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15 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 & Other Drugs
  • Developing Effective School-based Drug Abuse Prevention Programs

    Zavela KJ. Am J Health Behav 2002; 26(4): 252-265.

    Correspondence: Kathleen J. Zavela, Department of Community Health, College of Health and Human Sciences, University of Northern Colorado, Gunter 2280, Box 93, Greeley, CO 80639, USA; (email: kathy.zavela@unco.edu).

    OBJECTIVES: To research effective drug prevention strategies for school-aged populations from drug prevention programs funded by the USDHHS Center for Substance Abuse Prevention (CSAP).

    METHODS: Nine directors and staff members from model CSAP-funded programs were interviewed.

    FINDINGS: Fifteen strategies that focus on building trusted relationships, selecting well-qualified staff using existing communication networks, and providing timely evaluation feedback are discussed, with examples from the agencies cited.

    CONCLUSIONS: Formulating effective partnerships that support both the goals of the outside agency with drug prevention resources and the mission of a school can contribute toward effective school-based drug prevention programs.

Commentaray & Editorials
  • Australia needs to follow New Zealand's lead on sports injuries.

    Orchard JE, Finch CF. Med J Aust 2002; 177 (1): 38-39.

    Correspondence: John W Orchard, South Sydney Sports Medicine, 111 Anzac Parade, Kensington, NSW 2033, AUSTRALIA; (email: johnorchard@msn.com.au).

    Online: HERE.

    Sports injuries result in substantial costs to the Australian community and also act as a barrier to increased participation in physical activity. However, the Australian healthcare system has no coordinated approach for monitoring or preventing sports injuries. This is in contrast to New Zealand, which has a specific body responsible for managing sports injuries, in a similar way to work injuries and traffic accidents

    The Federal Government body devoted to sport, the Australian Sports Commission (ASC), has been extremely successful in promoting and developing Australian sport at the elite level. However, it does not consider itself responsible, in any major way, for the promotion of safe sport at the community level, and devotes most of its resources to the areas for which it is accountable, such as Australia's performance in elite sporting events.

    The approach to road trauma in Australia is a good example of how the healthcare system could better manage sports injuries. Traffic accidents are managed entirely outside the Medicare system, through bodies such as the Transport Accident Commission in Victoria. These bodies provide an infrastructure to support and develop preventive measures and actively engage in data collection to monitor injury trends. That Australian roads are much safer today than they were 20–30 years ago is testament to the success and extent of this preventive approach.

    The New Zealand approach to managing the problem of sports injuries may not be perfect, but it is surely better than the Australian approach of having no overall plan. Australian government bodies concerned with health and sport need to establish a body with national responsibility for sports safety and injury surveillance, exploring options such as a New Zealand-style national sports injury insurance scheme. It is only with an established infrastructure for monitoring sports injuries that significant advances will be made towards preventing sports injuries and ensuring safe, lifelong participation in physical activity for all Australians. (Copyright © 2002 Medical Journal of Australia)

Disasters
  • No reports this week

Occupational Issues
  • How is it possible? Why didn't we do anything? A case history!

    Pasman HJ, Grollier Baron R. J Hazard Mater 2002; 93(1):147-154.

    Correspondence: H.J. Passman, TNO Defence Research, Schoemakerstraat 97, P.O. Box 6006, 2600 JA Delft, THE NETHERLANDS; (email: pasman@do.tno.nl).

    Two similar serious incidents occurred at a metal refining process installation within a 6-month time interval. The first one killed ten people, and the second incident one person. The events provide a typical case history of how a safety management system and a corresponding organisation could have prevented the occurrence of such an accident or, at least, have reduced its effects. The case is also interesting because it illustrates the complexities forming the root cause of the events.

Pedestrian & Bicycle Issues
  • Safety evaluation of right turn on red.

    Fleck JL, Yee BM. Inst Transp Eng J 2002 72(6): 46-48.

    Correspondence: Jack L. Fleck, San Francisco Department of Parking and Traffic,25 Van Ness Avenue, Suite 345, San Francisco, CA 94102, USA (email: unavailable).

    California law permitting right turns on red took effect on Jan. 1, 1939. Section 21453 (b) of the California Vehicle Code (CVC) requires drivers to make the turn "after stopping"; it also requires drivers to "yield the right-of-way to pedestrians lawfully within an adjacent crosswalk and to traffic lawfully using the intersection."

