17 June 2002
See abstract under Violence
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Earthquake disasters--lessons to be learned.
- Peleg K, Reuveni H, Stein M. Isr Med Assoc J 2002; 4(5):361-365.
Correspondence: Kobi Peleg, Trauma and Emergency Medicine Research Unit, Gertner Institute for Health Policy Research, Tel Hashomer, ISRAEL; (email: kobip@gertner.health.gov.il).
Human beings do not have the ability prevent earthquakes. However, we can take measures to minimize injuries and damage by using strict building codes and constructing infrastructures in areas of less risk. A great number of buildings in Israel, including some hospitals, will not withstand a major earthquake as they were built with inadequate standards. Data collected during earthquakes show a significant rise in cardiac-related disease and stress-related medical problems in addition to conventional injuries. Public health issues are of increasing importance due to the collapse of sanitation facilities. In addition to field clinics, field hospitals should be deployed in the vicinity of the stricken area. While planning the medical response for disasters such as earthquakes, one should take into account the availability of local medical personnel. Some or most of the local staff may be unable to function. A study from the Gulf War showed that even the threat of chemical attack resulted in less staff reporting to work [33]. During the 1999 earthquakes in Turkey, many of the hospital staff opted to care for their close families instead of reporting to work at the hospital. Regular training exercises in prehospital emergency medical services for the more common multiple casualty incidents should be bolstered with additional exercises in mass casualty incidents. The basic functions in these scenarios may be quite different. Although no exercise can mimic the real event, preplanning and drills are invaluable. When an earthquake does occur, medical management includes local search and rescue teams together with emergency medical service teams if these can still function. Early deployment of local medical centers can alleviate the burden from local hospitals. Evacuation to distant medical centers is probably a major key for success. Psychological problems are abundant in such incidences, affecting also rescue and medical teams. It becomes a major issue when there are large numbers of pediatric casualties and the operations continue for more than a few days. (Copyright © 2002 Israel Medical Association Journal)
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Work-related injuries among firefighters: sites and circumstances of their occurrence.
- Szubert Z, Sobala W. Int J Occup Med Environ Health 2002; 15(1):49-55.
Correspondence: Zuzanna Maria Szubert, Department of Occupational and Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, POLAND; zuzanna@imp.lodz.pl).
OBJECTIVES: The aim of the present study was to determine the injury ratio, causes and duration of temporal work disability from on-duty injuries among firefighters, taking into account the site and circumstances of their occurrence.
METHODS: The study was performed on a representative sample of 1503 firefighters from 29 fire stations who were employed between 1994 and 1997. Subject to investigation were data on the number of days and cases of work disability due to on-duty injury, personal data (age, work duration) and data on the circumstances of injury during emergency operations, taking part in compulsory physical training, performing maintenance and repair works, on duty at the fire station, and when commuting to or from work.
RESULTS: The analysis of work-related causes and circumstances of injuries among firefighters revealed that the majority of injuries (40%) occurred during compulsory physical training, being responsible for 41% of post-injury absence at work. The workers employed for less than one year were at highest risk of injury. Injuries during emergency operations made 25% of all injuries and accounted for 24% of post-injury absence. The analysis of data showed that the frequency of injuries was not significantly aged-dependent, however, the duration of work disability was found to increase by 20% with increasing age of workers.
CONCLUSIONS: The results indicated the need for undertaking preventive interventions to minimize occupational hazards to those involved in firefighting. (Copyright © 2002 Polish Association of Occupational Medicine)
The influence of light on circarhythms in humans.
- Kuller R. J Physiol Anthropol Appl Human Sci 2002; 21(2):87-91.
Rikard Kuller, Environmental Psychology Unit, School of Architecture, Lund Institute of Technology, Box 118, SE-221, Lund, SWEDEN; (email: mpe@mpe.lth.se).
