SafetyLit - 1 July 2002

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1 July 2002

We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.

Alcohol's role in domestic violence: a contributing cause or an excuse?

Leonard KE. Acta Psychiatr Scand Suppl 2002; (412):9-14.

Correspondence: Kenneth E. Leonard, Research Institute on Addictions, University at Buffalo, State University of New York and Department of Psychiatry, School of Medicine, University at Buffalo, State University of New York, USA; (email: leonard@ria.buffalo.edu).

OBJECTIVES: This paper reviews evidence regarding the deviance disavowal approach to alcohol-related violence. It focuses on whether alcohol intoxication is used to excuse domestic violence, and whether this can explain alcohol/violence association.

METHODS: Four hypotheses derived from the deviance disavowal approach were identified, including (i) people accept alcohol as a cause of violence; (ii) people attribute less blame and punishment to intoxicated aggressors than to sober aggressors; (iii) the belief that alcohol causes or excuses violence should be associated with and predict the occurrence of alcohol-related domestic violence; and (iv) the administration of a placebo should increase aggressive behaviour.

RESULTS: The review suggested that some people do accept alcohol as a cause of violence, but that alcohol does not appear to mitigate blame, and this belief is not longitudinally predictive of violence.

CONCLUSIONS: The evidence for a deviance disavowal model of alcohol and domestic violence appears quite weak.(Copyright © 2002 Blackwell Publishing)

The underlying causes of accidents.

Andrews E. Commun Dis Public Health 2002; 5(1):87-88.

Many theories about the causation of accidents have developed over years, some of which are very complex. Often, multiple causes can be identified. Often, too, it is tempting to deal with the most obvious ones and ignore the others, which may be more difficult to address. Using a fairly straightforward approach, the causes of accidents can be divided in two main types, 'immediate' or 'primary', and 'indirect' or 'secondary'.
Recent paradigms for risk informed decision making

Amendola A. Safety Science 2002, 40(1-4): 17-30.

Correspondence: Aniello Amendola, International Institute for Applied Systems Analysis (IIASA) A-2361 Laxenburg, AUSTRIA; (email: amendola@iiasa.ac.at).

Any project aimed at technical harmonisation of risk assessment procedures should not ignore recent theories and policy recommendations on risk governance. For this reason, it is opportune to review the shift of paradigms for risk based decision making, which seem now to inform policy discussion on both sides of the Atlantic. Early deliberations on risk advocated a three-stage approach: establish the probability and magnitude of the hazards respecting the inherent scientific uncertainties (a technical process), evaluate the benefits and costs (a social process), and set priorities in such a way that the greatest social benefits are achieved at the lowest cost. In this perspective, the risk assessment phase was strictly separated from the management. Recent paradigms call for a participatory procedure, in which the different stakeholders are involved early in the risk analysis process to "characterise" risks, even before they are given a formal assessment. This does not diminish the role of modelling and quantification, but is aimed at eliciting the "values" and the perspectives of the community involved so that the multiple dimensions of risk can be taken into account early on in the assessment. Furthermore, the implications on risk assessment of the precautionary principle, on which the EU health and environmental policy is based, are briefly discussed. (Copyright © 2002 Elsevier Science)

Nuclear terrorism.

Hogan DE, Kellison T. Am J Med Sci 2002; 323(6):341-349.

Correspondence: David E. Hogan, Department of Emergency Medicine, St. Michael Hospital, Oklahoma City, OK, USA; (email: shogan@mmcable.com).

Recent events have heightened awareness of the potential for terrorist attacks employing nonconventional weaponry such as biological agents and radiation. Historically, the philosophy of nuclear risk has focused on global or strategic nuclear exchanges and the resulting damage from large-scale releases. Currently, nuclear accidents or terrorist attacks involving low-level or regional release of radiation are considered the most likely events. Thus far, there have been several regional radiation incidents exposing hundreds of thousands of people to radiation, but there have been only a limited number of significant contaminations resulting in death. There are several different types of radioactive particles that differ in mass, extent of radiation emitted, and the degree to which tissue penetration occurs. Radiation affects its toxicity on biological systems by ionization, which creates tissue damage by the generation of free radicals, disruption of chemical bonds, and directly damaging cellular DNA and enzymes. The extent of damage depends on the type of radioisotope and the radiation dose. Radiation doses exceeding 2 to 10 Gy are considered lethal. Optimal management of radiation casualties requires knowledge of the type and dose of radiation received, a recognition of the manifestations of radiation sickness, and the use of standard medical care, decontamination, and decorporation techniques.(Copyright © 2002 Southern Society for Clinical Investigation)

Fire and flame related events with multiple occupational injury fatalities in the United States, 1980-1995.

Biddle EA, Hartley D. Injury Control Safety Promo 2002; 9(1): 9-18.

Correspondence: Elyse A. Biddle, National Institute for Occupational Safety and Health, Analysis and Field Evaluations Branch, Division of Safety Research, 1095 Willowdale Road, Morgantown, WV 26505-2888, USA (email: egb6@cdc.gov).

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)
Management of violence in the workplace: a New Zealand survey.

Gale C, Pellett O, Coverdale J, Paton Simpson G. Acta Psychiatr Scand Suppl 2002; (412): 41-43.

Correspondence: Chris Gale, Division of Psychiatry, Faculty of Medicine and Health Sciences University of Auckland, Grafton, Auckland, New Zealand; (email: c.gale@auckland.ac.nz).

OBJECTIVES: : To estimate the rate of adverse events to staff, to survey the use of various preventative measures, and to assess any association between these factors and the reported event rate.

METHODS: An anonymous postal nation-wide survey of violence reported to managers of psychiatric units in New Zealand.

RESULTS: The mean rate of adverse event per 100 full time equivalent staff was 16.2 (range 0-187) for property damage, 16.3 (range 0-204) for attempted assault, 12 (range 0-194) for physical attack, 1.3 (range 0-33) for sexual harassment and 1.1 (range 0-17) for stalking. Inpatient units, the use of pocket alarms, and training in de-escalation were associated highly with an increase risk of adverse events.

CONCLUSIONS: There is a high variation in the rate of violence. The issue of increased rate of events with certain interventions will require further research. (Copyright © 2002 Blackwell Publishing)

Pedestrian-vehicle crashes and analytical techniques for stratified contingency tables.

Al-Ghamdi AS. Accid Anal Prev 2002; 34(2): 205-214.

Correspondence: Ali S. Al-Ghamdi, College of Engineering, King Saud University, P.O. Box 800, Riyadh, SAUDI ARABIA. asghamdi@ksu.edu.sa).

In 1999 there were 450 fatalities due to road crashes in Riyadh, the capital of Saudi Arabia, of which 130 were pedestrians. Hence, every forth person killed on the roads is a pedestrian. The aim of this study is to investigate pedestrian-vehicle crashes in this fast-growing city with two objectives in mind: to analyze pedestrian collisions with regard to their causes, characteristics, location of injury on the victim's body, and most common patterns and to determine the potential for use of the odds ratio technique in the analysis of stratified contingency tables. Data from 638 pedestrian-vehicle crashes reported by police, during the period 1997-1999, were used. A systematic sampling technique was followed in which every third record was used. The analysis showed that the pedestrian fatality rate per 10(5) population is 2.8. The rates were relatively high within the childhood (1-9 years) and young adult (10-19 years) groups, and the old-age groups (60 - > 80 years), which indicate that young as well as the elderly people in this city are more likely to be involved in fatal accidents of this type than are those in other age groups. The analysis revealed that 77.1% of pedestrians were probably struck while crossing a roadway either not in a crosswalk or where no crosswalk existed. In addition, the distribution of injuries on the victims' bodies was determined from hospital records. More than one-third of the fatal injuries were located on the head and chest. An attempt was made to conduct an association analysis between crash severity (i.e. injury or fatal) and some of the study variables using chi-square and odds ratio techniques. The categorical nature of the data helped in using these analytical techniques. (Copyright © 2002 Elsevier Science)
A Study of Influences of Vehicle Speed and Front Structure on Pedestrian Impact Responses Using Mathematical Models

Liu XJ, J. K. Yang JK, Lövsund P. Traffic Injury Prev 2002; 3(1): 31-42.

