SafetyLit - 29 July 2002

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29 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 consumption and mortality: modeling risks for men and women at different ages.

White IR, Altmann DR, Nanchahal K. BMJ 2002; 325(7357): 191-194.

Ian R White, Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge CB2 2SR, UK; (email: ian.white@mrc-bsu.cam.ac.uk).

Alcohol consumption increases the risk of various cancers, hypertension, liver disease, unintentional injuries, and violence. Definitions of light and moderate alcohol consumption vary, but these levels of consumption are generally found to decrease the risk of ischemic heart disease. For all cause mortality the relation is typically U shaped, with non-drinkers and heavier drinkers having higher risks than light and moderate drinkers. The royal colleges of physicians, psychiatrists, and general practitioners have therefore advised men and women to drink less than 21 and 14 units a week, respectively, whereas the UK government has recommended no more than 4 and 3 units a day, respectively; 1 unit is 8-10 g of alcohol. However, the levels giving the lowest or a low risk are likely to vary with age as well as sex and have not been systematically quantified.

METHODS: We used statistical models relating alcohol consumption to the risk of death from single causes to estimate the all cause risk for men and women of different ages in England and Wales. Analyses used published systematic reviews and population data. Setting: England and Wales in 1997. Main outcome measures were death from any of the following causes: cancer of lip, oral cavity, pharynx, esophagus, colon, rectum, liver, larynx, and breast, essential hypertension, coronary heart disease, stroke, cirrhosis, non-cirrhotic chronic liver disease, chronic pancreatitis, and injuries.

FINDINGS: A direct dose-response relation exists between alcohol consumption and risk of death in women aged 16-54 and in men aged 16-34. At older ages the relation is U shaped. The level at which the risk is lowest increases with age, reaching 3 units a week in women aged over 65 and 8 units a week in men aged over 65. The level at which the risk is increased by 5% above this minimum is 8 units a week in women aged 16-24 and 5 units a week in men aged 16-24, increasing to 20 and 34 units a week in women and men aged over 65, respectively.

DISCUSSION: Substantially increased risks of all cause mortality can occur even in people drinking lower than recommended limits, and especially among younger people.(Copyright © 2002 British Medical Journal)
Blood alcohol content (BAC)-negative victims in alcohol-involved injury incidents.

Levy DT, Miller TR, Mallonee S, Spicer RS, Romano EO, Fisher DA, Smith GS. Addiction 2002; 97(7): 909-914.

Correspondence to: David T. Levy, PhD 14403 Sylvan Glade Drive, N. Potomac, MD 20878, USA. Tel: + 1 301 984 6517, Fax: + 1 301 755 2799, USA; (email: levy@pire.org).

OBJECTIVES: To understand better how often BAC-negative victims suffer fatal and non-fatal alcohol-involved injuries.

METHODS: We analyzed 1988-1993 data from Oklahoma surveillance systems that track all people killed or hospitalized due to burns, submersions and spinal cord injuries (SCIs) and investigate alcohol use by victims and any others who contributed to their injuries. OUtcome measures included the percentage of victims BAC-positive and percentage of victims BAC-negative in alcohol-involved incidents.

FINDINGS: Of 5107 cases studied, alcohol involvement was known for 4773 (93%), 1882 fire burns (93%), 1560 scald and other burns (97%), 698 submersions (92%) and 967 spinal cord injuries (89%). By type of injuries, BAC-negative victims were 4%, 13%, 6% and 8% of alcohol-involved cases, respectively.

DISCUSSION: A sizeable number of BAC-negative victims suffer alcohol-involved injuries. Although alcohol is not the cause of some of these injuries, alcohol policy changes probably could avert others. (Copyright © 2002 Blackwell Science Publishers)
Reducing high-risk drinking by young Americans south of the border: the impact of a partial ban on sales of alcohol.

Voas RB, Lange JE, Johnson MB. J Stud Alcohol 2002; 63(3): 286-292.

Correspondence: Pacific Institute for Research and Evaluation,11710 Beltsville Drive. Suite 300, Calverton, MD 20705-3102, USA; (email: voas@pire.org).

OBJECTIVE: Determine the effect of a partial sales ban on cross border drinking in Mexico.

METHODS: On weekend evenings, thousands of youths (younger than 21 years) and young adults (21 to 25 years) residing in communities along the U.S. border cross over into Mexico to patronize all-night bars where the drinking age is 18 rather than 21 years and where the price of alcohol is considerably less than in the United States. On January 1, 1999, Juarez, Mexico, across the border from El Paso, Texas, implemented a 2 AM bar closing policy replacing the previous 5 AM closing time. Breath alcohol tests of pedestrians at the Juarez/El Paso border before and after the policy change were compared with a similar sample of pedestrians at the Tijuana, Mexico/San Diego, California border.

FINDINGS: At the Juarez/El Paso border, the total number of youths with positive BACs returning from Juarez after 3 AM when the bars were closed was reduced 89%, whereas the number returning between midnight and 3 AM remained unchanged. There was no change in either period at the Tijuana/San Diego comparison site.

CONCLUSIONS: Early closing of the bars in Juarez reduced the number of youths returning after 3 AM to the United States with positive BACs. (Copyright © 2002 Center of Alcohol Studies Rutgers University)
Alcohol and the accident and emergency department: a current review.

