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8 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.

• See report Under Transportation.

• See report Under Violence.

Evaluations:

• Controlled evaluation of a community based injury prevention program in Australia.

  Ozanne-Smith J, Day L, Stathakis V, Sherrard J. Inj Prev 2002; 8(1):18-22.
  
  Correspondence: Joan Ozanne-Smith, Monash University Accident Research Centre, Monash University, Victoria, AUSTRALIA; (email: joan.ozanne-smith@general.monash.edu.au).

  OBJECTIVE: To evaluate the effects of a community based, all age, all injury prevention program, the Safe Living Program, on injury risk and injury rates.
  
  METHODS: DESIGN: A quasiexperimental population based evaluation using an intervention and comparison community design. SETTING: The intervention community (Shire of Bulla, n = 37,257) is an outer metropolitan area of Melbourne, Australia. The demographically matched comparison community (Shire of Melton, n=33,592) is located nearby. SUBJECTS AND METHODS: The Safe Living Program in the Shire of Bulla targeted injury reduction in all settings with a focus on high risk groups. Strategies included program publicity, education and training, injury hazard reduction, and environmental change. Baseline and follow up measures of program reach, risk factors, and injury rates in both communities were used to evaluate program process, impact, and outcome.
  
  FINDINGS: Increase in program awareness was moderate and similar to other community based programs. The program achieved injury hazard reduction on the road, in schools, and, to a more limited extent, in the home. Other changes in injury risk factors could not necessarily be attributed to the program as similar changes were observed in the comparison community. No significant changes were found in rates of injury deaths, hospitalizations, or emergency department presentations in the Shire of Bulla after six years. Self reported household injuries, mostly minor, were reduced in the intervention community, but had been higher at program launch than in the comparison community.
  
  CONCLUSIONS: The Safe Living Program was unable to replicate the significant reductions in injuries reported in other community based interventions. Replication of apparently successful community based injury prevention programs in different settings and populations requires evidence based interventions, sustained and effective program penetration, reliable data systems to measure change, at least one control community, and sufficient budget and time for effects to be observable.

• Evaluation of a child safety program based on the WHO safe community model.

  Lindqvist K, Timpka T, Schelp L, Risto O. Inj Prev 2002; 8(1):23-26.
  
  Correspondence: Kent Lindqvist, Department of Health and Society, Faculty of Health Sciences, Linkoping University, S-581 85 Linkoping, SWEDEN; (email: kenli@ihm.liu.se).

  OBJECTIVES: To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.
  
  METHODS: A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjolby municipality) areas, both in Ostergotland county, Sweden.
  
  FINDINGS: The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% Cl 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3-6) injuries remained constant.
  
  CONCLUSIONS: After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs.

• No reports this week

• Differences between Japanese pre-school and school-age pedestrian mortality and morbidity trends.

  Nakahara S, Wakai S. Public Health 2002; 116(3):166-172.
  
  Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Japan.

  BACKGROUND: The risk of pedestrian injury during childhood in industrialized countries is decreasing in a trend that is related to exposure to traffic. Examining the differences between age groups and their behavior provides an insight into exposure to risks.
  
  METHODS: Using data for the period 1968-1998, we compared the changes in pedestrian mortality and morbidity in pre-school children (aged 0-6) with those of school-age children (aged 7-12).
  
  FINDINGS: Pedestrian mortality and morbidity decreased in children of all ages in the early 1970s. However, after the mid-1970s, both mortality and morbidity continued to decrease only in pre-schoolers. In school-age children, mortality continued to decrease but morbidity did not change.
  
  CONCLUSIONS: These age-related differences in mortality and morbidity indicate that over the past 30 y the environment for child pedestrians did not become safer. Instead, some of the decrease in children's injuries was probably achieved at the expense of their outdoor activities. Efforts to protect children from vehicular traffic should focus on changing the outdoor environment rather than on restricting children's activities. (Copyright © 2002 Nature Publishing Group)

• No reports this week

• Recreational injury and its relation to socioeconomic status among school aged children in the US.

  Ni H, Barnes P, Hardy AM. Inj Prev 2002; 8(1):60-65.
  
  Correspondence: Hanyu Ni, Division of Health Interview Statistics, National Center for Health Statistics, Center for Disease Control, Hyattsville, Maryland 20782, USA; (email: hni@cdc.gov).

  OBJECTIVES: This study described epidemiologic patterns of recreational injuries among school aged children in the US and assessed the relation of these patterns to socioeconomic status.
  
  METHODS: Combined data from the 1997-98 National Health Interview Surveys for 38 458 children aged 6-17 years regarding non-fatal recreational injury episodes that received medical attention, reported by a household adult, were analyzed. Logistic regression analysis was used to assess the association between recreational injury and socioeconomic status while controlling for confounding factors.
  
  FINDINGS: The annualized rate of recreational injury was 91.2 episodes per 1,000 children, with an increased risk associated with a higher family income status or being non-Hispanic white. For children from not poor families, most injury episodes occurred in sport facilities, whereas for children from poor and near poor families, most occurred outside the home.
  
  CONCLUSION: Recreational injury is a significant health problem for school aged children in the US. Non-Hispanic white children and children from affluent families are at increased risk of recreational injury. (Copyright © 2002 BMJ Publishing Group)

• An analysis of race and demographic factors among motor vehicle fatalities.

  Mayrose J, Jehle DV. J Trauma 2002; 52(4):752-755.
  
  Correspondence: James Mayrose, Department of Emergency Medicine, State University of New York at Buffalo 14215, USA; (email: mayrose@buffalo.edu).

  BACKGROUND: According to the National Highway Traffic Safety Administration, from 1982 through 1995 safety belts are estimated to have saved 74,769 lives. Even more lives could be saved and serious injuries avoided if there was increased seat belt use in the United States. METHODS: This study analyzed safety belt use among drivers and passengers involved in fatal motor vehicle crashes from 1993 through 1995. Age, sex, race, safety belt use, and position in the vehicle were the demographic factors obtained from both the Fatality Analysis Reporting System and the National Highway Traffic Safety Administration.
  
  FINDINGS: Overall, safety belt use increased by an average of 1.3% per year for the entire study population. Forward logistic regression identified age, female gender, Caucasian race, and driver as significant predictors of safety belt use.
  
  CONCLUSION: This study has identified younger males, African Americans, and passengers as high-risk populations for nonuse of safety belts among fatal motor vehicle crashes. These high-risk populations should be educated regarding the importance of safety belt use.

• Adolescent injury morbidity in New Zealand, 1987-96.