Correspondence: X. J. Liu, Crash Safety Division, Department of Machine and Vehicle Design, Chalmers University of Technology, Göteborg, SWEDEN; (email: liuxj@mvd.chalmers.se).

A validated pedestrian multibody model was used to investigate the influences of impact speed and vehicle front structure on the pedestrian dynamic responses in vehicle collisions. To predict the injury risks of pedestrians at different impact speeds, the injury-related parameters concerning head, chest and lower extremity areas were calculated from mathematical simulations. Four vehicle types including large and compact passenger cars, minivans and light trucks were simulated according to their frequency of involvement in real world accidents. The influences of various vehicle front shape and compliance parameters were analyzed.

Based on the results from the parametric study, the possible benefits from speed control in urban area were assessed, and a feasible speed limit was proposed to reduce the risks of pedestrian injuries. Moreover, the possible countermeasures on basis of vehicle front design to mitigate the injury severity of the pedestrians were discussed. (Cpyright © 2002 Taylor & Francis)
Safety education of pedestrians for injury prevention (Cochrane Review).

Duperrex O, Roberts I, Bunn F. Cochrane Database Syst Rev 2002;(2):CD001531.

Institut de Medecine Sociale et Preventive, Centre medical universitaire, 1, rue Michel-Servet, CH-1211, Geneve 4, SWITZERLAND; (email: Olivier.Duperrex@imsp.unige.ch).

Available online: http://www.update-software.com/abstracts/ab001531.htm.

BACKGROUND: Each year about one million people die and about 10 million are seriously injured on the world's roads. Educational measures to teach pedestrians how to cope with the traffic environment are considered to be an essential component of any prevention strategy, and pedestrian education has been recommended in many countries. However, as resources available for road safety are limited, a key question concerns the relative effectiveness of different prevention strategies.

OBJECTIVES: To quantify the effectiveness of pedestrian safety education programmes in preventing pedestrian-motor vehicle collisions.

SEARCH STRATEGY: We searched the Injuries Group specialised register, Cochrane Controlled Trials Register, TRANSPORT, MEDLINE, EMBASE, ERIC, PSYCHLIT, SPECTR, and the WHO database on the Internet. We checked reference lists of relevant reviews and papers and contacted experts in the field. Most database searching was conducted in 1999.

SELECTION CRITERIA: Randomised controlled trials of safety education programmes for pedestrians of all ages.

DATA COLLECTION AND ANALYSIS: One reviewer screened records. Two reviewers independently extracted data and assessed methodological quality of trials. Because of differences in the types of interventions and outcome measures used in the trials, meta-analyses were not carried out.

RESULTS: We found 15 randomised-controlled trials of pedestrian safety education programmes, conducted between 1976 and 1997. Methodological quality of the included trials was generally poor. Allocation concealment was adequate in three trials, outcome assessment was blinded in eight, and in most of the studies large numbers of participants were lost to follow-up. Study participants were children in 14 studies and institutionalised adults in one. Eight studies involved the direct education of participants, seven used parents as educators. No trials were conducted in a developing country and there were none of pedestrian safety training in the elderly. None of the included trials assessed the effect of pedestrian safety education on the occurrence of pedestrian injury but six trials assessed the effect on observed behaviour. Some of these trials showed evidence of behavioural change following pedestrian safety education but it is difficult to predict what effect this might have on pedestrian injury risk.

CONCLUSIONS: Pedestrian safety education can result in improvement in children's knowledge and can change observed road crossing behaviour but whether this reduces the risk of pedestrian motor vehicle collision and injury occurrence is unknown. There is evidence that changes in safety knowledge and observed behaviour decline with time suggesting that safety education must be repeated at regular intervals.
Interventions for increasing pedestrian and cyclist visibility for the prevention of death and injuries (Cochrane Review).

Kwan I, Mapstone J, Roberts I. Cochrane Database Syst Rev Issue 2 2002. Oxford: Update Software.

Correspondence: Irene Kwan, Public Health Intervention Research Unit, London School of Hygiene & Tropical Medicine, 49-51 Bedford Square, London, WC1B 3DP, UK; Irene.Kwan@lshtm.ac.uk).

Available online: http://www.update-software.com/abstracts/ab003438.htm

BACKGROUND: Pedestrians and cyclists account for nearly one in three of all road users killed and seriously injured in road traffic crashes. Late detection of other road users is one of the basic driver failures responsible for collisions. Aids to improve pedestrians and cyclist visibility have been used to avert potential collisions. However, the impact of these strategies on drivers' responses, and on pedestrian and cyclist safety is not known.

OBJECTIVES: To quantify the effect of visibility aids vs no visibility aids, and of different visibility aids on the occurrence of pedestrian and cyclist-motor vehicle collisions and injuries. To quantify the effect of visibility aids vs no visibility aids, and of different visibility aids on drivers' detection and recognition responses.

SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, the Injuries Group Specialised Register, MEDLINE, TRANSPORT, TRANSDOC from ECMT (European Conference of Ministers of Transport), IRRD (International Road Research Documentation), TRIS (Transportation Research Information Services), NRR (National Research Register), PsycInfo and PsycLit.

SELECTION CRITERIA: 1. Randomised controlled trials and controlled before/after trials of the effect of visibility aids on the occurrence of pedestrian and cyclist-motor collisions and injuries. 2. Randomised controlled trials of the effect of visibility aids on drivers' detection and recognition responses. This included trials where the order of presentation of visibility aids was randomised or balanced using a Latin square design.

DATA COLLECTION AND ANALYSIS: Two reviewers independently screened records, extracted data and assessed trial quality.

RESULTS: We found no trials assessing the effect of visibility aids on the occurrence of pedestrian and cyclist-motor vehicle collisions and injuries. We identified 37 trials assessing the effect of visibility aids on drivers' responses. Fluorescent materials in yellow, red and orange colours improve detection and recognition in the daytime. For night-time visibility, lamps, flashing lights and retroreflective materials in red and yellow colours increase detection and recognition. Retroreflective materials arranged in a 'biomotion' configuration also enhance recognition. Substantial heterogeneity between and within the trials limited the possibility for meta-analysis. Summary statistics and descriptive summaries of the outcomes were presented for individual trials when appropriate.

CONCLUSIONS: Visibility aids have the potential to increase visibility and enable drivers to detect pedestrians and cyclists earlier. Public acceptability of these strategies would merit further development. However, the effect of visibility aids on pedestrian and cyclist safety remains unknown. Studies which collect data on simple, meaningful outcomes are required.

No reports this week

Small watercraft injuries in children.

Beierle EA, Chen MK, Langham MR Jr, Kays DW, Talbert JL. Am Surg 2002; 68(6):535-538.

Department of Surgery, University of Florida, Gainesville 32610-0286, USA; (email: beierea@mail.surgery.ufl.edu).