    According to the CVC, right turns are permitted, "except when a sign is in place prohibiting a turn..." San Francisco currently has signs prohibiting turns on red at about 125 of its 1,050 signalized intersections. Right turns on red are often prohibited at intersections with high volumes of pedestrian/ vehicle conflicts or where sight distances or intersection geometrics may pose a safety problem for right turns on red. The Department of Parking and Traffic evaluates requests for RTOR prohibitions on a case-by-case basis.

    Right-turn on red (RTOR) is a proven, safe and effective traffic-engineering policy. Since the question of the desirability of prohibiting RTOR at all intersections in California comes up frequently in discussions with the public, it is important for traffic engineers to understand the advantages and disadvantages of prohibiting right turns on red. California's law and San Francisco's current policy permitting right turns on red is sound. It has a proven record of safety. (Copyright © 2002 Institute of Transportation Engineers)

Poisoning
  • Elderly patients with deliberate self-poisoning treated in an Australian general hospital.

    Ticehurst S, Carter GL, Clover KA, Whyte IM, Raymond J, Fryer J. Int Psychogeriatr 2002; 14(1):97-105.

    Correspondence: Stephen Bruce Ticehurst, Faculty of Medicine and Health Sciences, The University of Newcastle, Callaghan, AUSTRALIA; (email: mdsbt@mail.newcastle.edu.au).

    OBJECTIVES: To examine the demographic, prescription, ingestion, and psychiatric diagnostic factors that distinguished elderly from nonelderly patients treated for deliberate self-poisoning (DSP).

    METHOD: A prospective case series study of 2,667 patients presenting to a regional referral center for poisoning (Newcastle Mater Hospital, NSW, Australia), January 1991 to July 1998. The sample was stratified into two groups, 65 years or greater (n = 110) and 64 years or less (n = 2,557) at the time of index admission. The groups were compared using a forward stepwise logistic regression model. Uncontrolled comparisons were analyzed by chi-square statistic with Bonferroni-adjusted p values and controlled comparisons by odds ratio (OR) with 95% confidence interval (CI).

    FINDINGS: The elderly group represented 4.1% of the total. The logistic regression analysis found the elderly DSP group was more likely to have a longer length of stay (OR 5.90, CI 3.87-9.00), to have been prescribed "other" drugs (neither benzodiazepines, mood treatment drugs, nor paracetamol) before admission (OR 5.32, CI 3.34-8.48), to have been prescribed benzodiazepines (OR 3.15, CI 2.03-4.89), and to be diagnosed with major depression (OR 2.17, CI 1.41-3.36) than the younger group. The elderly group was less likely to have ingested paracetamol (OR 0.28, CI 0.14-0.54) or "other" drugs (neither benzodiazepines nor mood treatment drugs) in the DSP episode (OR 0.33, CI 0.20-0.54).

    CONCLUSIONS: Elderly DSP patients differ in several important respects from younger patients. They have higher morbidity as a result of the DSP. Major depression plays a more important role. The strong relationship between benzodiazepine prescription and DSP in the elderly raises questions and possible prevention strategies. (Copyright © 2002 International Psychogeriatric Association)

Recreation & Sports
  • Recommendations for lightning protection in sport.

    Makdissi M, Brukner P. Med J Aust 2002; 177 (1): 35-37.

    Correspondence: Michael Makdissi, Centre for Sports Medicine Research and Education, School of Physiology, University of Melbourne, Melbourne, VIC 3010, AUSTRALIA; (email: m.makdissi@pgrad.unimelb.edu.au).

    Available online: HERE.

    Lightning is an important cause of weather-related morbidity and mortality and is often underrated. Each year many people are killed or injured by lightning due to misinformation and inappropriate behaviour during thunderstorms. Analysis of the circumstances surrounding lightning strikes shows that, while there has been a large decrease in the number of lightning casualties in farming and outdoor work, there has been a smaller relative increase in sports-related casualties. Moreover, with large crowds gathering to participate in or watch an outdoor event, the potential exists for mass casualties to occur from a lightning strike at any one venue. Hence, there is a need to develop specific approaches for lightning safety at sports events.