  Kypri K, Chalmers DJ, Langley JD, Wright CS. Inj Prev 2002; 8(1):32-37.
  
  Correspondence: Kypros Kypri, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, P.O. Box 913, Dunedin, NEW ZEALAND; (email: kkypri@ipru.otago.ac.nz).

  OBJECTIVES: Adolescents are over-represented in injury statistics. New Zealand is privileged in having a hospital discharge database allowing for analysis of non-fatal injury data at a national level. An epidemiological description of adolescent injury morbidity is provided and options for prevention are discussed.
  
  METHODS: People aged 15-19 years admitted to hospital for their injuries in the period 1 987-96 were identified from the New Zealand Health Information Service morbidity data files. The manner, causes, and nature of injury were examined. Injury prevention strategies were reviewed.
  
  FINDINGS: The incidence of hospitalized injury was 1,886 per 100,000 person years. The victims were male (70%). The leading causes of injury were road traffic crashes, sports injuries, and self poisoning. The most common injury diagnoses were head injuries (29%) and limb fractures (21%). Road traffic crashes produced the highest proportion of serious injuries.
  
  CONCLUSIONS: Road traffic crashes, sports injuries, and self inflicted poisoning, stood out as areas with the greatest potential for reducing the burden of injury in late adolescence. Graduated driver licensing shows promise as an injury prevention measure but remains inadequately implemented. Policies to reduce self inflicted poisoning are of unknown efficacy, and evidence is awaited on the effectiveness of measures to reduce injury in sport. (Copyright © 2002 BMJ Publishing Group)

• Predictors of mortality in adult trauma patients: the physiologic trauma score is equivalent to the Trauma and Injury Severity Score.

  Kuhls DA, Malone DL, McCarter RJ, Napolitano LM. J Am Coll Surg 2002; 194(6): 695-704.
  
  Correspondence: Lena M Napolitano, Department of Surgery, University of Maryland School of Medicine, 10 North Greene St, Baltimore, MD 21201 USA (email: unavailable)

  BACKGROUND: Several statistical models (Trauma and Injury Severity Score [TRISS], New Injury Severity Score [NISS], and the International Classification of Disease, Ninth Revision-based Injury Severity Score [ICISS]) have been developed over the recent decades in an attempt to accurately predict outcomes in trauma patients. The anatomic portion of these models makes them difficult to use when performing a rapid initial trauma assessment. We sought to determine if a Physiologic Trauma Score, using the systemic inflammatory response syndrome (SIRS) score in combination with other commonly used indices, could accurately predict mortality in trauma.
  
  METHODS: Prospective data were analyzed in 9,539 trauma patients evaluated at a Level I Trauma Center over a 30-month period (January 1997 to July 1999). A SIRS score (1 to 4) was calculated on admission (1 point for each: temperature > 38 degrees C or < 36 degrees C, heart rate > 90 beats per minute, respiratory rate > 20 breaths per minute, neutrophil count > 12,000 or < 4,000. SIRS score, Injury Severity Score (ISS), Revised Trauma Score (RTS), TRISS, Glasgow Coma Score, age, gender, and race were used in logistic regression models to predict trauma patients' risk of death. The area under the receiver-operating characteristic curves of sensitivity versus 1-specificity was used to assess the predictive ability of the models.
  
  FINDINGS: The study cohort of 9,539 trauma patients (of which 7,602 patients had complete data for trauma score calculations) had a mean ISS of 9 +/- 9 (SD) and mean age of 37 +/- 17 years. SIRS (SIRS score > or = 2) was present in 2,165 of 7,602 patients (28.5%). In single-variable models, TRISS and ISS were most predictive of outcomes. A multiple-variable model, Physiologic Trauma Score combining SIRS score with Glasgow Coma Score and age (Hosmer-Lemenshow chi-square = 4.74) was similar to TRISS and superior to ISS in predicting mortality. The addition of ISS to this model did not significantly improve its predictive ability.
  
  CONCLUSIONS: A new statistical model (Physiologic Trauma Score), including only physiologic variables (admission SIRS score combined with Glasgow Coma Score and age) and easily calculated at the patient bedside, accurately predicts mortality in trauma patients. The predictive ability of this model is comparable to other complex models that use both anatomic and physiologic data (TRISS, ISS, and ICISS). (Copyright © 2002 American College of Surgeons and Elsevier Science)

• Using mortuary statistics in the development of an injury surveillance system in Ghana.

  London J, Mock C, Abantanga FA, Quansah RE, Boateng KA. Bull World Health Organ 2002; 80(5): 357-364.
  
  Correspondence: Charles N. Mock, Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104 USA; (email: cmock@u.washington.edu)
  
  Available online at: http://www.who.int/bulletin/pdf/2002/bul-5-E-2002/80(5)357-364.pdf

  OBJECTIVE: To develop, in a mortuary setting, a pilot program for improving the accuracy of records of deaths caused by injury.
  
  METHODS: The recording of injury-related deaths was upgraded at the mortuary of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, in 1996 through the creation of a prospectively gathered database.
  
  FINDINGS: There was an increase in the number of deaths reported annually as attributable to injury from 72 before 1995 to 633 in 1996-99. Injuries accounted for 8.6% of all deaths recorded in the mortuary and for 12% of deaths in the age range 15-59 years; 80% of deaths caused by injury occurred outside the hospital and thus would not have been indicated in hospital statistics; 88% of injury-related deaths were associated with transport, and 50% of these involved injuries to pedestrians.
  
  CONCLUSIONS: Injury was a significant cause of mortality in this urban African setting, especially among adults of working age. The reporting of injury-related deaths in a mortuary was made more complete and accurate by means of simple inexpensive methods. This source of data could make a significant contribution to an injury surveillance system, along with hospital records and police accident reports. (Public Domain)

• Trauma scoring.

  Champion HR. Scand J Surg 2002; 91(1): 12-22.
  
  Correspondence: Howard R. Champion, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (email: HRCHAMPION@aol.com).

  Severity scales to characterize the nature and extent of injury are important adjuncts to trauma care systems, trauma research and many of the elements of a complete public health approach to injury. This article provides a brief overview of severity scale development over the past 30 years during which the science to support such initiatives has matured substantially. Anatomical, physiological, intensive care, composite and complex scales and models now abound and are being applied to a variety of tasks with increasing precision. Trauma registries enable the meaningful aggregation of data for the development and testing of models. Future challenges are identified as are potentially fruitful avenues of research. (Copyright © 2002 Scandinavian Journal of Surgery)

• No reports this week

• 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. This 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)

• 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)

• Rural elementary students', parents', and teachers' perceptions of bullying.