The speed and use of small watercraft have increased dramatically in recent years. We report our experience with pediatric trauma resulting from small watercraft accidents. We conducted a retrospective chart review including all children admitted with injuries sustained in small watercraft accidents. Sixteen children were included; nine were injured in jet ski accidents and seven in accidents involving other craft. Jet ski accidents tended to result in more serious injuries (closed-head injuries, hollow and solid viscus injuries, chest trauma, spinal injuries leading to paralysis, and death) than those sustained in accidents with small boats. Skin and soft-tissue injuries and long-bone fractures were the most frequent injuries following accidents with other small boats. Six of eight children (75%) injured on jet skis required operative interventions. Only three of seven (43%) children in other watercraft accidents required surgery (P < 0.05 jet ski vs other watercraft). When compared with children injured in accidents involving small boats those involved in jet ski accidents tended to have more serious injuries and require operative intervention more frequently. A high index of suspicion for serious injuries must be maintained when evaluating children with this mechanism of injury. (Copyright © 2002 Southeastern Surgical Congress)
Snowmobile fatalities aspects on preventive measures from a 25-year review.

Ostrom M, Eriksson A. Accid Anal Prev 2002; 34(4): 563-568.

Correspondence: Anders Eriksson, Oakland County Medical Examiner Office, 1200 North Telegraph Road, Pontiac, MI 48341-0438, USA; (email: erikssona@co.oakland.mi.us)

During October 1973 through May 1998, 157 snowmobile fatalities were autopsied in Northern Sweden, including 131 riders, 15 passengers, six occupants with unknown position and five victims pulled by a snowmobile. Most fatalities occurred during March and April (41%), on weekends/holidays (75%), between 18:00 and 02:00 h (59%), during darkness (63%), in clear weather (84%) and at leisure time (94%). The median age was 39 years and 92% were men. The most common causes of death were blunt trauma (53%) and drowning (38%). A total of 64% were inebriated by alcohol, with a mean blood alcohol concentration of 1.7 g/l. More inebriated victims were found during weekends/holidays than on weekdays (75 vs. 51%) and during nighttime than during daytime (92 vs. 52). Driving into water was the most common event (38%) followed by collisions with immobile objects (20%). Alcohol and speeding were the most common contributors to the crashes, while flotation snowmobile suit and helmet use were considered to be the most important injury prevention factors. (Copyright © 2002 Elsevier Science)

Dog bites in children less than fourteen years old in Turin.

Savino F, Gallo E, Serraino P, Oggero R, Silvestro L, Mussa GC. Minerva Pediatr 2002; 54(3):237-242.

Correspondence: Francesco Savino, Dipartimento di Scienze Pediatriche e dell'Adolescenza, Ospedale Infantile Regina Margherita, Azienda Ospedaliera OIRM S. Anna, Universita degli Studi, Turin, ITALY; (email: staff.nucleare@pediatria.unito.it).

BACKGROUND: The purpose of this study was to describe the epidemiology of injuries caused by dog bites treated in the emergency department of OIRM from January 1, 1997 to December 31, 2000. METHODS: Data on dog's attacks were obtained from declaration forms filled in the emergency department. RESULTS: 253 children were observed: 145 boys and 118 girls. The mean age was 6.4 years. The peak incidence was in children aged 3 to 8 years old. Fifty-six children (22.31%) required admission to the hospital. Thirty-five were younger than 5 years. Injuries to the face (29.48%), hands (14.55%), legs (9.33%) were more common. The prognosis was 5 (18.97%), 7 (21.74%) and 10 (16.6%) days. Twenty-five children had prognosis over fifteen days (9.88%). Children aged 5 or younger presented most face and hand lesions while children aged 6 to 14 years had most hand, legs and arms injuries. Tetanus and rabies prophylaxis were administered only in 4 and 2 cases respectively, while immunoglobulin anti tetanus were administered in 5 children. The great number of attacks occurred during the summer months, with a peak in June and July. CONCLUSIONS: More attention should be paid to the prevention of dog bites. Pediatricians should advice parents about the risks of interactions with dogs.

"Slip and Fall" theory -- extreme order statistics.

Barnett RL. Int J Occup Saf Ergon 2002; 8(2): 135-159.

Correspondence: Ralph Barnett, Mechanical and Aerospace Engineering, Illinois Institute of Technology, Chicago, USA; (email: barnett@iit.edu

Classical "slip and fall" analysis was reformulated in this paper to account for the stochastic nature of friction. As it turned out, the new theory, arising from this analysis, was a precise statement of the distribution function for the smallest value among n independent observations. This made it possible to invoke an important result from the asymptotic theory of extreme order statistics that reduced the theory to a simple and elegant relationship among the probability of slipping, the critical friction criterion, the distance traveled by the walker, and the average, spread and asymmetry of the distribution of friction coefficients. The new theory reveals that short walks lead to fewer falls; low friction floors are sometimes better than high friction ones. (Copyright © 2002 Central Institute for Labour Protection)
Generalised linear accident models and goodness of fit testing.

Wood GR. Accid Anal Prev 2002; 34(4): 417-427.

Correspondence: Graham R. Wood, Institute of Information Sciences and Technology, College of Sciences, Massey University, Palmerston North, NEW ZEALAND; (email: g.r.wood@massey.ac.nz).

This paper has two aims. The primary aim is to provide a practical resolution of the low mean value' problem, a barrier to goodness of fit testing for the commonly used generalised linear accident model. A secondary aim of the paper is to describe the underlying mechanism of these models, so making them fully accessible to the transport modeller. (Copyright © 2002 Elsevier Science)

Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study.

Wood BH, Bilclough JA, Bowron A, Walker RW. J Neurol Neurosurg Psychiatry 2002; 72(6):721-725.

Correspondence: R W Walker, Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK; (email: Richard.walker@northumbria-healthcare.nhs.uk).

OBJECTIVES: To accurately establish the incidence of falls in Parkinson's disease (PD) and to investigate predictive risk factors for fallers from baseline data.

METHODS: 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data, disease specific rating scales, physiotherapy assessment, tests of visual, cardiovascular and autonomic function, and bone densitometry. Patients were then prospectively followed up for one year using weekly prepaid postcards along with telephone follow up.

RESULTS: Falls occurred in 68.3% of the subjects. Previous falls, disease duration, dementia, and loss of arm swing were independent predictors of falling. There were also significant associations between disease severity, balance impairment, depression, and falling.

CONCLUSIONS: Falls are a common problem in PD and some of the major risk factors are potentially modifiable. There is a need for future studies to look at interventions to prevent falls in PD. (Copyright © 2002 Journal of Neurology Neurosurgery and Psychiatry)

Cognitive-behavioral approaches to farm community safety education: a conceptual analysis.

Cole HP. J Agric Saf Health 2002; 8(2): 145-159.

Correspondence: Henry P. Cole, Department of Educational and Counseling Psychology, College of Education, University of Kentucky, Lexington 40505-9842, USA; (email: hcole@uky.edu).