    In Australia, fatality rates for lightning strikes have fallen from 0.21 per 100 000 population in 1910–19194 to about 0.01 per 100 000 population in the 1990s. From 1990 to 1999, 23 fatalities were directly attributable to lightning. Furthermore, from 1993 to 1998, lightning was responsible for 95 hospital admissions. From these figures, we can estimate that the mortality rate from lightning strikes in Australia is currently about 10%. This is below the generally accepted mortality rate of 30%, although other authors have reported mortality rates as low as 5%.

    Organisers of sporting events should have a lightning safety policy that includes a designated weather watcher with the authority to stop or postpone the event, a specific chain of command, and designated safe areas.

    Suspension and resumption of play should follow the "30/30" rule: play should stop when the flash-to-bang count is 30 seconds, and should not resume until 30 minutes after the last lightning.

    At events with large crowds, additional time should be allowed for evacuating all people to safe areas. (Copyright © 2002 Medical Journal of Australia)

RISK FACTOR PREVALENCE
  • No reports this week

Research Methods
  • A note on the variance of paired comparisons estimates.

    Hertz ES. Accid Anal Prev 2002; 34(3):401-404.

    Correspondence:Ellen S. Hertz, National Highway Traffic Safety Administration, Washington, DC 20590, USA; (email: ehertz@nhtsa.dot.gov).

    The method of paired comparisons to estimate treatment effectiveness was introduced by Evans (Evans L. Double pair comparison--a new method to determine how occupant characteristics affect fatality risk in traffic crashes. Accident Analysis and Prevention 1985;12:217-27). It is similar in form to other effectiveness estimates based on odds ratios using independent groups. Therefore, it has been generally assumed that the variance is computed in the same way. In this note, it is demonstrated. using a simple binomial model and linear approximation, that the variance is lower for paired comparisons estimates than for odds ratios estimates based on independent groups. In order to use odds ratios, there must be a treated group and an untreated group. Within each group there are occurrences of an event against which treatment effectiveness is being estimated and, also, occurrences of different event that is considered unamenable to the treatment. The treatment effectiveness, e, is estimated by 1-R where R is the ratio of amenable type events to unamenable ones in the treated group, divided by the same ratio for the untreated group. A distinction is made between 'real' paired comparisons and odds ratios based on independent data. An example of the independent case is. x is the number of fatalities in frontal crashes without air bags; y the number of fatalities in non-frontal crashes without air bags; s the number of fatalities in frontal crashes with air bags, and t the number of fatalities in non-frontal crashes with air bags. While fatalities in non-frontal crashes serve as denominators in R, a particular frontal crash is not paired with one particular non-frontal crash. In this case, in which all the data are independent, the variance of e is approximately R2(1/x + 1/y + 1/s + 1/t), a result which is consistent with well known results about the log odds ratio. For an example of real paired comparisons, we consider fatalities in cars that have a driver and exactly one unbelted right front seat passenger. Suppose there were x driver fatalities and y passenger fatalities in the cars in which the driver was also unbelted and s driver fatalities and t passenger fatalities in the cars in which the driver was belted. Since the fate of the passenger would not be amenable to 'treating' the driver, the same estimate of belt effectiveness based on these data. 1 - (s/t)/(x/y), is reasonable. In this case, x and y, and s and t are not independent. This is due to the fact that while the overall probability of fatality in a crash is very low, the conditional probability of fatality given that someone else in the car died is greater than the unconditional probability of fatality. Under these circumstances, the variance of the paired comparisons estimate is reduced. (This report is in the public domain. Published by Elsevier Science Ltd.)

  • Use of statistical techniques in studies of suicide seasonality, 1970 to 1997.

    Hakko H, Rasanen P, Tiihonen J, Nieminen P. Suicide Life Threat Behav 2002; 32(2): 191-208.

    Correspondence: Helina Hakko, Department of Psychiatry at the University of Oulu, FINLAND; (email: helina.hakko@oulu.fi).