  Stockdale MS, Hangaduambo S, Duys D, Larson K, Sarvela PD. Am J Health Behav 2002; 26(4):266-77.
  
  Correspondence: Margaret S. Stockdale, Department of Psychology, Southern Illinois University at Carbondale, 62901, USA; (email: pstock@siu.edu).

  OBJECTIVE: To examine the prevalence and correlates of bullying in 7 rural elementary schools from students', parents', and teachers' perspectives.
  
  METHODS: Surveys were completed by 739 fourth, fifth, and sixth grade students, 367 parents, and 37 teachers.
  
  FINDINGS: Students tended to report higher prevalence of bullying than did parents or teachers, and their reports were associated with aggression, attitudes toward violence, and perceptions of school safety.
  
  CONCLUSIONS: Bullying behavior is prevalent in rural elementary schools and is indicative of aggression and proviolence attitudes. Parents and teachers need to pay closer attention to bullying behavior among school children and to impart their knowledge to children in a comprehensive, coordinated manner. (Copyright © 2002 American Academy of Health Behavior)

• Sexual assault history and suicidal behavior in a national sample of women.

  Ullman SE, Brecklin LR. Suicide Life Threat Behav 2002; 32(2):117-130.
  
  Correspondence: Sarah E. Ullman, Department of Criminal Justice, University of Illinois at Chicago, 1007 W. Harrison Chicago IL 60607-7140, USA; (email: seullman@uic.edu).

  This study examined demographic and psychosocial correlates of suicidal ideation and suicide attempts in women with histories of sexual assault in childhood and/or adulthood identified from a national sample of women. Multivariate analyses showed that women with histories of sexual assault in both childhood and adulthood reported significantly greater odds of lifetime suicide attempts, controlling for demographic factors and other psychosocial characteristics. As predicted, younger age (marginal), stressful life events (marginal), depression, PTSD, and alcohol dependence symptoms were also significantly associated with suicidal ideation. Furthermore, number of lifetime traumatic events and depression were each associated with lifetime odds of suicide attempts. Implications for studying the role of sexual trauma and other psychosocial factors in relation to women's suicidal behavior are discussed. (Copyright © 2002 American Association of Suicidology)

• Injuries and Deaths Among Children Left Unattended in or Around Motor Vehicles --- United States, July 2000--June 2001

  E McLoughlin E, Middlebrooks JA, Annest JL, Holmgreen P, Dellinger A, Fennell J, Struttman T, Schroeder T, Downs C, McDonald A, Gotsch K. MMWR 2002; 51(26): 570-572.
  
  Full report including tables, figures, and a discussion of study limitations is available HERE.

  National attention concerning motor vehicles (MVs) and child safety has focused largely on protecting children as occupants transported in traffic on public roads. However, children who are unattended in or around MVs that are not in traffic also are at increased risk for injury and death. CDC and the nonprofit Trauma Foundation examined data from two databases on both nonfatal and fatal nontraffic MV-related incidents. This report summarizes the results of that analysis, highlights the major causes of this type of childhood death and injury, and underscores the need for effective interventions.
  
  Nationally representative data on nonfatal injuries treated in hospital emergency departments (EDs) from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) were examined. Data on fatal injuries occurring across the country were reported from a database developed by the Trauma Foundation's KIDS 'N CARS™ program. During July 2000--June, 2001, data from these two programs documented an estimated 9,160 nonfatal injuries and 78 fatal injuries among children aged < 14 years who were left unattended in or around MVs that were not in traffic.
  
  NEISS-AIP, which is operated by the U.S. Consumer Product Safety Commission, collects data annually on approximately 500,000 cases from a nationally representative sample of 65 hospital EDs in the United States. National estimates of nonfatal injuries treated in hospital EDs were calculated by using the sum of sample weights of study cases; weights were derived based on the inverse of the probability of selection; confidence intervals (CIs) were computed by using a direct variance estimation procedure. Population estimates for computing rates were obtained from the U.S. Bureau of Census.
  
  NEISS-AIP study case-patients were children treated in a U.S. hospital ED after being injured while left unattended in or around MVs (e.g., cars, trucks, vans, and SUVs) not in traffic. These nontraffic injuries included those associated with 1) parked MVs on or off the street and 2) MVs in motion off the street. Children injured during the normal course of getting in or out of stationary MVs were excluded.
  
  NEISS-AIP obtains data routinely for each nonfatal injury on the principal diagnosis, body part primarily affected, ED discharge disposition, and locale of occurrence (e.g., home or public place). Narratives describing each injury event were used to identify the surface where the incident occurred (e.g., driveway, parking lot, or street) and type of event. A classification scheme assigned cases to the following types of events: run over or backed over by an MV, struck by an MV, fell out of an MV in motion, or fell off of the exterior of an MV (e.g., the bed of a pick-up truck), and other specified (e.g., bumped against, dragged by, submerged in, or overheated in an MV).
  
  The KIDS 'N CARS™ database was used to describe specific incidents involving children aged < 14 years who died as a result of being left unattended in or around MVs. National estimates of fatalities cannot be derived from this database. KIDS 'N CARS™ identifies cases through 1) online searches of LexisNexis™, a service providing access to thousands of newspapers and magazines worldwide; 2) keyword searches on Internet search engines, the registration of keyword preferences with Internet providers and news media sites, and searches within archives of newspaper websites; 3) news accounts from a clipping service; 4) contacts with child death review teams; and 5) information from an informal nationwide network of professional and personal contacts. Documentation from news media archives and other record sources is used to validate all cases identified.
  
  A total of 192 NEISS-AIP study cases was identified, representing a national estimate of 9,160 (95% CI=5,344--12,976) children with nonfatal injuries treated in U.S. hospital EDs during July 2000--June 2001. Approximately 42% of injured children were aged <4 years, and 61.9% were male. Injuries occurred predominantly to the head and neck region (30.4%) and the extremities (53.1%). Most (56.8%) injuries were minor contusions and abrasions; however, more serious injuries also were common (26.5% were fractures or internal injuries). Most (81.8%) injured children were treated and released from the ED. Most injuries occurred near the home (47.8%) or on public property (31.1%). Injuries occurred in driveways and parking lots in at least 27.2% of incidents. The most common type of nonfatal incident was being struck by an MV, followed by being run over or backed over by an MV and falling out or off of an MV. For nonfatal incidents, approximately 70% of MVs were moving at a slow speed (e.g., moving forward or backward shortly after being set in motion), and approximately 20% were moving backward.
  