For many years, farm health and safety education efforts have focused on the presentation of safety rules and guidelines. This method of instruction tends to ignore the contingencies that influence the actual behavior of farmers. Consequently, while most farmers understand the safety instruction messages they receive, they frequently continue to engage in risky behaviors. They do so even when they are aware of the injury consequences that can result from engaging in risky behaviors during farm work. Consequently, educational programs for the delivery of farm health and safety knowledge have been judged to be of questionable effectiveness. Yet, current political, social, and economic realities suggest that safety and health education will remain a favored methodology for the foreseeable future. These observations suggest that farm safety education efforts may need to be reconceptualized. This article examines the learning of safe and unsafe work practices from three historical learning theory perspectives: behaviorism, constructivism, and socioculturalism. The conceptual analysis is illustrated through case study examples. The analysis may provide insights into why transmission of knowledge by itself is not effective for replacing risky behaviors with safe work practices. It may also assist the design of farm health and safety education programs that impart knowledge, as well as change attitudes and behavior that support safe work practices. (Copyright © 2002 American Society of Agricultural Engineers)
Coalitions: partnerships to promote agricultural health and safety.

Palermo T, Ehlers J. J Agric Saf Health 2002; 8(2): 161-174.

Correspondence: Teri Palermo, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505-2888, USA; (email: tpalermo@cdc.gov).

Throughout the 1990s, a variety of partnerships and community-based organizations have been formed with the primary mission to promote agricultural safety and health. These groups are altruistic, creative, energetic, and provide critical perspectives for improving the safety and health of the agricultural workforce at the local, regional, and national levels. These coalitions have been created as a result of philanthropic support, public funding, grassroots interest, and personal experiences with agricultural injuries and fatalities. They are playing important roles in collaborating with researchers and in reaching the individual agricultural communities. They have been instrumental in conducting needs assessments and are critical to the development and implementation of successful surveillance programs and interventions. Outreach and dissemination of research findings and other safety and health information to target audiences are strengths of these diverse coalitions. Th! is article will focus on primarily community-based coalitions, providing an overview of the development, foci, membership activities, and contributions or impact of these groups during the 1990s and the challenges in maintaining and sustaining the coalitions. This information should be useful to those seeking to understand the activities of existing coalitions and identify potential partnerships for future activities. (Copyright © 2002 American Society of Agricultural Engineers)
Costs of occupational injuries in agriculture.

Leigh JP, McCurdy SA, Schenker MB. Public Health Rep 2001; 116(3): 235-48.

Correspondence: John P. Lee, Department of Epidemiology and Preventive Medicine, School of Medicine TB168, University of California at Davis, Davis, CA, USA (email jpleigh@epm.ucdavis.edu).

OBJECTIVE: This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992.

METHODS: The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance.

RESULTS: Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion.

CONCLUSIONS: The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs. Copyright © 2001 Association of Schools of Public Health)

See Reports under Violence

Explaining the gender difference in self-reported suicide attempts: a nationally representative study of Norwegian adolescents.

Wichstrom L, Rossow I. Suicide Life Threat Behav 2002; 32(2):101-116.

Correspondence: Lars Wichstrom, Department of Psychology, Norwegian University of Science and Technology/Norwegian Social Research, Trondheim, NORWAY; (email: lars.wichstrom@svt.ntnu.no).

Predictors of self-reported suicide attempts were studied cross-sectionally and prospectively in order to discern which variables may account for the gender difference in such reports. A representative sample of Norwegian students (N= 9,679) in grades 7-12 were followed from 1992 to 1994. More girls (10.4%) than boys (6.0%) reported a previous attempt and more girls (3.3%) than boys (1.9%) reported an attempt during the study period. The gender difference in previous suicide attempts was significantly reduced when depressed mood was controlled, and was no longer significant when disordered eating was included. There was no gender difference in future attempts when previous attempts, depressed mood, physical appearance, pubertal timing, and romantic involvement were controlled. Girls' higher level of risk factors may account for their higher level of self-reported nonfatal suicidal behavior. (Copyright © 2002 American Association of Suicidology)
Preliminary effects of brief school-based prevention approaches for reducing youth suicide--risk behaviors, depression, and drug involvement.

Eggert LL, Thompson EA, Randell BP, Pike KC. J Child Adolesc Psychiatr Nurs 2002; 15(2):48-64.

Correspondence: Leona L. Eggert, Psychosocial and Community Health, University of Washington School of Nursing, Seattle, USA; (email: eggert@u.washington.edu).

PACKGROUND: Few empirically tested, school-based, suicide-prevention programs exist.

OBJECTIVES: The purpose of this study was to evaluate the postintervention efficacy of Counselors-CARE (C-CAST) and Coping and Support Training (CAST) vs. "usual care" controls for reducing suicide risk.

METHODS: A randomized prevention trial; 341 potential dropouts, 14 to 19 years old, from seven high schools (52% female, 56% minorities) participated. Trend analyses using data from three time points assessed over time changes.

RESULTS: Significant decreases occurred for all youth in suicide-risk behaviors, depression, and drug involvement. Intervention-specific effects occurred for decreases in depression.

CONCLUSIONS: School-based prevention approaches are feasible and show promise for reducing suicidal behaviors and related depression. (Copyright © 2002 Nursecom)
States' spending for public welfare and their suicide rates, 1960 to 1995: what is the problem?

Zimmerman SL. J Nerv Ment Dis 2002; 190(6): 349-360.

Shirley L. Zimmerman, 3843 Glenhurst Avenue, Minneapolis, Minnesota 55416, USA; (email address unavailable).

Drawing on Durkheim's theory of social integration, this discussion reports on findings from a pooled time-series analysis of states' spending for public welfare and their suicide rates, controlling for states' divorce rates, population change rates, population density, unemployment rates, sex ratio, and racial composition. The analysis spans a 35-year period, 1960 to 1995, at six different data points: 1960, 1970, 1980, 1985, 1990, and 1995. The major hypothesis was that states' suicide rates would increase with decreases in per capita spending for public welfare, controlling for the variables listed above in three different models and using OLS to analyze the data. In the basic model, states' spending for public welfare showed no relationship to states' suicide rates; in the second model that controlled for data year and in the third model that controlled for both data year and state, its relationship was significant, but in a negative direction. Suicide rates increased in states that reduced their per capita expenditures for public welfare during the observational period. Of all the variables, the influence of divorce on suicide was the most persistent and pronounced, followed by the percentage of whites in states' populations. Whether the findings reflect an increase in the unendurable psychological pain associated with suicide, or the weakening of ties that bind individuals to each other and to the larger society (as measured by states' divorce rates and per capita expenditures for public welfare), or the vulnerabilities associated with race, states can help counter suicide trends and such negative influences as divorce as evidenced by states that spend more for public welfare and have lower suicide rates. Given that clinicians work with people experiencing the unendurable psychological pain associated with suicide, the findings from these analyses have relevance for their practice. (Copyright © 2002 Lippincott Williams & Wilkins)
Neighborhood predictors of hopelessness among adolescent suicide attempters: preliminary investigation.

Perez-Smith A, Spirito A, Boergers J. Suicide Life Threat Behav 2002; 32(2): 139-145.

Correspondence: Alina Perez-Smith, Abt Associates, 55 Wheeler Street, Cambridge, MA 02138-1168 USA; (email address unavailable).

The role of neighborhood factors in predicting hopelessness among adolescent suicide attempters was examined in this study. Forty-eight adolescents who attempted suicide were administered measures of hopelessness and depression. Family socioeconomic status (SES) was calculated based on family demographics and characteristics of neighborhood context were examined using a geocoding software package. Adolescents who lived in neighborhoods with weak social networks reported higher levels of hopelessness, even after controlling for SES and depression. These preliminary findings suggest that environmental context may play a role in the emotional status of adolescents who attempt suicide. (Copyright © 2002 American Association of Suicidology)
Does legalized gambling elevate the risk of suicide? An analysis of U.S. counties and metropolitan areas.