    The effect of seasons on suicides has been suggested repeatedly. In order to reveal a true seasonal pattern, an appropriate statistical technique, which is sensitive to a specific type of cyclic variation in the data, must be chosen. This study is a review of the use of statistical techniques for seasonality and of some important characteristics of study samples that were evaluated from 46 original suicide seasonality articles published in major psychiatric journals. The results showed that statistical techniques were applied in a majority of articles, but they were commonly lacking regarding analyses, which compared seasonal patterns among subgroups of a population. In recent studies more sophisticated statistical techniques were utilized for seasonality, like spectral analyses, as compared with earlier studies, in which the emphasis was on chi-square tests. Lack of reporting essential features of the data, such as the sample size and monthly values of suicides, were frequent. The calendar effect was adjusted only in 11 studies. Some recommendations concerning the methodological and reporting issues are summarized for future articles on the seasonal affect on suicides. (Copyright © 2002 American Association of Suicidology)

Injuries at Home
  • No reports this week

Rural & Agricultural Issues
  • Effects of safety behaviours with pesticide use on occurrence of acute symptoms in male and female tobacco-growing Malaysian farmers.

    Nordi RB, Araki S, Sato H, Yokoyama K, Wan Muda WA, Win Kyi D. Ind Health 2002; 40(2):182-190.

    Correspondence: R. B. Nordi, Department of Public Health and Occupational Medicine, Graduate School of Medicine, The University of Tokyo, JAPAN; (email: unavailable).

    The effects of safety behaviours associated with pesticide use on the occurrence of acute organ symptoms in 395 male and 101 female tobacco-growing farmers in Malaysia were studied. We used a 15-questionnaire checklist on safe pesticide-use behaviours and a 25-questionnaire checklist on acute organ symptoms reported shortly after spraying pesticides. Results of stepwise multiple linear regression analysis indicated that no smoking while spraying, good sprayer-condition, and changing clothes immediately after spraying significantly prevented occurrence of acute symptoms just after pesticide spray in male farmers; in female farmers, only wearing a hat while spraying significantly prevented the symptoms. Safety behaviours in pesticide use in male and female tobacco-growing farmers are discussed in the light of these findings. (Copyright © 2002 American Society of Agricultural Engineers)

  • Tractor risk abatement and control as a coherent strategy.

    Myers ML. J Agric Saf Health 2002; 8(2): 185-198.

    Correspondence: Melvin L. Myers (email: melmyers@bellsouth.net).

    The agricultural tractor was the principal source of fatal injury on American farms for the latter part of the 20th century, and they maintain that distinction today. Much has been learned about the toll of these fatalities and how to prevent them over the last ten years, yet public policy has generally been unsuccessful in reducing this toll. A policy conference entitled Tractor Risk Abatement and Control convened in 1997 to develop recommendations to reduce this death toll. Several stakeholders at the conference agreed on 25 action items, which if implemented would reduce the number of tractor-related deaths by more than 2,000 by the year 2015. These recommendations relate to tractor overturns, runovers, and traffic collisions as well as youth operators. This article addresses the completeness of a strategy for preventing tractor-related injuries for each of these four areas based upon an evaluation model derived from the Theory of Planned Behavior and an antecedent model. The ultimate result of this model is to influence an individual's intention to act to prevent injury. The set of recommendations was found to provide a coherent strategy. In addition, implementing the strategy at an organizational level is discussed. (Copyright © 2002 American Society of Agricultural Engineers)

  • Agricultural machinery injuries in Ontario, 1985-1996: a comparison of males and females.

    Locker AR, Pickett W, Hartling L, Dorland JL. J Agric Saf Health 2002; 8(2): 215-223.

    Correspondence: William L. Pickett, Community Health and Epidemiology, Queen's University, Ontario, Canada; (email: pickettw@post.QueensU.CA). .

    Males and females on farms perform different types of work. This study investigated whether certain injuries experienced by women and men on farms also differed. Gender-based comparisons were made of fatal and hospitalized agricultural machinery injuries that took place in Ontario, Canada, between 1985 and 1996. Data compiled by the Canadian Agricultural Injury Surveillance Program (CAISP) were used. Comparisons were based on 2,333 injury records and six descriptors: age group, time period, agricultural season in which the injury occurred, machinery involved, mechanism of injury, type of machinery, and admission category (where applicable). Distributions of injuries between males and females were statistically different by age group, agricultural production season, and mechanism of injury. These and other differences suggest that gender-specific injury patterns exist. Future studies should examine the factors contributing to these differences, including degree and duration of exposure to agricultural machinery. (Copyright © 2002 American Society of Agricultural Engineers)

School Issues
  • See report under Alcohol and Other Drugs

Suicide
  • See abstract under Poisoning

  • See abstract under Research Methods

  • Additive impact of childhood emotional, physical, and sexual abuse on suicide attempts among low-income African American women.