  The KIDS 'N CARS™ database provided information on 78 children who died during July 2000--June 2001 in 76 separate incidents. Fatalities occurred in 28 states and the District of Columbia. Of the fatally injured children, 64 (82.1%) were aged < 4 years, and 42 (53.8%) were male. In 57 (73.1%) cases, the MV was located near a home (e.g., driveway, unpaved area near home, or street in front of home); in 39 (50%) cases, the child lived at that home. The driver was the parent in 12 (57.1%) of the 21 cases in which a child was backed over. The most common type of fatal incident was exposure to excessive heat inside an MV (e.g., when a child was left inside an MV during hot weather) (34.6%), followed by being backed over and being hurt when a child put an MV in motion (26.9%). Approximately 82% of fatal injuries occurred among children aged < 4 years.
  
  The findings in this report highlight the characteristics of nontraffic-related injuries and deaths among children. Many more U.S. children aged < 14 years are injured (e.g., an estimated 37,115 [CI=21,029--53,200] injury-related ED visits in 2000) or killed (e.g., 533 deaths in 1999) by being struck by a moving MV while in the street. However, the nontraffic-related incidents described in this report are an important cause of injuries and deaths among children. These incidents are preventable, and effective interventions must be determined to protect children.
  
  Several areas for possible intervention include education, legislation, regulation, and changes in vehicle design. Education campaigns aimed at parents and caregivers should communicate the following: 1) ensure adequate supervision when children are playing in areas near parked MVs; 2) never leave children alone in an MV, even when they are asleep or restrained; and 3) keep MVs locked in a garage or driveway and keep keys out of children's reach.
  
  Laws related to endangering the life or health of a child by leaving the child unattended in an MV have been enacted by 11 states; the nature of these laws and associated penalties vary by state. In California, funds from 70% of fines resulting from noncompliance with its associated law will go to counties to support public education campaigns to address these preventable deaths and injuries.
  
  Children might be protected further by commercially available vehicle enhancements, such as sensors that detect unseen obstacles behind an MV or devices that emit audible signals when an MV is in reverse. Evaluation of such interventions should be conducted to inform policy makers about their effectiveness in reducing nontraffic MV-related injuries and deaths among children. (Public Domain)

• Understanding the knowledge and attitudes of commercial drivers in Ghana regarding alcohol impaired driving.

  Asiamah G, Mock C, Blantari J. Inj PrevInj Prev 2002; 8(1):53-56.
  
  Correspondence: Charles N. Mock, Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104 USA; (email: cmock@u.washington.edu).

  OBJECTIVES: The knowledge and attitudes of commercial drivers in Ghana as regards alcohol impaired driving were investigated. This was done in order to provide information that could subsequently be used to develop antidrunk driving social marketing messages built upon the intrinsic values and motivation of these drivers.
  
  METHODS: Focus group discussions were held with 43 bus and minibus drivers in the capitol city, Accra. A structured discussion guide was used to capture information related to values, risk perceptions, leisure time activities, and attitudes on alcohol impaired driving.
  
  RESULTS: The majority of drivers expressed an understanding that drunk driving was a significant risk factor for crashes. There was a significant under-appreciation of the extent of the problem, however. Most believed that it was only rare, extremely intoxicated drivers who were the problem. The drivers also had a minimal understanding of the concept of blood alcohol concentration and related legal limits. Despite these factors, there was widespread support for increased enforcement of existing antidrunk driving laws.
  
  CONCLUSIONS: In Ghana, commercial drivers understand the basic danger of drunk driving and are motivated to assist in antidrunk driving measures. There are misconceptions and deficits in knowledge that need to be addressed in subsequent educational campaigns. (Copyright © 2002 BMJ Publishing Group)

• The early effects of Ontario's Administrative Driver's Licence Suspension law on driver fatalities with a BAC > 80 mg%.

  Mann RE, Smart RG, Stoduto G, Beirness D, Lamble R, Vingilis E. Can J Public Health 2002; 93(3):176-180.
  
  Correspondence: Robert Mann, Social, Prevention and Health Policy Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, CANADA; (email: robert_mann@camh.net).

  BACKGROUND: On November 29, 1996, Ontario introduced an Administrative Driver's Licence Suspension (ADLS) law, which required that anyone charged with driving with a blood alcohol concentration (BAC) over the legal limit of 80 mg% or failing to provide a breath sample would have their licence suspended for a period of 90 days at the time the charge was laid.
  
  OBJECTIVES: This study evaluates the early effects of Ontario's ADLS law on alcohol-involved driver fatalities.
  
  METHODS: Interrupted time series analysis with ARIMA modeling was applied to the monthly proportion of drivers killed in Ontario with a BAC over 80 mg% for the period Jan. 1, 1988 to Dec. 31, 1997.
  
  RESULTS: A significant intervention effect was found, with ADLS being associated with an estimated reduction of 17.3% in the proportion of fatally injured drivers who were over the legal limit.
  
  CONCLUSION: These data provide an early indication that the law resulted in some success in reducing alcohol-related driver fatalities. (Copyright © 2002 Canadian Public Health Association)

• Role of drivers' personal characteristics in understanding traffic sign symbols.

  Al-Madani H, Al-Janahi AR. Accid Anal Prev 2002; 34(2):185-196.
  
  Correspondence: Hashim Al-Mandani, Department of Civil and Architectural Engineering, University of Bahrain, P.O. Box 32038, SAUDI ARABIA; (email: madanihshm@eng.uob.bh).

  This study investigated the role of age, marital status, gender, nationality, educational background and monthly income in drivers' comprehension of traffic signs. The populations sampled here were from five Arabian Gulf Countries. A total of 28 symbolic warning and regulatory signs were investigated. A questionnaire specially prepared to collect the necessary data was distributed to over 9000 drivers in the five countries; 4774 responded (53%). The results indicated substantial problems with the level of comprehension among the drivers about the traffic signs. The percentages of drivers who correctly identified the regulatory signs and warning signs were around 55 and 56%, respectively. Age, gender, education and income played major roles in determining drivers' comprehension of signs, whereas marital status showed no significant effect. Drivers who are young, female, those with lower levels of education or lower incomes understand the signs significantly worse than drivers who are older, male, with higher levels of education or higher incomes. Drivers from Europe and USA are significantly better than Asian and Arab drivers. These findings are believed to be important for the designers of road signs for international applications. (Copyright © 2002 Elsevier Science)

• The relationship between body weight and risk of death and serious injury in motor vehicle crashes.