The present review discusses two types of biological rhythms, namely, circadian rhythms and circannual rhythms. Humans possess a circadian rhythm of approximately 24 hours, which is regulated by neural and hormonal processes. The synchronisation of this rhythm with the solar day and night is maintained through entrainment mainly by light. Dark environments completely lacking windows may have a negative effect on well-being and work capacity. During shift work the biological clock tends to maintain its normal 'diurnal' rhythm, which may lead to extreme tiredness and increased risk of accidents. Negative effects such as these may be partially alleviated by means of bright light during the night. During air travel across several time zones there is little time for the biological clock to adjust, but the resulting 'jet lag' may possibly be overcome by means of appropriately timed exposure to bright light. In countries situated far from the equator, the biological clock may become seriously disrupted during the short days of the dark season. Characterised by fatigue, sadness and sleep problems, these seasonal affective disorders may be cured or alleviated by means of regular periods outdoors, better lighting indoors, or, in the most serious cases, light therapy. (Copyright © 2002 Japan Society of Physiological Anthropology)
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Fatal pedestrian-bicycle collisions.
- Graw M, Konig HG. Forensic Sci Int 2002; 126(3):241-247.
Correspondence: Matthias Graw, Institut für Rechtsmedizin, Universität München, Frauenlobstr. 7a, 80337 München, GERMANY; (email: matthias.graw@gmx.de).
Although, fatal collisions between pedestrians and bicycles are relatively rare, they are still of forensic relevance because of the need to explore the circumstances of the accident. Based on three reconstructed cases, situation and injury patterns are presented that might prove useful in future cases: 1) usually the person causing the accident is the cyclist while the pedestrian generally suffers more severe injuries; 2) the situation at the site of accident is important for its reconstruction: end location of the persons involved in the accident, injuries and traces on pedestrians and cyclists, traces at the site of accident and on the bicycle; 3) because of the lack of pre-crash traces and any eyewitness accounts, the pedestrian's injuries are the best starting point for the reconstruction of the accident; 4) a characteristic wound on the lower leg of the pedestrian that reveals the initial impact between the front wheel and the leg is crucial not because of its seriousness, but because of its external morphology; 5) the injuries that can be expected by the following impact between body and handlebar are unspecific and only minor; 6) the most severe injuries to the pedestrian as a result of the accident are caused secondarily by falling and hitting the head on the road; 7) the fall of the cyclist, however, corresponds to a throw-off followed by a sliding phase with less impact load when the head hits the ground [maximum abbreviated injury scale 1 (MAIS 1)]; 8) the cyclists involved are mainly younger persons on fashionable bicycles (here: mountain bikes); in the great majority of cases, the injured pedestrians are frail, elderly people with a lower tolerance of trauma. (Copyright 2002 Elsevier Science)
All-terrain vehicle and bicycle crashes in children: epidemiology and comparison of injury severity.
- Brown RL, Koepplinger ME, Mehlman CT, Gittelman M, Garcia VF. J Pediatr Surg 2002; 37(3):375-380.
Correspondence: Rebeccah L. Brown, Department of Pediatric Surgery, Pediatric Orthopedic Surgery, Children's Hospital Medical Center, OSB-3, 3333 Burnet Ave, Cincinnati, OH 45229-3039 USA; (email: rebeccah.brown@chmcc.org).
BACKGROUND: Despite statements by the American Academy of Pediatrics (AAP) and the US Consumer Product Safety Commission (CPSC) against the use of all-terrain vehicles (ATVs) by children under the age of 16 years, nearly half of ATV-related injuries and over 35% of all ATV-related deaths continue to occur in this age group.
OBJECTIVES: Because ATV and bicycle crashes have been associated with serious injury in children, the authors compared the demographics, mechanism of injury, injury severity, and outcome of children with ATV- and bicycle-related injuries. Further, the authors sought to identify whether ATV-related injuries elicited changes in risk-taking behavior.
METHODS: A retrospective, comparative analysis of 109 children admitted for ATV-related injuries and 994 children admitted for bicycle-related injuries to a level 1 pediatric trauma center between January 1991 and June 2000 was performed. A phone survey was conducted to determine self-reported changes in safety behaviors or use patterns after ATV injury.
