 1.09-1.74). Rates in the largest medical category, 'cardiovascular conditions', were not higher than controls. Rates were higher than control for some conditions, such as 'alcohol' and 'learning and memory', for some adverse events (RR 2.2 -5.75). Drivers with more than one medical condition appeared comparable to the general group of medical conditions program drivers.
CONCLUSIONS: Drivers in Utah medical conditions program had modestly elevated rates of adverse driving events compared to matched controls. Possible underreporting of medical conditions and accurate assessment of exposure rates are potential weaknesses in the program.
Is the claim that 'variance kills' an ecological fallacy?
- Davis GA. Accid Anal Prev 2002 May;34(3):343-346.
Correspondence: Gary A. Davis, Department of Civil Engineering, University of Minnesota, Minneapolis 55455, USA (email: drtrips@tc.umn.edu).
Over the past 15 years, a number of studies have reported positive correlations between estimated traffic crash rate and the dispersion of vehicle speeds. These correlations have on occasion been interpreted as supporting the view that slower and/or faster drivers have higher crash risks, or that speed variance itself is a causal factor for individual crash risk. This paper points out first that such positive correlations can be expected in situations where individual crash risk is either an increasing, or a decreasing, or a U-shaped function of speed, and so the correlations in themselves provide no evidence concerning the relation between speed and crash risk for individuals. Second, since such correlations can be expected in circumstances where individual risk is independent of speed variance, observation of these correlations provides no support for the hypothesis that increases in speed variance increase individual risk.
Femur fractures in relatively low speed frontal crashes: the possible role of muscle forces.
- Tencer AF, Kaufman R, Ryan K, Grossman DC, Henley BM, Mann F, Mock C, Rivara F, Wang S, Augenstein J, Hoyt D, Eastman B; Crash Injury Research and Engineering Network (CIREN). Accid Anal Prev 2002 Jan;34(1):1-11.
Department of Orthopedics, Harborview Medical Center, 325 9th Ave., Seattle, WA 98104, USA (email: atencer@u.washington.edu).
In a sample of relatively low speed frontal collisions (mean collision speed change of 40.7 kph) the only major injury suffered by the partly or fully restrained occupant was a femur fracture. However, femur load measurements from standardized barrier crash tests for similar vehicles at a greater speed change (mean of 56.3 kph) showed that in almost all the cases, the occupant's femur would not have fractured because the loads were below fracture threshold. In order to address this discrepancy, the load in the femurs of the occupants in the crash sample were estimated and compared with the femur fracture threshold. Femur load was estimated by inspecting the scene and measuring deformations in each vehicle, defining occupant points of contact and interior surface intrusion, and calculating crash change in velocity and deceleration. From this data, the measured femoral loads from standardized crash test data in a comparable vehicle were scaled to the actual crash by considering crash deceleration, occupant weight, and restraint use. All the occupants (7 males, average age 26.7 years, 13 females, average age 36 years) sustained at least a transverse midshaft fracture of the femur with comminution, which is characteristic of axial compressive impact, causing bending and impaction of the femur. However, the estimated average maximum axial load was 8187 N (S.D. = 4343N), and the average probability for fracture was only 19% (based on the femur fracture risk criteria). In 13 crashes the fracture probability was less than 10%. Two factors were considered to explain the discrepancy. The occupant's femur was out of position (typically the driver's right front leg on the brake) and did not impact the knee bolster, instead hitting stiffer regions of the dashboard. Also, since most victims were drivers with their foot on the brake to avoid the collision, additional compressive force on the femur probably resulted from muscle contraction due to bracing for impact. Adding the estimated muscle load on the femur to the estimated external load increased the femur loads beyond threshold, explaining the fracture in all but one case. Since crash tests using dummies cannot simulate out of position occupants or muscle contraction loading, they may underestimate the total load acting on the femur during actual impacts where the driver is bracing for the crash. These results may have implications for altering knee bolster design to accommodate out of position occupants and the additional load caused by muscle forces during bracing.
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Traumatic injuries caused by hazing practices.
- Finkel MA. Am J Emerg Med 2002; 20: 228-233.
Correspondence: Michelle A. Finkel, MD, Massachusetts General Hospital, Clinics 115, Fruit Street, Boston, MA 02114 USA (email: mfinkel@partners.org).
Hazing is defined as committing acts against an individual or forcing an individual into committing an act that creates a risk for harm in order for the individual to be initiated into or affiliated with an organization. Hazing is an enduring activity with roots that date back to the ancient and medieval eras. It has become increasingly prevalent in fraternities and sororities, high school and college athletic organizations, the military, professional sports teams, and street gangs. Scant information is available in the medical literature regarding hazing. This article reviews the history of hazing, provides statistics regarding its prevalence, presents information on specific hazing practices and consequent traumatic injuries, and assesses alcohol's influence on hazing. It also offers recommendations on how to recognize victims of hazing in the Emergency Department and proposes guidelines for their treatment. Current legislation and information on the prevention of traumatic injuries from hazing are discussed. (Copyright 2002, Elsevier Science)
Drug Dealers, Robbery and Retaliation. Vulnerability, Deterrence and the Contagion of Violence.