  Mock CN, Grossman DC, Kaufman RP, Mack CD, Rivara FP. Accid Anal Prev 2002; 34(2): 221-228.
  
  Correspondence: Charles N. Mock, Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104 USA; (email: cmock@u.washington.edu).

  We sought to investigate the effect of increased body weight on the risk of death and serious injury to occupants in motor vehicle crashes. We employed a retrospective cohort study design utilizing data from the National Automotive Sampling System, Crashworthiness Data System (CDS), 1993-1996. Subjects in the study included occupants involved in tow-away crashes of passenger cars, light trucks, vans and sport utility vehicles. Two outcomes were analyzed: death within 30 days of the crash and injury severity score (ISS). Two exposures were considered: occupant body weight and body mass index (BMI; kg/m2). Occupant weight was available on 27263 subjects (76%) in the CDS database. Mortality was 0.67%. Increased body weight was associated with increased risk of mortality and increased risk of severe injury. The odds ratio for death was 1.013 (95% CI: 1.007, 1.018) for each kilogram increase in body weight. The odds ratio for sustaining an injury with ISS > or = 9 was 1.008 (95% CI: 1.004, 1.011) for each kilogram increase in body weight. After adjustment for potentially confounding variables (age, gender, seatbelt use, seat position and vehicle curbweight), the significant relationship between occupant weight and mortality persisted. After adjustment, the relationship between occupant weight and ISS was present, although less marked. Similar trends were found when BMI was analyzed as the exposure. In conclusion, increased occupant body weight is associated with increased mortality in automobile crashes. This is probably due in part to increased co-morbid factors in the more overweight occupants. However, it is possibly also due to an increased severity of injury in these occupants. These findings may have implications for vehicle safety design, as well as for transport safety policy. (Copyright © 2002 Elsevier Science)

• Anger and aggression among drivers in three European countries.

  Parker D, Lajunen T, Summala H. Accid Anal Prev 2002; 34(2): 229-235.
  
  Correspondence: Dianne Parker, Department of Psychology, University of Manchester, Manchester M13 9PL, UK; (email: parker@fs4.psy.man.ac.uk).

  Recent reports of 'road rage' in the British media give the impression that driver aggression is escalating. In order to understand this phenomenon we need to know what it is about driving that provokes motorists to feel anger and then to go on to express that anger in the form of aggression. A postal questionnaire survey of more than 2500 drivers was carried out in three European countries: Britain, Finland and the Netherlands. The study had three main aims: (a) to discover how angry, if at all, a range of situations on the road make drivers, (b) to find out how many drivers are likely to react aggressively to those situations, and (c) to investigate individual and/or cultural differences in terms of anger and/or aggressive responses among motorists. Results indicate that the same types of behavior provoke anger and aggression in all three countries, and that traffic density may play a role. (Copyright © 2002 Elsevier Science)

• Evaluation of a combined brake-accelerator pedal.

  Nilsson R. Accid Anal Prev 2002; 34(2): 175-183.
  
  Correspondence: Rickard Nillson, Department of Psychology, Uppsala University, Box 1225, S-751 42, Upsala,SWEDEN; (email: rickard.nilsson@psyk.uu.se).

  Over the years, designers have developed various combined brake-accelerator pedals in an effort to eliminate the operator's risk of pressing the wrong pedal as well as to reduce his or her reaction time in braking. The goal of this study is to highlight problems that drivers may face when they switch between pedal systems. Eighteen male and female drivers varying in age participated in the study. The evaluation was carried out during special driving maneuvers and in normal traffic in which all drivers used the same test vehicle. The results indicate that drivers were able to learn the new combined pedal mechanism quickly and effortlessly and that the number of mistakes was extremely low during the acquisition phase in learning the new system. The drivers reported that they preferred the combined brake-accelerator pedal to the conventional pedals, noting that the combined pedal offered greater physical comfort and was considerably more natural to operate. Because of the risk of compensation, whereby increased safety is forfeited as a result of reduced safety margins, future experiments of the new combined pedal are desirable. (Copyright © 2002 Elsevier Science)

• Injury to the spinal cord in motor vehicle traffic crashes.

  O'Connor P. Accid Anal Prev 2002; 34(2): 477-485.
  
  Correspondence: Peter O'Conner, Australian Spinal Cord Injury Register, AIHW National Injury Surveillance Unit, Flinders University Research Centre for Injury Studies, Bedford Park, Australia. peter.oconnor@nisu.flinders.edu.au

  Motor vehicle traffic crashes (MVTCs) are the leading cause of traumatic spinal cord injury. Evidence of putative risk factors for this type of injury comes largely from descriptive studies. This study is the first case-control study of risk factors for spinal cord injury specifically in car crashes. Cases of occupant spinal cord injury in South Australia were identified from the Australian Spinal Cord Injury Register (ASCIR) which provides full coverage of the adult population. The comparison group was other seriously injured car occupants. In single vehicle car crashes in the country, the likelihood of spinal cord injury was five times higher for occupants of non-sedan type cars compared with sedans. The likelihood of spinal cord injury was especially high in non-sedan type cars involved in rollover crashes; ten times higher than sedans. The implications of the findings for prevention are highlighted. Concern is expressed over the increasing proportion of four wheel drive passenger vehicles (sport utility vehicles) in the car fleet in Australia, and in the USA, as they are more prone to rollover. (Copyright © 2002 Elsevier Science)

• Incidence and patterns of spinal cord injury in Australia.

  O'Connor P. Accid Anal Prev 2002; 34(2): 405-415.
  
  Correspondence: Peter O'Connor, AIHW National Injury Surveillance Unit, Research Centre for Injury Studies, Flinders University, Bedford Park, SA, AUSTRALIA; (email: peter.oconnor@nisu.flinders.edu.au).

  The objective of this paper is to report on the epidemiology of spinal cord injury (SCI) based on the Australian SCI register and to discuss the implications for prevention. All adult cases of SCI are reported to the registry. The case reports for 1998/1999 were aggregated and described. The age adjusted rate of persisting SCI was 14.5 per million of population. Rates were highest in young adults and in males. The vast majority of cases (93%) were due to unintentional injury. Forty-three percent were due to motor vehicle crashes, principally from motor vehicle rollover. Cases of SCI from falls, aquatic activities, and working for income are also described. Incomplete cervical cord injuries were most common (38%), particularly as a result of motor vehicle crashes and low falls. The study indicates that the surveillance of SCI needs to be improved internationally so that comparative studies can be undertaken. It is recommended that the Centers for Disease Control case definition be adopted. Australia is one of the few countries that have a register based on that case definition, and the only one that has a register covering a full national adult population. The results presented on the basis of this data source provide some hitherto unavailable information on the incidence rates and patterns of SCI. National population based surveillance is fundamental to an understanding of the epidemiology, and hence the prevention, of this severe and costly health and welfare problem. (Copyright © 2002 Elsevier Science)

• Effects of child seats on the cardiorespiratory function of newborns.