RESULTS: Mean age was 11.1 plus minus 3.5 years (range, 2 to 18 years) for ATV crashes versus 9.4 plus minus 3.3 years (range, 1 to 17 years) for bicycle crashes (P < .05). Ninety-three percent of ATV crashes occurred in children less than 16 years of age; 31% in children less-than-or-equal10 years of age; and 7% in children less-than-or-equal5 years of age. Male-to-female ratio was about 3:1 for both groups. White race accounted for 97% of ATV injuries compared with 79% of bicycle injuries (P < .05). Falls from ATVs or bicycles were the most common mechanism of injury (41% v 59%, respectively). Collisions with motor vehicles were more common for bicyclists (32% v 10%), whereas collisions with stationary objects were more common among ATV riders (27% v 9%). Sixteen percent of ATV crashes were caused by a roll-over mechanism. Mean injury severity score (ISS) were significantly higher for victims of ATV crashes (8.3 ATV v 6.7 bicycle; P < .05). ATV-related trauma was associated with multiple injuries, more operative interventions, and longer hospital stays. Location and distribution of injuries were similar for both groups. Helmet use was low in both groups but higher for ATV riders (23% v 8%; P < .5). Mortality rate was similar for both groups (0.9% for ATV riders v 0.7% for bicyclists). There was a 39% response for the phone survey post-ATV injury. Twenty-three of 43 (53%) respondents owned the ATV, and 70% of these received safety information at the time of purchase. However, only 14% of injured riders received any formal training before riding ATVs. Postinjury, 60% of children continued to ride, although 42% reported decreased riding time. Fifty-four percent of children reportedly wore helmets preinjury, and there were no changes in helmet usage postinjury. There were no differences in pre- and postinjury parental supervision (61% v 65%).
CONCLUSIONS: Both ATV and bicycle-related injuries occur predominantly in boys, but ATV victims are older and almost all are white. Almost all ATV injuries occurred in children under the age of 16 years. Although both ATV and bicycle crashes cause severe injuries in children, injury severity is higher for ATV crashes in terms of multiple injuries, need for operative intervention, and longer length of stay. Despite severe injuries, the majority of children injured by ATVs continue to ride, albeit fewer hours per day, and safety behaviors are unaltered. These data reinforce the current AAP stance that legislation prohibiting the use of ATVs in children under the age of 16 years without a valid driver's license should be pursued and enforced aggressively. (Copyright © 2002 by W.B. Saunders Company)
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Epidemiology of poisoning in children: a 7-year survey in a paediatric emergency care unit.
- Lamireau T, Llanas B, Kennedy A, Fayon M, Penouil F, Favarell-Garrigues JC, Demarquez JL. Eur J Emerg Med 2002; 9(1): 9-14.
Thierry Lamireau, Paediatric Emergency Care Unit, Children's Hospital, Place Amélie Raba Léon, 33077, Bordeaux, Cedex, FRANCE; (email: thierry.lamineau@chu-bordeaux.fr).
Acute poisoning in children is still a major public health problem, and represents a frequent cause of admission in emergency departments. We carried out an epidemiological study of poisonings leading to admission to a paediatric emergency care unit (PECU). We analysed data from 2988 children who were admitted to the PECU of Bordeaux, France with acute poisoning from 1989 through 1995. During the 7-year period, the poison exposure numbers decreased slightly from 490 to 382 (6% vs. 3% of total medical emergencies). This represented a mean annual incidence of 1.4 poison exposures per 1000 children younger than 18 years of age and living in Bordeaux and its surroundings. Characteristics of the study population, circumstances of poisoning and substances involved were similar to those previously described. Eighty per cent of children were younger than 5 years of age, presented with a benign course. Forty per cent were not treated and 75% were discharged home either immediately or within 24 hours of admission. Only 1.5% of cases, mainly adolescent girls who attempted suicide, were admitted to a paediatric intensive care unit. Overall mortality rate was 0.33/1000. In children, most cases of acute poisoning are accidental, benign, and mainly attributed to the ingestion of a non-toxic substance. This points to the need for better information of the population on availability of poison control centre calling facilities, in order to decrease the number of admissions to the PECU. Patients suspected of having ingested a potentially dangerous substance can be managed in short-stay observation units, thus avoiding unnecessarily prolonged hospitalization. Acute poisoning in children remains a frequent problem, highlighting the need to develop an education programme on primary prevention in our region. (Copyright © 2002 Lippincott Williams & Wilkins)
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See abstract under Bicycles & Pedestrians
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The Economic Impact of Motor vehicle Crashes 2000.
- Blincoe LJ, Seay AG, Zaloshnja E, Miller TR, Romano EO, Luchter S, Spicer RS. (2002) Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration.