McCleary R, Chew KS, Merrill V, Napolitano C. Suicide Life Threat Behav 2002; 32(2): 209-221.

Correspondence: Richard D. McCleary, Department of Environmental Analysis and Design, School of Social Ecology, University of California, Irvine 92697-7070, USA; (email: mccleary@uci.edu).

This study addresses a possible link between suicide and casino gambling. Resident suicide rates are analyzed for (a) a 1990 cross-section of 148 U.S. metropolitan areas and (b) before and after the advent of legalized casinos in five U.S. counties. Data are drawn from government and gaming industry sources. In cross-section, metro area suicide is strongly correlated with region, accidental death and homicide rates, age and race composition, and economic vitality, followed by a modest net positive correlation with casino presence. By contrast, the time series analysis yields no evidence of a gambling effect. (Copyright © 2002 American Association of Suicidology)

The role of ambient light level in fatal crashes: inferences from daylight saving time transitions.

Sullivan JM, Flannagan MJ. Accid Anal Prev 2002; 34(4): 487-498.

Correspondence: John M. Sullivan, University of Michigan Transportation Research Institute, Ann Arbor 48109-2150, USA; (email: jsully@umich.edu).

The purpose of this study was to estimate the size of the influence of ambient light level on fatal pedestrian and vehicle crashes in three scenarios. The scenarios were: fatal pedestrian crashes at intersections, fatal pedestrian crashes on dark rural roads, and fatal single-vehicle run-off-road crashes on dark, curved roads. Each scenario's sensitivity to light level was evaluated by comparing the number of fatal crashes across changes to and from daylight saving time, within daily time periods in which an abrupt change in light level occurs relative to official clock time. The analyses included 11 years of fatal crashes in the United States, between 1987 and 1997. Scenarios involving pedestrians were most sensitive to light level, in some cases showing up to seven times more risk at night over daytime. In contrast, single-vehicle run-off-road crashes showed little difference between light and dark time periods, suggesting factors other than light level play the dominant role in these crashes. These results are discussed in the context of the possible safety improvements offered by new developments in adaptive vehicle headlighting. (Copyright © 2002 Elsevier Science)
Premature avoidable deaths by road traffic injuries in Belgium: trends and geographical disparities.

Leveque A, Humblet PC, Lagasse R. Eur J Epidemiol 2001; 17(9): 841-845.

Correspondence: Alain Leveque, Department of Health Policies and Health Systems Research, School of Public Health, Universite Libre De Bruxelles, Brussels, BELGIUM; (email: alain.leveque@ulb.ac.be).

Road traffic injuries are a major public health problem. In this study, we chose Years of Potential Life Lost (YPLL) to analyse the trends during the period 1974-1994 and the relative impact of the traffic injuries death on total mortality and on total avoidable mortality in Belgium. We analysed the geographical trends over a 20-year period at the district level. The YPLL age-adjusted rates were analysed for four successive 5-year periods: 1974-1978, 1980-1984, 1985-1989, 1990-1994 and the ratios of YPLL rates were used to describe changes between 1974 and 1994 at district level. The YPLL rates decrease for 'all causes mortality', 'total avoidable causes' and 'road traffic injuries'. This trend can be observed during the four periods of 5 years. A slowing down of the decrease of the YPLL rates for road traffic injuries, both for men and women is observed: 11.7% between periods 2 and 1, and only 3% between periods 4 and 3 for men (16.2 and 7.5% for women). The geographical analysis shows marked differences between districts. Even though a favourable trend is observed for the traffic injuries deaths in Belgium it is important to highlight the important slowing down of this trend during the most recent years. It is also necessary to underline the importance of geographical disparities in the distribution of YPLL rates within the entire population. (Copyright © 2001 Kluwer Academic Publishers)
Reporting epileptic drivers to licensing authorities is unnecessary and counterproductive.

Lee W, Wolfe T, Shreeve S. Ann Emerg Med 2002; 39(6):656-659.

Correspondence: Wally Lee, MD, Division of Emergency Medicine, 1150 Moran Building, 75 North Medical Drive, Salt Lake City, UT 84132 USA; (email: Wally.Lee@hsc.utah.edu).

Before the late 1940s, all persons with epilepsy were prohibited from driving because of the potential for sudden loss of consciousness and the risk of a motor vehicle crash (MVC). With the development of antiepileptic medications and electroencephalography, this prohibition was modified to allow epileptics in "good control" to drive. Licensing and physician-reporting requirements for epileptic drivers now vary considerably from state to state. Six states (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania) require mandatory physician reporting of patients with seizures to regulatory authorities. Three of these states specifically mention epilepsy in their statutes, and the other 3 require that any condition resulting in "lapses of consciousness" be reported to the licensing agency. The remaining states typically require the patient to self-report or face civil liability, criminal liability, or both.

Although regulating driving privileges of epileptic patients may seem beneficial, it actually hinders optimal medical management and may increase the risk of traffic accidents. This review article (47 references) contrasts the relative risk of MVCs for epileptic drivers versus other less regulated conditions, discusses the negative effect reporting statutes have on epileptic patients and society, and recommends eliminating physician reporting of epileptic patients to driver-licensing authorities.

The reported relative risk for MVC among epileptic drivers ranges from no difference to almost twice the risk of nonseizure cohorts. These rates are comparable or markedly less than those of other medical conditions that are not under the same regulatory guidelines. (Copyright © 2002 American College of Emergency Physicians)
Falling asleep while driving and automobile accidents among patients with obstructive sleep apnea-hypopnea syndrome.

Shiomi T, Arita AT, Sasanabe R, Banno K, Yamakawa H, Hasegawa R, Ozeki K, Okada M, Ito A. Psychiatry Clin Neurosci 2002; 56(3):333-334.

Correspondence: Toshiaki Shiomi, Sleep Disorders Center, Aichi Medical University School of Medicine, 21 Karimata, Yazako, Nagakute-cho, Aichi 480-1195, JAPAN; (email: toshiaki@amugw.aichi-med-u.ac.jp).

Among 448 patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), 40 patients (8.9%) had been involved in one or more automobile accidents during the preceding 5 years. The main cause of these accidents was falling asleep while driving. Excessive sleepiness during driving was associated with an Epworth sleepiness scale (ESS) score of > 11 and/or an apnea-hypopnea index (AHI) of > 15. The automobile accident rate among 182 patients with severe OSAHS (AHI > 30) was significantly higher than the rate among 106 simple snorers (AHI < 5). Although four of the simple snorers were involved in automobile accidents, their ESS scores were all very high (15 or more). (Copyright © 2002 Blackwell Publishing)
About morphological findings in fatal railway collisions.

Driever F, Schmidt P, Madea B. Forensic Sci Int 2002; 126(2):123-128.

Correspondence: Frank Driever, Institute of Legal Medicine, Rheinische Friedrich-Wilhelms-University of Bonn, Stiftsplatz 12, 53111, Bonn, GERMANY; (email address unavailable).