  Nagase H, Yonetani M, Uetani Y, Nakamura H. Pediatr Int 2002; 44(1):60-63.
  
  Correspondence: Hiroaki Nagase MD, Chuo-ku, Kusunoki-cho, 7-chome, 5-1 Kobe 650-0017, JAPAN; (email: hiroaki@med.kobe-u.ac.jp).

  BACKGROUND: This study aims to determine the effect of differently positioned infant car seats on cardio-respiratory parameters in healthy full-term newborns.
  
  METHODS: We examined 15 healthy term newborns for respiratory compromise due to normal restraint in a recommended infant car seat. There are currently two types of car seats available in Japan: a chair-shaped car seat and a bed-shaped car seat. Using a sleep apnea recorder, we simultaneously monitored heart rate, percutaneous oxygen saturation, chest impedance and nasal airflow in infants placed in each of the car seats and also placed in the supine position on a nursery cot. Episodes of oxygen desaturation below 95% and longer than 10 s (mild desaturation) and below 90% longer and than 10 s (moderate desaturation) were evaluated over 30 min observation period.
  
  FINDINGS: The amount of time infants spent in a sleep state was significantly longer in the car seats than it was on the cot (P = 0.0015 for bed-shaped, P = 0.0012 for chair-shaped) and there was no difference in this measure between the two types of car safety seats. Mean of oxygen saturation with the chair-shaped car seat (95.8%) was significantly lower than that with the bed-shaped car seat (98.8%) (P = 0.0008). Newborn infants laid on the cot showed no episodes of desaturation. Newborn infants placed in the chair-shaped car seat had significantly more episodes of mild desaturation (mean, 7.33 times in nine of 15 infants), whereas in the bed-shaped seat observed only once each in two infants (P = 0.008). Moderate desaturation was observed in four of 15 infants in the chair-shaped car seat, whereas not observed in the bed-shaped car seat (P = 0.068).
  
  CONCLUSION: The results suggest that prior to discharge the degree of oxygen desaturation that occurs when an infant is placed in a chair-style car seat should be checked. (Copyright © 2002Japan Pediatric Society and Blackwell Publishing)

• Pediatric residents buckle up: a child safety seat training program for pediatric residents.

  Tender JA, Taft CH, Frey C, Mickalide A, Gitterman BA. Ambul Pediatr 2001; 1(6):333-337.
  
  Correspondence: Jennifer A. F. Tender, Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA; (email: unavailable).

  OBJECTIVES: To assess the effectiveness of supervised installation of child safety seats (CSSs) as a teaching tool for pediatric residents and to evaluate acceptance of this hands-on learning experience.
  
  METHODS: Pediatric residents were divided into an intervention group and a control group. All residents completed an initial questionnaire regarding knowledge about CSS use. The intervention group listened to a CSS lecture, viewed a video, and installed CSSs under the supervision of certified CSS technicians. The control group received no intervention. A second questionnaire was administered to all residents. We compared the knowledge gained since the initial questionnaire. The intervention group answered questions regarding their acceptance of this learning experience.
  
  FINDINGS: Sixty-one residents participated in the study. Most residents had never installed a CSS and felt uncomfortable with their CSS knowledge. The percentage of the intervention group that received a passing score for knowledge increased from 3% initially to 97% on the posttest (P < .001). There was no change in the passing rate of the control group. The intervention group rated the CSS installation session as extremely helpful.
  
  CONCLUSION: A hands-on educational program can be an effective, well-accepted method for increasing pediatric residents' knowledge about CSS use. (Copyright © 2001 Ambulatory Pediatric Association)

• Seat-belt use by trauma center employees before and after a safety campaign.

  Scheltema KE, Brost SM, Skager GA, Roberts DJ. Am J Health Behav 2002; 26(4):278-283.
  
  Correspondence: Karen E. Scheltema, Research and Education, Health East Care System, St Paul, MN 55104-3727, USA; (email: kschelte@mninter.net).

  OBJECTIVES: To determine whether employees of a regional trauma center wore seat belts any more often than did visitors to the medical center and residents of the state. To demonstrate whether an intensive safety campaign would improve seat-belt compliance among trauma center employees. To determine the duration of improvement.
  
  METHODS: Hospital employees and visitors were observed as they exited the medical center's parking ramps over a 3-month period.
  
  FINDINGS: After a hospital-wide seat-belt campaign, employee compliance rose by 7.5%, to 81.5% at 14 days, but fell back to preintervention levels at one month (76.7%) and 3 months (77%) after the intervention.
  
  CONCLUSIONS: An intensive seat-belt safety campaign resulted in only modest and transient improvement in the rate of seat-belt use. (Copyright © 2002 American Academy of Health Behavior)

• Biomechanical analysis of padding in child seats and head injury.

  Kumaresan S, Sances A Jr, Carlin F. Biomed Sci Instrum (Conference Procedings) 2002; 38:453-458.
  
  Correspondence: Srirangam Kumaresan, Department of Computer Science, University of California, Biomechanics Institute, Santa Barbara, CA, USA; (email: kumar@cs.ucsb.edu).

  BACKGROUND: Head injury is a common finding for infants and young children involved in automobile accidents. Although the child restraint seats have increased the level of safety for the pediatric population, skull fracture and/or brain injury occur during the interaction between the child's head and interior of the car seats with no padding. The introduction of effective and sufficient padding may significantly reduce the head injury.
  
  OBJECTIVES: The present study was designed to evaluate the biomechanical effects of padding in child seats to reduce the potential for head injury.
  
  METHODS: A head drop test of a six-month old anthropomorphic dummy was conducted. The side of the dummy head impacted the interior wing of child car seats of relatively soft and stiff materials, and a rigid metal plate at velocities of 2.2, 4.5 and 6.7 m/s. In all tests, three types of padding environments were used (no padding, comfort foam, 16 to 19 mm polypropylene padding). All data were collected at 10 kHz and filtered. A total of 39 tests were conducted.
  