    Anderson PL, Tiro JA, Price AW, Bender MA, Kaslow NJ. Suicide Life Threat Behav 2002; 32(2): 131-138.

    Correspondence: Nadine J, Kaslow, Emory University School of Medicine, Department of Psychiatry, 80 Butler Street SE, Atlanta, GA 30335 USA; (email: nkaslow@emory.edu).

    This study examines the association between exposures to multiple forms of childhood abuse (emotional, physical, sexual) and adult suicidal behavior in a sample of low-income, African American women. We hypothesized a linear relation between childhood abuse and risk for making a suicide attempt, such that the more forms of childhood abuse to which a woman was exposed, the greater her risk would be to make a suicide attempt. Logistic regression analyses revealed that, compared to women who did not report any experiences of childhood abuse, women who experienced one, two, or three forms of abuse were 1.83, 2.29, or 7.75 times more likely to attempt suicide, respectively (all statistically significant). Furthermore, compared to women who reported one or two types of abuse, women who reported all three types of abuse were statistically more likely to attempt suicide. These findings have implications for clinicians working with African American women who report either childhood abuse or exhibit suicidal behavior. (Copyright © 2002 American Association of Suicidology)

  • Is evaluative research on youth suicide programs theory-driven? The Canadian experience.

    Breton JJ, Boyer R, Bilodeau H, Raymond S, Joubert N, Nantel MA. Suicide Life Threat Behav 2002; 32(2): 176-190.

    Correspondence: Jean-Jacques Breton, Research Unit, Riviere-des-Prairies Hospital, Universite de Montreal, QC,CANADA; (email: jj.breton.hrdp@ssss.gouv.qc.ca).

    An in-depth review found that only 15 Canadian youth suicide programs had been evaluated over the last decades. Most of these were conducted in schools; general education on suicide was the most common strategy used. The descriptions of the programs were incomplete, and their theoretical bases never presented. All evaluations looked at program effects in accordance with the predominant experimental paradigm in evaluative research. Only two of the programs led to a reduction in suicidal behavior. Future evaluative research should place greater emphasis on the content of programs, especially their theoretical bases. (Copyright © 2002 American Association of Suicidology)

  • Situational determinants of inpatient self-harm.

    Nijman HL, a Campo JM. Suicide Life Threat Behav 2002; 32(2): 167-175.

    Correspondence: Henk L. I. Nijman, De Kijvelanden forensic psychiatric hospital, Poortugaal, THE NETHERLANDS; (email: volkoren@wxs.nl).

    Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed. (Copyright © 2002 American Association of Suicidology)

Transportation
  • Travel health: a survey of life jacket designs currently in use on commercial aircraft.

    Bauer IL. J Travel Med 2002; 9(3): 132-136.

    Irmgard L. Bauer, School of Nursing Sciences, James Cook University, Townsville, Queensland, AUSTRALIA; (email: irmgard.bauer@jcu.edu.au).

    BACKGROUND: Although any travel harbors potential health problems, travel across water poses the additional risk of involuntary contact with water in the event of an emergency. Studies suggest that fatal boat-related accidents have occurred due to the passengers' inability to don their life jackets.

    OBJECTIVES: With the dramatic increase of long-haul flights, it was decided to investigate if potential safety hazards can be identified leading to similar problems in relation to the life jackets provided onboard aircraft. It was assumed that the variety of designs combined with a possible lack of attention paid to safety instructions could represent such a problem.

    METHODS: Safety instruction cards in passengers' seat pockets usually depict the life jacket model used on a particular aircraft. Ninety-eight such safety cards from 53 airlines were analyzed and categorized to identify the range and variety of designs currently in use.

    FINDINGS: Twelve different categories of life jacket models could be distinguished with some airlines using more than one model. It was also found that not all cards show a clear depiction of the models used, the cards of two airlines show two different designs on the same cards, and two other companies chose to change the model halfway through the pictured donning procedure.