The autopsy findings in fatal cases of railway collisions of the Bonn Institute of Legal Medicine in 1992-1999 were investigated and compared to the statements in the investigation files of the public prosecutor with regard to classification as accident or suicide as well as with regard to type and speed of collision. Of the 38 deaths, 10 were hit in an upright position, 11 fatal collisions affected persons lying outside the track and 13 were hit and overrun lying inside the track. According to the investigation classification 21 persons committed suicide (56%), while 10 died in an accident (26%). Our survey confirmed the leading role of being over-rolled in a lying position as an indication for suicides, while in accidents the upright hit was most important. With exception of the persons primarily affected between the rails in upright position and over-rolled consecutively an unequivocal assignment of injury patterns to the hit categories was possible. In cases of persons being primarily over-rolled in a lying position especially the criteria (i) opening of body cavities, (ii) organ injuries and (iii) loss of parts of the body allowed for careful conclusion on hit, respectively, overrunning speed. (Copyright © 2002 Elsevier Science)
Predicted effect of automatic crash notification on traffic mortality.

Clark DE, Cushing BM. Accid Anal Prev 2002; 34(4): 507-513.

Correspondence: David E. Clark, Department of Surgery, Maine Medical Center, 887 Congress Street, Suite 210, Portland, ME 04102-3113, USA; (email: clarkd@mail.mmc.org).

OBJECTIVE: To estimate the reduction in traffic mortality in the United States that would result from an automatic crash notification (ACN) system.

METHODS: 1997 Fatality Analysis Reporting System (FARS) data from 30,875 cases of incapacitating or fatal injury with complete information on emergency medical services (EMS) notification and arrival times were analyzed considering cases at any time to be in one of four states: (1) alive prior to notification; (2) alive after notification; (3) alive after EMS arrival; and (4) dead. For each minute after the crash, transition probabilities were calculated for each possible change of state. These data were used to construct models with (1) number of incapacitating injuries ranging from FARS cases up to an estimated total for the US in 1997; (2) deaths equal to FARS total; (3) transitions to death from other states proportional to FARS totals and rates and (4) other state transitions equal to FARS rates. The outcomes from these models were compared to outcomes from otherwise identical models in which all notification times were set to 1 min.

RESULTS: FARS data estimated 12,823 deaths prior to notification, 1800 after notification, and 14,015 between EMS arrival and 6 h. If notification times were all set to 1 min, a model using FARS data only predicted 10,703 deaths prior to notification, 2,306 after notification, and 15,208 after EMS arrival, while a model using an estimated total number of incapacitating injuries for the US predicted 9,569 deaths prior to notification, 2,261 after notification, and 15,134 after arrival. In the first model, overall mortality was reduced from 28,638 to 28,217 (421 per year. or 1.5%), while in the second model mortality was reduced to 26,964 (1,674 per year, or 6%).

CONCLUSIONS: Modest but important reduction in traffic mortality should be expected from a fully functional ACN system. Imperfect systems would be less effective. (Copyright © 2002 Elsevier Science)
Increasing the use of child restraints in motor vehicles in a Hispanic neighborhood.

Istre GR, McCoy MA, Womack KN, Fanning L, Dekat L, Stowe M. Am J Public Health 2002; 92(7):1096-1099.

Correspondence: Gregory R. Istre, Injury Prevention of Greater Dallas, PO Box 36067, Dallas TX 75235, USA; (no email address available).

The use of restraints in motor vehicles is less common in minority and low-income populations than in the general population. A preliminary survey of Hispanic preschool-aged children in west Dallas, Tex, conducted in 1997 showed much lower child restraint use (19% of those surveyed) than among preschool children of all races in the rest of the city (62%). Because there are few reports of successful programs to increase child restraint use among Hispanics, we undertook to implement and evaluate such a program. The program was conducted by bilingual staff and was tailored for this community. It was successful in increasing both child restraint use and driver seat belt use. (Copyright © 2002 American Public Health Association)
Rollover risk of cars and light trucks after accounting for driver and environmental factors.

Farmer CM, Lund AK. Accid Anal Prev 2002; 34(2): 163-173.

Correspondence: Charles M. Farmer, Insurance Institute for Highway Safety, Arlington, VA 21201-4751, USA; (email: cfarmer@iihs.org).

Characteristics of the driver, roadway environment, and vehicle were associated with the likelihood of rollover occurrence in more than 14000 single-vehicle fatal and 78000 single-vehicle injury crashes during 1995-98. Rollovers were more likely in crashes involving young drivers or occurring on rural curves. After accounting for the effects of driver age and gender, roadway alignment and surface condition, and whether or not the crash occurred in a rural area, light trucks were still twice as likely as cars to experience rollovers. Some light truck models were much more likely than others to experience rollovers. However, while physical differences (e.g. center of gravity height) could explain some of this variability, other factors affecting vehicle stability may be evident only after dynamic testing.
Speed and safety effect of photo radar enforcement on a highway corridor in British Columbia.

Chen G, Meckle W, Wilson J. Accid Anal Prev 2002; 34(2): 129-138.

Correspondence: Greg Chen, 910 Government Street, Victoria, BC, V8T 5A3 CANADA; (email: greg.chen@icbc.com)

This study evaluates the effect of the photo radar program on traffic speed and collisions at photo radar (PRP) influence locations (PRP location) and interleaving non-PRP locations on the Vancouver Island portion of Highway 17 (Pat Bay Highway) in British Columbia (BC). Simple before-after comparison was used to summarize the speed effect while observational before after method was employed to estimate the safety effect. To control for regression to the mean and time effect, Empirical Bayes (EB) method with comparison groups was employed in collision analysis. The study found a 2.8-km/h reduction in mean speed and a 0.5-km/h reduction in speed standard deviation at a monitoring site 2 km south of the treatment area. Corresponding to speed reduction. the study revealed a 14%+/-11% reduction in expected collisions at the PRP locations, a 19%+/-10% reduction at the non-PRP locations, and a 16%+/-7% reduction along the study corridor as a whole. No evidence was found for a localized effect in a 2-km range of the photo radar direct influence area, over and above those at the interleaving non-PRP locations. The results support the hypothesis of a distance spillover effect--that the program not only improved safety at the PRP locations, but along the entire enforcement corridor as well. It suggests that the unpredictable nature of the deployments lead drivers to modify their behavior along the length of the corridor because they could not discern 'safe' from 'unsafe' segments. (Copyright © 2002 Elsevier Science)
Predicting seat belt use in fatal motor vehicle crashes from observation surveys of belt use.

Salzberg P, Yamada A, Saibel C, Moffat J. Accid Anal Prev 2002; 34(2):139-148.

Correspondence: Philip Salzberg, Washington Traffic Safety Commission, 1000 S. Cherry Street, PO Box 40944, Olympia 98504, USA; (email: psalzberg@wtsc.wa.gov).

There is a large difference between the rates of observed seat belt use by the general public and belt use by motor vehicle occupants who are fatally injured in crashes. Seat belt use rates of fatally injured occupants, as reported in the Fatality Analysis Reporting System (FARS), are much lower than the use rates found in observation surveys conducted by the states. A series of mathematical models describing the empirical relationship between FARS and observed rates were explored. The initial model was a 'straw man' and used two simplifying assumptions: (a) belt users and nonusers are equally likely to be involved in 'potentially fatal collisions', and (b) belts are 45% effective in preventing deaths. The model was examined by comparing each state's FARS use rate with the predicted rate. The model did not fit the state data points even when possible biases in the data were controlled. We next examined the assumptions in the model. Changing the seat belt effectiveness parameter provided a reasonable fit, but required an assumption that seat belts are 67% effective in preventing fatalities. The inclusion of a risk coefficient for non-belted occupants also provided a reasonable fit between the model and data. A variable risk model produced the best fit with the data. The major finding was that a model consistent with the data can be obtained by incorporating the assumption that nonusers of seat belts have a higher risk of involvement in potentially fatal collisions than do seat belt users. It was concluded that unbelted occupants are over-represented in fatal collisions for two reasons: (a) because of a greater chance of involvement in potentially fatal collisions in the first place, and (b) because they are not afforded the protection of seat belts when a collision does occur. (Copyright © 2002 Elsevier Science)
Effects of daytime running lights on multiple-vehicle daylight crashes in the United States.