  FINDINGS: The head injury criteria (HIC), and head acceleration, and head angular acceleration were obtained. The HIC was calculated over a 36 ms interval from the resultant tri-axial acceleration. The angular accelerations were derived from the angular velocity data. The head injury biomechanical parameters decreased with the addition of padding. The HIC, peak acceleration, and angular acceleration were reduced up to 91%, 80%, and 61% respectively.
  
  CONCLUSIONS: The present results emphasize the importance of energy absorbing padding to provide an improved safety environment in child car seats.

• Restraint use and injury patterns among children involved in motor vehicle collisions.

  Valent F, McGwin G Jr, Hardin W, Johnston C, Rue LW 3rd. J Trauma 2002; 52(4):745-751.
  
  Correspondence: Francesca Valent, Epidemiology Unit, Center for Injury Sciences, University of Alabama at Birmingham, 35294-0016, USA; (email: valent@uab.edu).

  BACKGROUND: Motor vehicle collisions are the leading cause of death among children older than 1 year. Use of appropriate restraint systems is associated with reductions in morbidity and mortality in this age group. No studies have evaluated the association between specific injury patterns and restraint use among children.
  
  OBJECTIVES: The purpose of this study was to evaluate differences in risks of injuries in different body regions according to restraint use among children 0 to 11 years of age.
  
  METHODS: The 1995 to 1999 National Automotive Sampling System data files were used. The National Automotive Sampling System is a national probability sample of passenger vehicles involved in police-reported tow-away collisions. Information on occupant (seating position, restraint use), collision (change in velocity, vehicle intrusion), and outcome characteristics was evaluated. Risks of injuries in different body regions (Abbreviated Injury Scale, 1990 Revision score > or = 2) were calculated and compared according to restraint use.
  
  FINDINGS: Between 1995 and 1999, there were approximately 1.5 million children 0 to 11 years of age involved in police-reported tow-away MVCs who met the inclusion criteria for this study. Compared with unrestrained children, properly restrained children had significantly lower overall injury risk (risk ratio [RR], 0.37); significant risk reductions were also observed for injuries to the head (RR, 0.18), thorax (RR, 0.35), and lower extremities (RR, 0.26), and mortality (RR, 0.26). Significant risk reductions were not noted when comparing improperly restrained children with unrestrained children.
  
  CONCLUSIONS: Proper restraint use among children is associated with lower risk of injury. Educational initiatives should focus not only on encouraging restraint use but also on ensuring that parents know the appropriate age-dependent restraint method and how to use it properly. (Copyright © 2002 American Association for the Surgery of Trauma)

• The role of restraint and seat position in pediatric facial fractures.

  Arbogast KB, Durbin DR, Kallan MJ, Menon RA, Lincoln AE, Winston FK. J Trauma 2002; 52(4): 693-698.
  
  Correspondence: Kristy B. Arbogast, TraumaLink and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA; (email: arbogast@email.chop.edu).

  BACKGROUND: Recently, head and brain injuries were identified as consequences of the inappropriate use of seat belts by children. The proposed mechanism of these injuries might also place a child at risk for facial fracture.
  
  METHODS: A probability sample of children under age 16 involved in crashes were enrolled in an ongoing crash surveillance system (1998-2001) that links insurance claims data to telephone survey and crash investigation data (unweighted, n = 12,659; weighted, n = 131,717). Incidence of facial fracture was estimated and a series of cases were examined using in-depth crash investigation to identify the mechanisms of these injuries, specifically, the role of seating position and restraint use in the mechanism of injury.
  
  FINDINGS: Ninety-two children suffered a fracture of the facial bones (0.07% of all children in crashes). Among restrained children with facial fractures (n = 68), those inappropriately restrained were at a 1.6-fold higher risk (95% confidence interval, 1.2-2.1; p = 0.001) of significant injury than those appropriately restrained for their age. The in-depth investigations revealed that excessive head excursion resulting from suboptimal torso restraint caused facial impact, which resulted in the facial injuries described.
  
  CONCLUSION: The potential for disfigurement associated with these facial injuries may resonate strongly with parents, and prevention of disfigurement may provide additional motivation for proper restraint, in particular, booster seats and rear seat location, for this pediatric population.

• "Scared Straight" and other juvenile awareness programs for preventing juvenile delinquency (Cochrane Review)

  Petrosino A , Turpin-Petrosino C, Buehler J. Cochrane Database Syst Rev Issue 2 2002. Oxford: Update Software.
  
  Correspondence: Anthony Petrosino, Initiatives for Children Program (IFC), American Academy of Arts & Sciences, Center for Evaluation, 136 Irving Street, Cambridge, MA 02138, USA; (email: apetrosino@amacad.org).
  
  Available online: http://www.update-software.com/abstracts/ab002796.htm

  BACKGROUND: 'Scared Straight' and other programmes involve organized visits to prison by juvenile delinquents or children at risk for criminal behavior. programmes are designed to deter participants from future offending through first-hand observation of prison life and interaction with adult inmates. These programmes remain in use world-wide despite studies and reviews questioning their effectiveness.
  
  OBJECTIVES: To assess the effects of programmes comprising organized visits to prisons by juvenile delinquents (officially adjudicated or convicted by a juvenile court) or pre-delinquents (children in trouble but not officially adjudicated as delinquents), aimed at deterring them from criminal activity.
  
  SEARCH STRATEGY: Handsearching by the first author in identifying randomized field trials 1945-1993 relevant to criminology was augmented by structured searches of 16 electronic data bases, including the Campbell SPECTR database of trials and the Cochrane CCTR. Experts in the field were consulted and relevant citations were followed up.
  
  SELECTION CRITERIA: Studies that tested the effects of any program involving the organized visits of juvenile delinquents or children at-risk for delinquency to penal institutions were included. Studies that included overlapping samples of juvenile and young adults (e.g. ages 14-20) were included. We only considered studies that randomly or quasi-randomly (i.e. alternation) assigned participants to conditions. Each study had to have a no-treatment control condition with at least one outcome measure of "post-visit" criminal behavior.
  
  DATA COLLECTION & ANALYSIS: We report narratively on the nine eligible trials. We conducted one meta-analysis of post-intervention offending rates using official data. Information from other sources (e.g. self-report) was either missing from some studies or critical information was omitted (e.g. standard deviations). We examined the immediate post-treatment effects (i.e. "first-effects") by computing Odds Ratios (OR) for data on proportions of each group re-offending, and assumed both fixed and random effects models in our analyses.
  