Full report available online: ( Download Document ).
This report presents the results of an analysis of motor vehicle crash costs in the United States in the year 2000. The total economic cost of motor vehicle crashes in 2000 was $230.6 billion. This represents the present value of lifetime costs for 41,821 fatalities, 5.3 million non-fatal injuries, and 28 million damaged vehicles, in both police-reported and unreported crashes. Lost market productivity accounted for $61 billion of this total, while property damage accounted for nearly as much - $59 billion. Medical expenses totaled $32.6 billion and travel delay accounted for $25.6 billion. Each fatality resulted in an average discounted lifetime cost of $977,000. Public revenues paid for roughly 9 percent of all motor vehicle crash costs, costing tax payers $21 billion in 2000, the equivalent of over $200 in added taxes for every household in the U.S. Alcohol-involved crashes accounted for $51.1 billion or 22 percent of all economic costs, and 75 percent of these costs occurred in crashes where a driver or non-occupant had a BAC of .10 or greater. In roughly 80 percent of these cases, alcohol was the cause of the crash. Crashes in which police indicate that at least one driver was exceeding the legal speed limit or driving too fast for conditions cost $40.4 billion in 2000. Safety belt use prevented 11,900 fatalities, 325,000 serious injuries, and $50 billion in injury related costs in 2000, but the failure of a substantial portion of the driving population to buckle up caused 9,200 unnecessary fatalities, 143,000 serious injuries, and cost society $26 billion in easily preventable injury related costs.
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Suicide among young people in selected Brazilian State capitals.
- Souza ER, Minayo MC, Malaquias JV. Cad Saude Publica 2002; 18(3):673-683.
Correspondence: Edinilsa Ramos de Souza, Departamento de Epidemiologia e Metodos Quantitativos em Saude, Escola Nacional de Saude Publica, Fundacao Instituto Oswaldo Cruz, Rio de Janeiro, RJ, 21041-210, BRAZIL; (email: edinilsa@claves.fiocruz.br).
This study analyzes suicide among young Brazilians (15-24 years old) in nine metropolitan areas. Mortality data for 1979-1998 were obtained from the Mortality Information System of the Ministry of Health. External causes are the main causes of death among youth, and suicide is the sixth most frequent of these causes. The distribution is heterogeneous, varying according to the social stratum, specific age group, sex, and means used to commit suicide. All cities analyzed showed increased suicide rates from 1979 to 1998 (from 3.5 to 5.0 per 100,000 inhabitants 15-24 years old). Salvador and Rio de Janeiro had the lowest suicide rates, while Porto Alegre and Curitiba had the highest. The principal means used by youth to commit suicide were hanging, strangling, and suffocation (Porto Alegre), followed by firearms and explosives (Belo Horizonte). (Copyright © 2002 Escola Nacional de Saúde Pública)
Opera subculture and suicide for honor.
- Stack S. Death Stud 2002; 26(5):431-437.
Correspondence: Steven J. Stack, Wayne State University, Detroit, Michigan, USA; (email: sstack@wayne.edu).
The influence of music-based subcultures on suicidality has been the subject of much debate but little scholarly research.While previous work has documented that suicide is a remarkably frequent cause of death in opera, it has not explored the related consequences on opera's audience. In particular, the possible influence of the opera subculture on suicide acceptability has been largely unexplored. Suicide in the case of life without honor, the "Madame Butterfly Effect," is a theme in opera. Persons who are drawn into and/or influenced by the opera subculture of honor are hypothesized to be more accepting of suicide in the case of dishonor to one's family. Data are from the national general social surveys (N = 845). A multivariate logistic regression analysis finds that opera fans are 2.37 times more accepting of suicide because of dishonor than nonfans. Only two variables, religiosity and education, are more closely related to suicide acceptability than opera fanship. These are the first empirical results on the subject of opera and suicide acceptability. (Copyright © 2002 Taylor & Francis)
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Role of lateral acceleration in curve driving: driver model and experiments on a real vehicle and a driving simulator.
- Reymond G, Kemeny A, Droulez J, Berthoz A. Hum Factors 2001; 43(3):483-495.