Farmer CM, Williams AF. Accid Anal Prev 2002; 34(2): 197-203

Correspondence: Charles M. Farmer, Insurance Institute Highway Safety, Arlington, VA 22201-4751, USA; (email: cfarmer@iihs.org).

Involvements in multiple-vehicle daylight crashes in nine states over 4 years were analyzed for a group of passenger cars and light trucks equipped with automatic daytime running lights. On average, these vehicles were involved in 3.2% fewer multiple-vehicle crashes than vehicles without daytime running lights (P = 0.0074). (Copyright © 2002 Elsevier Science)
Impact of roadside features on the frequency and severity of run-off-roadway accidents: an empirical analysis.

Lee J, Mannering F. Accid Anal Prev 2002; 34(2): 149-161.

Correspondence: Jinsun Lee, Department of Civil and Environmental Engineering, University of Washington, 201 More Hall, Box 352700 Seattle, WA 98195-2700, USA; (email: flm@u.washington.edu ).

In the US, single-vehicle run-off-roadway accidents result in a million highway crashes with roadside features every year and account for approximately one third of all highway fatalities. Despite the number and severity of run-off-roadway accidents, quantification of the effect of possible countermeasures has been surprisingly limited due to the absence of data (particularly data on roadside features) needed to rigorously analyze factors affecting the frequency and severity of run-off-roadway accidents. This study provides some initial insight into this important problem by combining a number of databases, including a detailed database on roadside features, to analyze run-off-roadway accidents on a 96.6-km section of highway in Washington State. Using zero-inflated count models and nested logit models, statistical models of accident frequency and severity are estimated and the findings isolate a wide range of factors that significantly influence the frequency and severity of run-off-roadway accidents. The marginal effects of these factors are computed to provide an indication on the effectiveness of potential countermeasures. The findings show significant promise in applying new methodological approaches to run-off-roadway accident analysis.
Effects of uncertainty, transmission type, driver age and gender on brake reaction and movement time.

Warshawsky-Livne L, Shinar D. J Safety Res 2002; 33(1):117-128.

Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, PO Box 653, 84105 Beersheba, ISRAEL; (email: shinar@bgumail.bgu.ac.il).

BACKGROUND: Braking time (BT) is a critical component in safe driving, and various approaches have been applied to minimize it.

OBJECTIVES: This study analyzed the components of BT in order to assess the effects of age, gender, vehicle transmission type, and event uncertainty, on its two primary components, perception-reaction time and brake-movement time.

METHODS: Perception-reaction time and brake-movement time were measured at the onset of lights for 72 subjects in a simulator. The six experimental conditions were three levels of uncertainty conditions (none, some, and some + false alarms) and two types of transmission (manual and automatic). The 72 subjects, half male and half female, were further divided into three age groups (mean of 23, 30, and 62 years). Each subject had 10 trials in each of the three levels of uncertainty conditions.

RESULTS: Transmission type did not significantly affect either perception-reaction time or brake-movement time. Perception-reaction time increased significantly from 0.32 to 0.42 s (P < .05) as uncertainty increased but brake-movement time did not change. Perception-reaction time increased (from 0.35 to 0.43 s) with age but brake-movement time did not change with age. Gender did not affect perception-reaction time but did affect brake-movement time (males 0.19 s vs. females 0.16 s).

CONCLUSIONS: At 90 km/h, a car travels 0.25 m in 0.01 s. Consequently, even such small effects multiplied by millions of vehicle-kilometers can contribute to significant savings in lives and damages. (Copyright © 2002 National Safety Council)
Changes in risky driving behavior from age 21 to 26 years.

Begg D, Langley J. J Safety Res 2001; 32(4):491-500.

Correspondence: Dorothy Begg, Injury Prevention Research Unit, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, NEW ZEALAND; (email: dorothy.begg@ipru.otago.ac.nz).

OBJECTIVES: The aim of this study was to determine whether the prevalence of risky driving behavior changed between ages 21 and 26 years, among a cohort of young people.

METHODS: This study was part of the Dunedin Multidisciplinary Health and Development Study, which is a longitudinal study of a birth cohort. This study involved examining changes in the prevalence of risky driving behavior among young adults at ages 21 and 26 years. At both ages, 936 members of the cohort were administered face-to-face interviews, using a structured questionnaire that included items on a range of risky driving and thrill-seeking activities.

RESULTS: The results showed that risky driving was predominantly a male activity, but by 26 years of age, many had "matured out" of this behavior. At the same time, the desire for thrill-seeking increased among the males. Among the females, there were few significant changes between ages 21 and 26 years, but at both ages, the prevalence of risky driving and thrill-seeking was relatively low.

CONCLUSIONS: These results show that the main target population for road safety interventions aimed at reducing risky driving behavior should be young, male drivers. (Copyright © 2001 National Safety Council)
Public transport in metropolitan areas - a danger for unprotected road users.

Hedelin A, Bunketorpb O, Björnstig U. Safety Science 2002, 40(5): 467-477.

Correspondence: Annika Hedlin,Västra Götalandsregionen, Emergency and Disaster Planning and Education, S-405 44 Göteborg, SWEDEN; (email: annika.hedelin@vgregion.se).

The risks associated with bus and tram traffic (Am. cable car) for unprotected road users, within a well-defined geographic area, were analyzed in a descriptive study using data from the hospital's special traffic injury register and from all other available sources of crash and injury data. The risk of suffering a non-fatal injury was four times higher per vehicle-kilometer for tram traffic compared with bus traffic, while the risk of death was 9¯15 times higher for tram traffic. The injury incidence in relation to age had a biphasic shape with the highest risks for young and old people. However, the tram injury rate for men was highest for middle aged men (30¯49 years at age). Three quarters of those injured both in bus and tram incidents sustained their injuries at bus or tram stops, or at pedestrian crossings. One third of the injury cases with trams, and one quarter with buses, occurred in the dark. The greater danger associated with trams for unprotected road users is a factor worth to be considered. However, injury-reducing measures, e.g. in the vehicle design and in the traffic area, especially at and near tram and bus stops, might reduce the injuries caused by both trams and buses. (Copyright © 2002 Elsevier Science)

Socio-economic differences in intentional injuries: a national study of Swedish male and female adolescents.

Engstrom K, Laflamme L. Health Soc Work 2002; 27(2): 26-29.

Correspondence: Karin Engstrom, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, SWEDEN; (email: Karin.Engstrom@socmed.sll.se).

OBJECTIVES: To measure socio-economic differences in intentional injuries among Swedish adolescents.

METHODS: A cross-sectional study, based on linkage of records from national registers, considering injuries incurred by all adolescents domiciled in Sweden in 1990-94. Absolute and relative differences between adolescents from four household socio-economic groups (SEGs) were measured, considering separately males and females, two age categories (10-14 and 15-19 years) and injuries caused by interpersonal violence and self-inflicted injuries.

RESULTS: Absolute differences (in injury incidence) between SEGs were greatest for self-inflicted injuries, among older female adolescents. There were clear social gradients in all instances, but relative differences (relative risks) reached a peak for interpersonal violence among younger adolescents, for both boys and girls.