  FINDINGS: The analysis show the intervention to be more harmful than doing nothing. The program effect, whether assuming a fixed or random effects model, was nearly identical and negative in direction, regardless of the meta-analytic strategy.
  
  CONCLUSIONS: We conclude that programmes like 'Scared Straight' are likely to have a harmful effect and increase delinquency relative to doing nothing at all to the same youths. Given these results, agencies that permit such programmes must rigorously evaluate them not only to ensure that they are doing what they purport to do (prevent crime) - but at the very least they do not cause more harm than good.

• Understanding the abnormal by studying the normal.

  Andershed H, Kerr M, Stattin H. Acta Psychiatr Scand Suppl 2002; (412):75-80.
  
  Correspondence: Henrik Andershed, Center for Developmental Research, Department of Social Sciences, Örebro University, Sweden (email: henrick.andershed@sam.oru.se).

  OBJECTIVES: In the present paper we ask whether it is meaningful to study psychopathic traits in non-referred youths and whether this kind of research can be used to understand the development of criminal full-blown psychopathy.
  
  METHODS: We review studies that have investigated the utility of assessing psychopathic traits in non-referred samples of youths.
  
  FINDINGS: Research shows that psychopathic traits in non-referred youths manifest similarly to how they are manifested among incarcerated offenders, as indicated by similarities in factor structures. Also, psychopathic traits relate similarly to frequent, violent antisocial behavior in non-referred youths as among adult and adolescent institutionalized criminal offenders. Thus, the differences between the non-referred conduct-problem youths exhibiting a psychopathic personality pattern and the incarcerated, criminal youths identified as psychopathic seem to be quantitative rather than qualitative.
  
  CONCLUSIONS: It is concluded that research on non-referred youth samples can provide important knowledge about the processes that underlie the development of psychopathic traits and how this development can be prevented. Implications for future research and intervention and prevention are discussed. (Copyright © 2002 Blackwell Publications)

• Violence, sexual abuse and health in Greenland.

  Curtis T, Larsen FB, Helweg-Larsen K, Bjerregaard P. Int J Circumpolar Health 2002; 61(2):110-122.
  
  National Institute of Public Health, Section for Research in Greenland, Copenhagen, DENMARK; (email: tc@niph.dk).

  The purposes of the study were to analyse the lifetime prevalence of violence and sexual abuse among the Inuit in Greenland and to study the associations between health and having been the victim of violence or sexual abuse. Associations were studied with specific attention to possible differences between women and men. Further, response rates were analyzed specifically in order to understand consequences of including questions on violence and sexual abuse in the questionnaire survey. The analyses were based on material from a cross-sectional health interview survey conducted during 1993-94 with participation from a random sample of the Inuit population in Greenland (N = 1393). The prevalence of ever having been a victim of violence was 47% among women and 48% among men. Women had more often than men been sexually abused (25% and 6%) (p < 0,001) and had more often been sexually abused in childhood (8% and 3%) (p = 0.001). Having been the victim of violence or sexual abuse was significantly associated with a number of health problems: chronic disease, recent illness, poor self-rated health, and mental health problems. The associations between having been the victim of violence or sexual abuse and health was stronger for women than for men. It is possible to secure a reasonably high response rate in a general health survey that includes questions on violence and sexual abuse. (Copyright © 2002 International Journal of Circumpolar Health)

• Issues in the measurement of violent incidents and the introduction of a new scale: the 'attacks' (attempted and actual assault scale).

  Bowers L, Nijman H, Palmstierna T, Crowhurst N. Acta Psychiatr Scand Suppl 2002;106 Suppl 2002; (412): 106-109.
  
  City University, London, UK, TBS-Clinic De Kijvelanden, the Netherlands and St Goran's Hospital, Stockholm, Sweden.

  OBJECTIVE: To review the strengths and weaknesses of existing violent incident measures, and introduce a new scale, the 'attacks'. The new scale provides an objective measure of incident severity and focuses on interpersonal physical violence in isolation from other behaviors.
  
  METHODS: The new scale was piloted on six psychiatric wards in the East End of London over a period of 16 weeks. Descriptive data were obtained and validated against official violent incident records.
  
  FINDINGS: There were 40 incidents by 21 aggressive patients, most of which occurred on the psychiatric intensive care unit. Striking assaults predominated. Continuous holding of the patient by nurses occurred after 17% of incidents. Special observation was also used as a subsequent management method in more than half of the incidents.
  
  CONCLUSIONS: The scale is acceptable to nurses and valid. Interesting questions are raised about the content of training for staff in the prevention and management of violent incidents. (Copyright © 2002 Blackwell Publications)

• A comparison of risk factors for habitual violence in pre-trial subjects.

  Kaliski SZ. Acta Psychiatr Scand Suppl 2002;106 Suppl 2002; (412): 58-61.
  
  Forensic Psychiatry Unit, Valkenberg Hospital, Department of Psychiatry, University of Cape Town, South Africa.

  OBJECTIVES: : Pre-trial referrals to the Valkenberg Hospital forensic unit over a 6-month period were studied. Habitually violent offenders were compared with those with no history of violence.
  
  METHODS: Risk factors known to be associated with violent behavior were elicited, i.e. demographics, behavior during index offence (such as impulsivity, identity of victim, use of weapon, accomplices, intoxication, psychotic symptoms), psychiatric and family histories, history of suicide attempts, past child abuse, head injury, criminal record, psychiatric diagnosis and presence of medical disorders. EEG's, Barratt's Impulsivity, Zuckerman's Sensation Seeking and Mini-Mental Scales were administered. Behavior in the ward during the 30 days was also appraised. Logistic regression models were used to determine relative risks.
  
  RESULTS: There were 155 subjects; 89.7% were male, 71.6% were single and 58.7% were unemployed. For 44.5% the index offence was violent, and 9.7% had committed sexual offenses; 61.9% had histories of habitual violence. A psychotic disorder was diagnosed in 32.3% and a personality disorder in 48.4%. Habitually violent subjects were distinguished by a history of issuing threats (OR=3.68; CI=3.19-4.16; P= 0.000), delusions of persecution (OR=3.43; CI=2.67-4.17; P=0.001), history of conduct disorder (OR=1.95; CI=1.70-2.19; P=0.006), alcohol/substance abuse (OR=2.08; CI=1.53-2.61; P=0.008) and violent index offence (OR=1.66; CI=1.54-2.61; P=0.035).
  
  CONCLUSIONS: : This seems to confirm the relationship between threats, feeling threatened, psychosis, a history of antisocial behavior and alcohol abuse. (Copyright © 2002 Blackwell Publications)

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