Correspondence: Gilles Reymond, Renault Dierection de la Recherche, Technocentre Renault, Guyancourt, FRANCE; (email: gilles.reymond@renault.com).
Experimental studies show that automobile drivers adjust their speed in curves so that maximum vehicle lateral accelerations decrease at high speeds. This pattern of lateral accelerations is described by a new driver model, assuming drivers control a variable safety margin of perceived lateral acceleration according to their anticipated steering deviations. Compared with a minimum time-to-lane-crossing (H. Godthelp, 1986) speed modulation strategy, this model, based on nonvisual cues, predicts that extreme values of lateral acceleration in curves decrease quadratically with speed, in accordance with experimental data obtained in a vehicle driven on a test track and in a motion-based driving simulator. Variations of model parameters can characterize "normal" or "fast" driving styles on the test track. On the simulator, it was found that the upper limits of lateral acceleration decreased less steeply when the motion cuing system was deactivated, although drivers maintained a consistent driving style. This is interpreted per the model as an underestimation of curvilinear speed due to the lack of inertial stimuli. Actual or potential applications of this research include a method to assess driving simulators as well as to identify driving styles for on-board driver aid systems. (Copyright © 2001 Human Factors and Ergonomics Society)
Human performance models and rear-end collision avoidance algorithms.
- Brown T L, Lee J D, McGehee D V. Hum Factors 2001; 43(3): 462-482.
Correspondence: John Lee, Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City 52242, USA; (email: jdlee@engineering.uiowa.edu).
Collision warning systems offer a promising approach to mitigate rear-end collisions, but substantial uncertainty exists regarding the joint performance of the driver and the collision warning algorithms. A simple deterministic model of driver performance was used to examine kinematics-based and perceptual-based rear-end collision avoidance algorithms over a range of collision situations, algorithm parameters, and assumptions regarding driver performance. The results show that the assumptions concerning driver reaction times have important consequences for algorithm performance, with underestimates dramatically undermining the safety benefit of the warning. Additionally, under some circumstances, when drivers rely on the warning algorithms, larger headways can result in more severe collisions. This reflects the nonlinear interaction among the collision situation, the algorithm, and driver response that should not be attributed to the complexities of driver behavior but to the kinematics of the situation. Comparisons made with experimental data demonstrate that a simple human performance model can capture important elements of system performance and complement expensive human-in-the-loop experiments. Actual or potential applications of this research include selection of an appropriate algorithm, more accurate specification of algorithm parameters, and guidance for future experiments. (Copyright © 2001 Human Factors and Ergonomics Society)
Distance perception of vehicle rear lights in fog.
- Cavallo V, Colomb M, Dore J. Hum Factors 2001; 43(3):442-451.
Correspondence: Viola Cavallo, Laboratoire de Psychologie de la Conduite, Institut National de Recherche sur les Transports et leur Securite, Arcueil, FRANCE; (email: cavallo@inrets.fr).
Perceptual difficulty is one of the main explanations given for the behavioral modifications and high accident rate associated with driving in fog. The present study investigates how fog and the characteristics of vehicle rear lights affect distance perception. Two experiments in a fog chamber (meteorological visibility range of 5-15 m) were run under conditions simulating nighttime fog. The participants gave verbal estimates of the distance (8-28 m) of vehicles simulated by rear-light arrangements. The results revealed an average increase of 60% in the perceived distance of vehicles in fog as compared with normal visibility conditions. Distance overestimation was particularly pronounced when the vehicle had only 1 fog light instead of 2 and when the lights were close together. No effect of light height was observed. These results suggest that the perception of vehicle distance in nighttime fog could be significantly improved by the presence of 2 lights with maximal spacing. Actual or potential applications of this research include vehicle rear light design. (Copyright © 2001 Human Factors and Ergonomics Society)
Acute stress disorder symptoms in children and their parents after pediatric traffic injury.
- Winston FK, Kassam-Adams N, Vivarelli-O'Neill C, Ford J, Newman E, Baxt C, Stafford P, Cnaan A. Pediatrics 2002; 109(6):e90.
Flaura Winston, The Children's Hospital of Philadelphia, TraumaLink, Philadelphia, Pennsylvania 19104, USA; (email: flaura@mail.med.upenn.edu).