    CONCLUSIONS: There is a wide variety of life jacket designs in use with the safety cards not always giving accurate instructions. This variety also has implications for the safety demonstration at the beginning of a flight. Further research is recommended into a range of topics, one being the quality and content of these instructions, and also into other personal floating devices provided for the safety of travelers in the event of an emergency over water. (Copyright © 2002 International Society of Travel Medicine)

  • Proper use of child safety seats.

    Biagioli F. Am Fam Physician 2002; 65(10):2085-2090.

    Correspondence: Frances Biagioli, Oregon Health & Science University, Department of Family Medicine, Gabriel Park Family Health Ctr., 4411 Southwest Vermont St., Portland, OR 97219 USA; (email: biagioli@ohsu.edu).

    Available on-line: http://www.aafp.org/afp/20020515/2085.html.

    Motor vehicle crashes continue to be the leading cause of death in children one to 14 years of age. Used correctly, child safety seats significantly reduce child morbidity and mortality. Although many parents know child safety seats are important, more than 80 percent of seats are misused. Increased education of parents regarding proper use of child safety seats can protect children from potentially fatal crash forces. Parents may also be educated about community resources and the several types of child safety seats. (Copyright © 2002 American Academy of Family Physicians)

  • Effect of head support on oxygen saturation in preterm infants restrained in a car seat.

    Dollberg S, Yacov G, Mimouni F, Ashbel G. Am J Perinatol 2002; 19(3): 115-118.

    Correspondence: Shaul Dollberg, Department of Neonatology, Lis Maternity Hospital, Tel Aviv-Sourasky Medical Center, Tel Aviv, ISRAEL; (email: unavailable).

    We prospectively tested the hypothesis that prevention of lateral movement of the head, using a specially designed head support apparatus, would prevent oxygen desaturation in preterm infants restrained in car seats. Preterm infants reaching 34 to 35 weeks' gestation were studied at the week of discharge in 3 different conditions for 20 minutes each time: supine decubitus, sitting position in a newborn car seat, and sitting position in the car seat equipped with an apparatus that supports the head, while monitored by pulse oxymetry. Data are expressed as percent of time over each period during which the oxygen saturation was below 90, 92, 94, or 96%. Statistical analysis was by analysis of variance (ANOVA) followed by paired Student t-test for differences of means. There were no significant differences among groups in percent of time with oxygen saturation below 96, 94, 92, or 90%. Oxygenation is not improved in relatively healthy preterm infants placed in a car seat when their head is supported to prevent lateral movements by a special apparatus. (Copyright © 2002Georg Thieme Verlag).

  • Risk factors for motor vehicle crashes in older women.

    Margolis KL, Kerani RP, McGovern P, Songer T, Cauley JA, Ensrud KE. J Gerontol A Biol Sci Med Sci 2002; 57(3): M186-91.

    Correspondence: Karen L. Margolis, Division of Clinical Epidemiology, Hennepin County Medical Center, Minneapolis, Minnesota 55415, USA; (email: marg006@tc.umn.edu).

    BACKGROUND: Motor vehicle crash and fatality rates are higher per mile driven for elderly drivers, with an exponential increase above age 75. Identifying elderly drivers who are at risk for automobile crashes may help direct interventions to reduce their high rate of injuries and deaths.

    METHODS: Subjects were 1416 women aged 65 to 84 enrolled in the Portland, Ore. site of the Study of Osteoporotic Fractures. Motor vehicle crash information for the years 1986-1995 for each participant was obtained from the Oregon State Department of Transportation. Items from questionnaires, interviews, and physical examinations were tested prospectively for associations with the occurrence of motor vehicle crashes.

    FINDINGS: About one third of participants (415 of 1416) had a motor vehicle crash during a mean follow-up time of 5.7 years. After adjustment for age and weekly driving mileage, risk factors significantly associated with motor vehicle crashes were a fall in the previous year [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.26-1.86], a greater orthostatic systolic blood pressure drop (HR 1.11 per 12.5 mm Hg, 95% CI 1.01-1.22), and increased foot reaction time (HR 1.10 per 0.06 second, 95% CI 1.00-1.22). Other neuromuscular tests, functional status, medical diagnoses, vision tests, and cognitive tests did not predict motor vehicle crashes in this study population.