- Topalli V, Wright R, Fornango R. Br J Criminology 2002; 42(2): 337-351.
Correspondence: Volkan Topalli, Department of Criminal Justice, College of Health and Human Sciences, Georgia State University, Atlanta, GA 30302-4018, USA (email: vtopalli@gsu.edu).
Because of their illicit status, drug dealers robbed in the course of doing business cannot go to the police. Thus, the deterrent, compensatory and retributive benefits of formal justice are unavailable to them. Informal avenues of redress represent their only means of obtaining justice. This article, based on interviews with 20 recently robbed, active drug dealers in St Louis, Missouri, explores how such victims perceive and respond to the assault. Results indicate that direct retaliation is the preferred response because it serves three important aims: reputation maintenance, loss recovery and vengeance. When dealer/victims are unable or unwilling to retaliate they resort to less satisfactory alternatives such as robbery displacement and the resumption of selling. The implications of these findings for the spread of drug market violence are discussed. (Copyright © 2002 Centre for Crime & Justice Studies)
A Personality-Based Model of Adolescent Violence.
- I. Sutherland I, J. P. Shepherd JP. Br J Criminology 2002; 42(2): 433-441.
Correspondence: I. Sutherland, The Violence Research Group, Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine, Cardiff, CF14 4XY. (email: Sutherlandi3@cardiff.ac.uk).
The aim of this study was to explore the relationship between adolescent violence and two personality constructs: self-esteem and lack of self-concern. Other types of delinquent behaviour such as use of alcohol and illicit drugs were also examined. It was hypothesized that adolescents who fought would have lower self-esteem and higher measures of a lack of self-concern than those who did not fight. It was also hypothesized that adolescent fighters would have a greater experience of substance use than non-fighters and that these factors would be inter-related.
The survey was of 13,650 pupils (aged 11-16) in a stratified sample from 39 schools in five Local Education Authority areas in Northern England, the Midlands and London. Data were collected during the latter part of 1999. Respondents were asked, in a confidential self-report questionnaire, about their levels of self-esteem and lack of self-concern, their experiences of fighting and their alcohol and illicit drug use.
14.4 per cent of this sample said they had hit someone within the past year. More boys than girls had hit someone in the past year (2 = 73.446, df1, p <.0001, O/R 1.8). 22.1 per cent of respondents had high levels of lack of self-concern. More boys than girls exhibited high levels of this trait (boys, 26.3%; girls 18.2 per cent 2 = 198.288, df2, p <.0001, O/R 1.6). 2.6 per cent of the population had low self-esteem with more boys than girls having low self-esteem (boys, 2.8 per cent; girls, 2.5 per cent 2 = 8.051, df2, p <.01, O/R 1.1). 12.7 per cent were regular alcohol drinkers, 16.6 per cent smokers and 3.3 per cent regularly used illicit drugs.
Binary logistic regression was used to develop a model that accounted for 87.2 per cent of the variance with over 96 per cent of those who fought being correctly identified. The model consisted of gender, self-esteem, lack of self-concern, cigarette smoking, illicit drug use, frequency of alcohol use and frequency of drunkenness (G = 2904.274, DF = 13, p < .0001).
Lack of self-concern and low self-esteem are useful constructs in predicting adolescent violence, but cannot be considered in isolation of other behaviours. Research should be encouraged which identifies the causes of low self-esteem in adolescents. (Copyright © 2002 Centre for Crime & Justice Studies)
Planning youth violence prevention efforts: decision-making across community sectors.
- Lutenbacher M, Cooper WO, Faccia K. J Adolesc Health 2002; 30(5): 346-354.
Correspondence: Melanie Lutenbacher, Vanderbilt University School of Nursing, Nashville, Tennessee, USA (email: melanie.lutenbacher@vanderbilt.edu).
OBJECTIVES: To identify practical components of decision-making for youth violence prevention program planning and to identify differences in decision-making across various provider sectors of the community.
METHODS: Data were collected in seven focus groups (n = 82) representing seven key sectors of the community involved in youth violence prevention activities (e.g., educators, law enforcement officers, and healthcare providers). Discussion was guided by a series of open-ended questions that we developed. Transcript-based content analysis using NVivo software identified common themes among and across sectors.
RESULTS: Similarities and differences in planning and selecting prevention efforts were found across sectors. Educators targeted behaviors that disrupt the school process, while other sectors focused on precursors and concurrent factors of violent behavior and the development of desirable behaviors. Public health and public policy participants underscored outcome measures, benchmarks, and a match between funding and effective programs as essential elements. Youth identified the need for respect from adults and the recognition of positive youth behaviors. All groups noted the lack of a systematic method of considering potential programs, the importance of youth and parental involvement in efforts, the lack of a scientific base for many programs, concerns about exposure to violence, and inappropriate role models in multiple environments.
CONCLUSIONS: Healthcare providers often participate in the development of youth violence prevention programs. Understanding similarities and differences in focus among key sectors of the community is essential in developing coordinated interdisciplinary approaches. (Copyright © 2002 Society for Adolescent Medicine)
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