OBJECTIVE: The American Academy of Pediatrics highlights the important role of pediatricians in recognizing adverse child responses to tragic events, such as traffic crashes. One challenge in effectively identifying children and their parents with troubling psychological responses to trauma is that little is known about the normal range of acute psychological responses in children and their parents in the immediate aftermath of traumatic events, making identification of adverse child responses difficult. Within the first month after a traumatic event, individuals may display reexperiencing, avoidance, and hyperarousal symptoms as well as dissociation (eg, feelings of unreality or emotional numbing). The presence of these responses, collectively known as acute stress disorder (ASD), alerts providers to those who may be at risk for ongoing difficulties. For beginning to develop an evidence base to guide pediatric care providers in addressing acute traumatic responses, the aim of the current investigation was to describe systematically the range and type of symptoms of ASD in children and their parents after pediatric traffic injury.
METHODS: A prospective cohort study was conducted of traffic-injured children, who were 5 to 17 years of age and admitted to the hospital for treatment of injuries from traffic crashes, and their parents. All children who met eligibility criteria between July 1999 and May 2000 were invited to participate in the study. After consent/assent was obtained, children and their custodial parents (or guardians) were interviewed within 1 month after injury via a structured assessment to determine the circumstances of the crash and the presence of ASD symptoms. Relevant demographic and clinical information (eg, age, race, gender, date of injury) was abstracted from the medical records of subjects. A survey instrument to assess the presence of ASD symptoms was completed by both the child and his or her guardian. All children completed the Child Acute Stress Questionnaire, and all parents completed the Stanford Acute Stress Reaction Questionnaire. Responses were scored for the presence of dissociation, reexperiencing, avoidance, and/or hyperarousal symptoms as well as broad distress (symptoms present in every category).
RESULTS: Symptoms of ASD were commonly observed in the children and parents. Eighty-eight percent of children and 83% of parents reported having at least 1 clinically significant symptom; this affected 90% of the families. Broad distress was observed for a large minority: 28% of children and 23% of parents. No statistically significant association was found between child broad distress and either child age (r = -0.12) or child injury severity score (r = -0.05). chi(2) analyses revealed no significant association between broad distress and child gender, child race, or mechanism of injury. No statistically significant association was found between parent broad distress and child age (r = -0.06) or child injury severity score (r = 0.09). chi(2) analyses revealed no significant association between parent broad distress and child gender or parent presence at the crash scene. Associations were found between parent broad distress and race in that fewer white parents reported broad distress. In addition, mechanism of injury was associated with parent broad distress: more parents reported broad distress when their children were involved in pedestrian-motor vehicle crashes, and fewer parents reported broad distress when their children were injured in a bicycle fall.
CONCLUSIONS: Pediatric care providers can expect to see some ASD symptoms in most children and parents in the immediate aftermath of traffic-related injury. Brief education is appropriate to explain that these symptoms are normal reactions that are likely to resolve. If symptoms persist for > 1 month or are particularly distressing in their intensity, then referral for psychological care may be necessary for treatment of posttraumatic stress disorder. Given the high prevalence of pediatric traffic crashes and the underdiagnosis of posttraumatic stress disorder, probing for recent crash exposure might be appropriate during routine child health maintenance. The following are recommendations for pediatricians: 1) routinely call the family several days and 1 to 2 weeks after a traffic injury and ask about behavioral symptoms and family function; 2) make use of the ongoing physician-patient relationship to explore symptom presence and intensity and any functional impairment in the injured child; a brief office visit with the child and parents could serve this purpose; 3) be sure to explore the effect that the child's injury has had on the family; remember that the parent's experience posttraumatic stress symptoms after pediatric traffic-related injuries and these symptoms may limit the parent's ability to support the child; 4) provide supportive care and give families the opportunity to discuss the crash and their current feelings; do not force families to talk about the crash; 5) although any child in a traffic crash or his or her parent is at risk for posttraumatic symptomatology, regardless of injury severity, particular attention should be paid to the parents of child pedestrians who are struck by motor vehicles. These parents experience posttraumatic symptoms more commonly than parents of children in other traffic crashes. (Copyright © 2002 American Academy of Pediatrics)
The effects of motorcycle helmet use between hospitals in states with and without a mandatory helmet law.