    CONCLUSIONS: This prospective study with extended follow-up of a large cohort of elderly women has identified crash risk factors that can be measured in the clinical setting. Further study is needed to determine if interventions aimed at these risk factors can decrease the risk of motor vehicle crashes. (Copyright © 2002 by The Gerontological Society of America)

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

    Zaliski SA. Acta Psychiatr Scand Suppl 2002;(412):58-61.

    Correspondence: S. Z. Kaliski, Forensic Psychiatry Unit, Valkenberg Hospital, Department of Psychiatry, University of Cape Town, SOUTH AFRICA; (email: unavailable).

    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 behaviour were elicited, i.e. demographics, behaviour 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. Behaviour in the ward during the 30days was also appraised. Logistic regression models were used to determine relative risks.

    FINDINGS: 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 offences; 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 distin- guished 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 behaviour and alcohol abuse.

  • Adult psychopathy and violent behavior in males with early neglect and abuse.

    Lang S, Af Klinteberg B, Alm PO. Acta Psychiatr Scand Suppl 2002;(412):93-100.

    Department of Psychology, Stockholm University, Sweden, Centre for Health Equity Studies, Stockholm University/Karolinska Institute, Sweden and Center for Clinical Research, Vasteras Central Hospital, Uppsala University, Uppsala, Sweden.

    OBJECTIVES: Within a Swedish longitudinal project, possible implications of childhood neglect and/or abuse on adult psychopathy checklist (PCL) scores and violent offending were studied.

    METHODS: The subjects were males (n=199), recruited from a socially high-risk neighborhood and grouped on an index variable of victimization, yielding high (n=110) and low victimization (n=89) groups. To highlight a possible comorbidity of all three problems in the same persons, a combined dimensional and categorical (configural frequency analysis, CFA) approach was applied.

    FINDINGS: The high victimization subjects exerted significantly more violence, as did subjects with high PCL scores. Furthermore, in the CFA two significant 'types' were found: one type indicating that 'high' victimization in childhood is closely linked to later 'extensive' violence and 'high' PCL scores at adult age in the same individuals; the other supporting a frequent co-occurring of 'low' victimization in childhood, 'none or minor' later indications of violence and 'low' adult PCL scores.

    CONCLUSIONS: The results point to possible underlying mechanisms linked to all three problems characterizing the affected subjects.

  • Date violence and date rape among adolescents: associations with disordered eating behaviors and psychological health.

    Ackar DM, Neumark-Sztainer D. Child Abuse Negl 2002 May;26(5):455-473.

    Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.

    OBJECTIVES: The goal of the study was to assess the prevalence of date violence and rape in adolescents, to examine associations between date violence and rape and disordered eating behaviors and psychopathology, and to determine if these associations remain significant after controlling for sociodemographic characteristics and other physical and sexual abuse by an adult. METHOD: A Minnesota school-based sample of 81,247 boys and girls in 9th and 12th grades completed the 1998 Minnesota Student Survey. FINDINGS: Overall, approximately 9% of girls and 6% of boys had experienced date violence or rape. Significant differences across race and grade were found. Date violence and rape is associated with higher rates of disordered eating behaviors and suicidal thoughts and attempts, and lower scores on measures of emotional well-being and self-esteem. Over 50% of youth reporting both date violence and rape also reported attempting suicide. Controlling for race and age, adolescents who have experienced both date violence and rape were more likely to use laxatives (OR: girls = 5.76; boys = 28.22), vomit (OR: girls = 4.74; boys = 21.46), use diet pills (OR: girls = 5.08; boys = 16.33), binge eat (OR: girls = 2.15; boys = 5.80), and have suicidal thoughts or attempts (OR: girls = 5.78; boys = 6.66) than their nonabused peers. These odds were weakened but remained significant after controlling for other abuse by an adult. Furthermore, a greater percentage of girls and boys who reported an abusive dating experience also reported repeat victimization (physical or sexual abuse perpetrated by an adult) when compared to their peers without an abusive dating experience. DISCUSSION: Abusive experiences during dating relationships may disrupt normal developmental processes, including the development of a stable self-concept and integrated body image during adolescence. This disruption manifests itself through thoughts, feelings, and behaviors. Further research should explore effects of adverse adolescent dating experiences.

  • Young guns: Examining alternative explanations of juvenile firearm homicide rates.