CONCLUSION: There is a clear association among Swedish adolescents between type of intentional injury and gender, with absolute differences remarkably wide for self-inflicted injuries. For a given age category, gender-specific social gradients are quite comparable within diagnosis. (Copyright © 2002 Blackwell Publications)
Gun violence and children: factors related to exposure and trauma.

Slovak K. Health Soc Work 2002; 27(2):104-112.

correspondence: Karen Slovak, Department of Social Work, Ohio University, Athens, USA; (email: slovak@oak.cats.ohiou.edu).

The study discussed in this article investigated the relationship between access to firearms and parental monitoring on rural youths' exposure to gun violence and examined the effect of gun violence exposure on the mental health of these youths. A survey was administered to rural students who participated in a student assistance program (n = 162) that provided in-school support groups for students in grades 6 through 12. Results indicated that a substantial number of students were exposed to gun violence and exposure was significantly related to firearm access and parental monitoring. Furthermore, gun violence exposure was significantly associated with trauma among the youths. Implications for social workers include advising high-risk clients and their families on gun removal and safe storage practices. (Copyright © 2002 National Association of Social Workers)
Preventing men's violence against women.

Leander K. Acta Psychiatr Scand Suppl 2002; (412):15-19.

Correspondence: Karin Leander, Center for Safety Promotion, The National Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, SWEDEN; (email: Karin.Leander@imm.ki.se).

BACKGROUND: The treatment and prevention of men's violence against women has increasingly been recognized as an issue not only for the criminal justice but also for the health and public health sectors.

OBJECTIVE: To determine how health care can avoid accelerating women's 'entrapment' in a violent situation and to contribute to empowering them to take proactive steps.

METHODS: Research and experience reveal how the nature of domestic violence can lead to health care playing a preventive role. The responsible body for health care in Stockholm, the Stockholm County Council, is one of several public authorities involved in a county-wide initiative called Operation Kvinnofrid, which has focused on internal training programmes as well as public poster campaigns.

RESULTS: Public awareness campaigns in combination with internal training programmes do have an impact, especially where political and management will is clear.

CONCLUSIONS: Heightened awareness among the public, enhanced skills among health workers, and multiagency coordination of the response to men's violence against women are essential elements of the long-term prevention of this violence. (Copyright © 2002 Blackwell Publications)
Anabolic androgenic steroids and violence.

Thiblin I, Parlklo T. Acta Psychiatr Scand Suppl 2002;106 Suppl 2002;(412): 125-128.

Correspondence: Igenar Thiblin, Department of Forensic Medicine Karolinska Institute, Stockholm, Sweden and Police Authority, Blekinge County, Drug Unit, Karlskrona, SWEDEN; (email: ingemar.thiblin@rmv.se).

OBJECTIVES: To scrutinize the criminal career among users of anabolic androgenic steroids (AAS) with focus on a possible relationship between use of AAS and violent offences.

METHODS: Prospective longitudinal follow-up of police records concerning known users of AAS.

RESULTS: The present study describes five young men who started to use AAS with the primary motive of gaining muscle mass and strength and who subsequently got involved in criminal activities, including violent offences. One person showed deviant behaviour suggestive of conduct disorder at an early age. The other persons appeared to have low self-confidence, but had not been acting out during early adolescence.

CONCLUSIONS: Use of AAS may constitute an increased risk of developing an antisocial life style with involvement in criminal violence. (Copyright © 2002 Blackwell Publications)
Prediction of violent recidivism.

Stone MH. Acta Psychiatr Scand Suppl 2002;106 Suppl 2002;(412): 44-46.

Correspondence: Michael H. Stone, Clinical Psychiatry,Columbia University College of Physicians & Surgeons, 225 Central Park West, New York, NY 10024, USA.

OBJECTIVE: To describe the changes and improvements in accuracy of the prediction of violent recidivism.

METHODS: The evolution of better prediction models is described by reviewing the more significant methods used and referring to the results of their application.

RESULTS: Development of instruments such as the Psychopathy Checklist-Revised, the Violence Risk Assessment Guide (VRAG), the HCR-20 and the multiple-item comprehensive questionnaire of Monahan and Steadman has substantially improved accuracy in risk assessment. The presence of full-blown psychopathy has proven itself a better predictor of violence than has a diagnosis of antisocial personality disorder according to the Diagnostic and Statistical Manual (DSW-IV). Shortcomings to the efficacy of the current instruments stem from the difficulty in detecting violence-proneness in persons who eventually assault or murder one or two persons (usually family members), but who have no, or a limited, record of past violence. Persons from affluent backgrounds are more adept at evading arrests or convictions than are the poor. Adolescent sons abused by parents are at risk to commit violent acts later on, but the community has little power to detect or intervene until these acts are committed.

CONCLUSION: Prediction of violence has significantly improved over the last 20 years, thanks to the development of objective instruments of risk assessment. (Copyright © 2002 Blackwell Publications)
Socio-economic differences in intentional injuries: a national study of Swedish male and female adolescents.

Engstrom K, Laflamme L. Acta Psychiatr Scand Suppl 2002;106 Suppl 2002;(412):26-29.

Correspondence: Karin Engstrom, Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden. Karin.Engstrom@socmed.sll.se).

OBJECTIVE: To measure socio-economic differences in intentional injuries among Swedish adolescents.

METHODS: A cross-sectional study, based on linkage of records from national registers, considering injuries incurred by all adolescents domiciled in Sweden in 1990-94. Absolute and relative differences between adolescents from four household socio-economic groups (SEGs) were measured, considering separately males and females, two age categories (10-14 and 15-19 years) and injuries caused by interpersonal violence and self-inflicted injuries.

RESULTS: Absolute differences (in injury incidence) between SEGs were greatest for self-inflicted injuries, among older female adolescents. There were clear social gradients in all instances, but relative differences (relative risks) reached a peak for interpersonal violence among younger adolescents, for both boys and girls.

CONCLUSIONS: There is a clear association among Swedish adolescents between type of intentional injury and gender, with absolute differences remarkably wide for self-inflicted injuries. For a given age category, gender-specific social gradients are quite comparable within diagnosis. (Copyright © 2002 Blackwell Publications)
Psychological impact of torture: a 3-month follow-up of mass-evacuated Kosovan adults in Sweden. Lessons learnt for prevention.

Ekblad S, Prochazka H, Roth G. Acta Psychiatr Scand Suppl 2002;106 Suppl 412:30-36.

Correspondence: Solvig Ekblad, Section of Psychiatry, Department of Neurotec, Karolinska Institutet, Stockholm, SWEDEN;Solvig.Ekblad@ipm.ki.se).

OBJECTIVES:To study the impact of torture on symptomatology among mass displaced adults.

METHODS: A sample (total 131; 70 females, 61 males) of mass displaced adults from Kosovo, in Sweden, completed 3months after a baseline study on trauma experiences and perceived symptoms, self-rated instruments measuring psychiatric symptoms, aggression and coping.

RESULTS: Torture is associated with poor coping (manageability); depression, anxiety and aggression are associated with post-traumatic stress disorder. All psychiatric symptoms and poor coping (but not aggression) are associated with being female. Limitations of the study include a relatively small sample. Ongoing trauma and stress before repatriation may also influence the responses. Several lessons learnt for prevention are discussed.

CONCLUSIONS: Anger and hostility are important consequences of torture. Further research is necessary to understand the associations among coping strategies, psychiatric symptoms, aggression, torture experience and gender over time after repatriation or applying for asylum. (Copyright © 2002 Blackwell Publications)

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