- Proscia N, Sullivan T, Cuff S, Nealon P, Atweh N, DiRusso SM. Conn Med 2002; 66(4):195-198.
Correspondence: Nicole Proscia, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
BACKGROUND: Motorcycle injuries and mortality are different depending on the use of a helmet. Helmet use varies greatly depending on state laws.
METHODS: Retrospective study using trauma registry data from two Level 1 Trauma Centers in states with (NY) and without (CT) a mandatory helmet law, from 1996 through 1998.
RESULTS: Motorcycle accident victims in both states were similar for sex, age, RTS, TRISS probability of survival, GCS on arrival and ISS. Helmet use was higher in New York than in Connecticut (91% vs 18%, P < .01). Mortality was higher in Connecticut than in New York (15% vs 6%, P < .05).
CONCLUSION: The demographics and injury severity of motorcycle accident victims presenting to Level 1 Trama Centers were very similar in the two adjoining states. The most significant difference between the states is that of helmet use. This is closely related to the decreased mortality rate and the higher GCS at discharge seen in the state with the mandatory helmet law. (Copyright © 2002 Connecticut State Medical Society)
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The role of aggression-related alcohol expectancies in explaining the link between alcohol and violent behavior.
- Zhang L, Welte JW, Wieczorek WW. Subst Use Misuse 2002; 37(4):457-471.
Lening Zhang , Behavioral Sciences Department , 216 Scotus Hall, Saint Francis College, Loretto, Pennsylvania, USA; (email: lzhang@francis.edu).
Studies have demonstrated an acute effect of alcohol on violent behavior. A remaining issue is the motivation of some offenders for using alcohol before offending. A common explanation is based on the relationship between daily drinking habit and drinking before offending. Drawing upon the deviance disavowal assumption, the embolden hypothesis, and expectancy theories, the present study argues that alcohol may be used intentionally to promote or excuse the violent consequences of drinking. Using data from the 1993 Buffalo Longitudinal Study of Young Men, the present study examines the independent effect of aggression-related alcohol expectancies on drinking before offending and the interactive effect of aggression-related alcohol expectancies and daily alcohol consumption on drinking before offending. The results indicate a significant effect of aggression-related alcohol expectancies on alcohol use before offending. This supports the argument that drinking may be a means for carrying out violent acts. A significant interactive effect was found between aggression-related alcohol expectancies and daily alcohol consumption. "Heavy" daily alcohol consumption increased the likelihood of drinking before offending for individuals who had high aggression-related alcohol expectancies more than those who had low such expectancies. Aggression-related alcohol expectancies moderated the effect of daily drinking on drinking before offending. The implications of these findings are discussed for the link between alcohol and violence. (Copyright © 2002 Institute for the Study of Drug Misuse and Marcel Dekker, Inc.)
Domestic violence across generations: findings from northern India.
- Martin SL, Moracco KE, Garro J, Tsui AO, Kupper LL, Chase JL, Campbell JC. Int J Epidemiol 2002; 31(3): 560-572.
Correspondence: Sandra L. Martin, Department of Maternal and Child Health, CB # 7445, University of North Carolina, Chapel Hill, NC 27599-7445, USA; (email: sandra_martin@unc.edu).
BACKGROUND: Although one cannot underestimate the importance of macrosystem-level forces (such as cultural and social norms) in the aetiology of gender-based violence within any country, including India, individual-level variables (such as observing violence between one's parents while growing up) may also play important roles in the development of such violence.
OBJECTIVES: This research studies men residing in northern India to: (1) estimate the prevalence of men's childhood experiences of witnessing parent-to-parent violence within their families of origin; (2) examine whether men raised in violent homes were more likely than men raised in non-violent homes to have attitudes supportive of husbands' control of their wives; (3) examine whether men raised in violent homes were more likely than men raised in non-violent homes to be abusive toward their own wives; and (4) estimate the extent to which wife abuse in this second generation could have been prevented had there not been parent-to-parent violence in the men's natal families.
METHODS: Married men (n = 6902) were surveyed concerning: their childhood experiences of witnessing parent-to-parent violence in their families of origin; their attitudes regarding the appropriateness of husbands' control of their wives; their physically and sexually abusive behaviours toward their own wives; and sociodemographic variables. Descriptive statistics, multivariable modelling procedures, and estimation of a population attributable fraction were used to address the study questions.