    Ousey GC, Augustine MC. Criminology 2001; 39(4): 933-968.

    Correspondence: Graham C. Ousey, Department of Sociology, University of Kentucky, Lexington, KY 40506-0027, USA; (email: gousey@pop.uky.edu).

    In recent years, youth firearm homicide has become a topic of great public concern in the United States. However, few macrolevel studies have examined intercity variation in juvenile firearm homicide. In the current study, we address this gap in the literature by examining whether intercity variation in firearm-related homicide rates among black and white juveniles is explained by three prominent structural factors: concentrated disadvantage, racial inequality, and the youth illicit drug market activity. Our findings suggest partial support for the concentrated disadvantage and juvenile drug market explanations of homicide. However, contrary to expectations, these relationships are only significant in models for white juveniles. (Copyright © 2001 American Society of Criminology)

  • Guns, violent crime, and suicide in 21 countries.

    Killias M, van Kesteren J, Rindlisbacher M. Can J Criminol 2001; 43(4): 429-448.

    Correspondence: Martin Killias, Institut de police scientifique et de criminologie, BCH CH-1015 Lausanne, SWITZERLAND; (email: Martin.Killias@ipsc.unil.ch).

    BACKGROUND: Research on the role of firearms in violence and fatal events has focused heavily on American data and research. This implies certain limitations, since the United States is one of the Western countries with exceptionally high homicide and gun ownership rates. Thus, the American context offers only limited variance in the most prominent independent as well as dependent variables. International comparisons offer challenging new perspectives.

    METHODS: This research is based on data on gun availability in private households, collected through the international victimization surveys of 1989, 1992, and 1996, and World Health Organization data on homicide and suicide from 21 countries. It updates and extends former research conducted on this issue, based on the surveys of 1989 and 1992. In addition, data from the International Crime Victimization Surveys were used on total and gun-related robbery and assault (including threats).

    FINDINGS: The results show very strong correlations between the presence of guns in the home and suicide committed with a gun, rates of gun-related homicide involving female victims, and gun-related assault. The picture is different for male homicide, total rates of assault, and generally, for robbery (committed with or without a gun). With the exception of robbery, most correlations are similar or stronger when all types of guns are considered, rather than handguns alone. Interestingly, no significant correlations with total suicide or homicide rates were found, leaving open the question of possible substitution effects.

    CONCLUSIONS: It is concluded that guns in the home are an important risk factor in suicide with guns, as well as a threat to women (especially female partners), whereas their role in homicide of male victims and street crime (such as robbery) may be much less prominent. Finally, the usual focus on handguns may lead to underestimate the role of other types of guns. (Copyright © 2001 Canadian Criminal Justice Association)

  • Does immigration increase homicide? Negative evidence from three border cities.

    Lee MT, Martinez R, Rosenfeld R. Sociol Q 2001; 42(4): 559-580.

    Correspondence: Matthew T. Lee, Department of Sociology, University of Akron, Akron, OH 44325-1905, USA; (email: mlee2@uakron.edu).

    Understanding the complex relationship between immigration and crime was once a core concern of American sociology. Yet the extensive post-1965 wave of immigration to the United States has done little to rekindle scholarly interest in this topic, even as politicians and other public figures advocate public policies to restrict immigration as a means of preventing crime. (Copyright © 2001 University of California Press and Midwest Sociological Society)

  • More guns, more crime.

    Duggan M. J Polit Econ 2001; 109(5): 1086-1114.

    Correspondence: Mark Duggan, Department of Economics, Division of Social Sciences, University of Chicago, 1126 East 59th Street, Chicago, IL 60637, USA; (email: mduggan@uchicago.edu).

    This paper examines the relationship between gun ownership and crime. Previous research has suffered from a lack of reliable data on gun ownership. I exploit a unique data set to reliably estimate annual rates of gun ownership at both the state and the county levels during the past two decades. My findings demonstrate that changes in gun ownership are significantly positively related to changes in the homicide rate, with this relationship driven almost entirely by an impact of gun ownership on murders in which a gun is used. The effect of gun ownership on all other crime categories is much less marked. Recent reductions in the fraction of households owning a gun can explain one-third of the differential decline in gun homicides relative to nongun homicides since 1993. (Copyright © 2001 University of Chicago Press)

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Rev. 13-Jul-2002.