RESULTS: Approximately one-third of the men had witnessed parent-to-parent violence as a child. Compared to men raised in non-violent homes, men from violent homes were significantly more likely to believe in husbands' rights to control their wives, and to be physically/sexually abusive toward their own wives. Non-violence in the earlier generation was strongly predictive of non-violence in the second generation, with about a third of the wife abuse in the second generation being attributable to parent-to-parent violence in the first generation.
CONCLUSIONS: These findings from northern India are congruent with those from other geographical/cultural settings in suggesting that witnessing violence between one's parents while growing up is an important risk factor for the perpetration of partner violence in adulthood. (Copyright © 2002 International Epidemiological Association)
Vulnerability to homicide in Karachi: political activity as a risk factor.
- Mian A, Mahmood S, Chotani H, Luby S. Int J Epidemiol 2002; 31(3): 581-585.
Correspondence: S Luby, Mailstop A-38, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (email: sxl2@cdc.gov).
BACKGROUND: Previous studies analysing Karachi ambulance data from 1993 to 1995 identified neighbourhoods in Karachi disproportionately affected by homicide.
OBJECTIVES:As a step toward developing intervention programmes to curb violence, we conducted a study to identify risk factors for becoming a homicide victim in a high violence area of Karachi.
METHODS We interviewed families of 35 cases, individuals intentionally killed through acts of violence between January 1994 and January 1997, and 85 community-based controls frequency matched by sex, from Orangi, a high violence area of Karachi.
RESULTS: Most of our cases and controls were male (97% and 92%, respectively) and had similar socioeconomic and ethnic backgrounds. All the victims were killed by firearms; 4 (11%) had been tortured prior to death. Most of the victims were killed in the streets (n = 25, 71%). Of these, 7 (36%) had been killed by law-enforcement officers, while 6 (24%) died from indiscriminate firing. People who were killed were 34 times more likely to have attended all political processions (29% versus 1%, odds ratio [OR] = 34; 95% CI: 4-749, P < 0.001), 19 times more likely to have attended political meetings (31% versus 2%, OR = 19; 95% CI: 4-136, P < 0.001), and 17 times more likely to have held an important position in a political party (29% versus 2%, OR = 17; 95% CI: 3-120, P < 0.001) than controls.
CONCLUSIONS: Homicide in Orangi was political. Efforts to improve trust between ethnic groups and to build legitimacy for non-violent forms of conflict resolution are important steps to limit future violence.(Copyright © 2002 International Epidemiological Association)
Bearing witness: ethics in domestic violence research.
- Ellsberg M, Heise L. Lancet 2002; 359(9317):1599-604.
Correspondence: Mary Ellsberg, Program for Appropriate Technology in Health (PATH), 1800 K St N W, Suite 800, 90006, Washington DC, USA; (email: mellsberg@path-dc.org).
Epidemiological research involving people has inherent risks. The Council for International Organization of Medical Sciences provides guidance on the ethical principles of epidemiological research, including respect for people, non-maleficence, beneficience, and justice. In this article we discuss the challenges of applying each principle to population research on domestic violence, an issue in which poorly designed research could put women in violent relationships at substantial risk. Main concerns include ensuring safety of respondents in a context in which many live with their abuser, protecting confidentiality when breaches could provoke an attack, and ensuring the interview process is affirming and does not cause distress. The inherent risks entailed in research can only be justified if the interview is used to provide information on available services and is a source of immediate referral when necessary, if high-quality data are obtained, and if findings are used to raise awareness of, and improve services for, women who experience domestic violence. (Copyright © 2002 Elsevier Science)
School violence: an overview.
- Strawhacker MT. J Sch Nurs 2002; 18(2):68-72.
Correspondence: MaryAnn T. Strawhacker, Des Moines University Osteopathic Medical Center, Iowa, USA.
School violence is a growing area of concern for school nurses across the nation. Recent national data and a compilation of risk factors for youth violence and school shootings are presented as a general guide to identifying students who may be in need of assistance. The nurse's role in multidisciplinary planning and developing violence prevention strategies in the school and the community are examined. (Copyright © 2002 National Association of School Nurses)
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