Charalambous MP. Alcohol Alcoholism 2002; 37(4): 307-312.

Michalis P. Charalambous, Imperial College of Science, Technology, and Medicine, St Mary's Hospital Medical School Campus, Norfolk Place, London W2 1NY, UK. (email: michalis.charalambous@ic.ac.uk).

Alcohol misuse constitutes a major problem in our modern society and both physical and mental alcohol-related harm result in a large number of Accident and Emergency (A & E) attendances, thus imposing a significant burden on the workload and financial resources of the department. The current management of problem drinking by most A & E departments could be further improved. The introduction of a holistic approach that includes efficient screening instruments and effective brief, anti-alcoholic interventions, for the management of these patients must be considered. This should strengthen the preventive role of A & E departments, and, in the long term, may result in a decrease in the number of cases of alcohol misuse and in alcohol-related attendances. (Copyright © 2002 Medical Council on Alcohol)
Association between state level drinking and driving countermeasures and self reported alcohol impaired driving.

Shults RA, Sleet DA, Elder RW, Ryan GW, Sehgal M. Inj Prev 2002; 8(2): 106-110.

Correspondence: Ruth A. Shults, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention CDC, Atlanta, Georgia 30341-3724, USA; (email: ras1@cdc.gov).

OBJECTIVES: In 1999, alcohol related motor vehicle crashes in the United States claimed 15786 lives and injured more than 300000 persons. Drinking and driving behavior is shaped by individual and environmental level influences. In this study, the association between each state's driving under the influence of alcohol (DUI) countermeasures and self reported alcohol impaired driving was explored.

METHODS: Mothers Against Drunk Driving's (MADD's) Rating the States 2000 survey, which graded states on their DUI countermeasures from 1996-99, was used as an index of each state's comprehensive DUI prevention activities. Information on alcohol impaired driving from residents of each state was obtained from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) survey. The association between the MADD state grades and alcohol impaired driving was assessed using multiple logistic regression.

FINDINGS: Of the 64162 BRFSS respondents who reported drinking any alcohol during the past month, 2.1% of women and 5.8% of men reported at least one episode of alcohol impaired driving in the past month. Those living in states with a MADD grade of "D" were 60% more likely to report alcohol impaired driving than those from states with a MADD grade of "A" (odds ratio 1.6, 95% confidence interval 1.3 to 2.1). The association existed for men and women.

DISCUSSION: These findings suggest that stronger state level DUI countermeasures are associated with lower rates of self reported alcohol impaired driving. (Copyright © 2002 BMJ Publications Group)

Research on injury prevention: topics for systematic review.

Rivara FP, Johansen JM, Thompson DC. Inj Prev 2002; 8(2): 161-164.

Correspondence: Fredrick P. Rivara, Harborview Injury Prevention and Research Center, 325 Ninth Avenue, Seattle, WA 98104-2499, USA; (email: fpr@u.washington.edu).

BACKGROUND: Duplication should be avoided in research and only effective intervention programs should be implemented.

OBJECTIVE: To arrive at a consensus among injury control investigators and practitioners on the most important research questions for systematic review in the area of injury prevention. DESIGN: Delphi survey.

METHODS: A total of 34 injury prevention experts were asked to submit questions for systematic review. These were then collated; experts then ranked these on importance and availability of research.

FINDINGS: Twenty one experts generated 79 questions. The prevention areas with the most number of questions generated were fires and burns, motor vehicle, and violence (other than intimate partner), and the least were other interventions (which included Safe Communities), and risk compensation. These were ranked by mean score. There was good agreement between the mean score and the proportion of experts rating questions as important or very important. Nine of the top 24 questions were rated as having some to a substantial amount of research available, and 15 as having little research available.

CONCLUSIONS: The Delphi technique provided a useful means to develop consensus on injury prevention research needs and questions for systematic review. (Copyright © 2002 BMJ Publications Group)
The evolution and current status of emergency medical services for children.

Haller JA Jr. Surg Clin North Am 2002; 82(2):263-271.

Johns Hopkins University Hospital, Baltimore, MD 21205, USA; (email: amancalled@mindspring.com).

Emergency physicians have come to believe that comprehensive pediatric emergency care should be integrated into an overall medical system and organized regionally to address the special needs of children. Since our emergency medical systems have evolved in the care of adult trauma victims, we must look to that development for the origin of our present emergency medical services for children. Not until the 1970s did it became obvious that children, just as adults, should be included in an comprehensive emergency medical system for the care of their life threatening injuries. Since there is considerable overlap in the basic principles of trauma resuscitation and management of shock in children and adults, most children's regional trauma program developed as a part of an overall emergency medical system. The sharing of trauma facilities made it possible to utilize the special expertise of a very small number of pediatric surgeons who had trauma experience and to incorporate their skills into the broader concept of comprehensive regional trauma centers for children and adults. With further experience we soon realized that such emergency medical services for children's systems should include the following components: A two way communication system, a transport system with special equipment for the management of small children, a training program for first responders at the trauma site, a designated pediatric trauma center, a pediatric intensive care unit at the regional trauma center, a neurology/neurosurgery intermediate care unit at the regional center, a pediatric trauma rehabilitation unit and finally a pediatric trauma longterm rehabilitation and management unit for those with residual disabilities. With the further development of this concept of trauma units for children, pediatric surgeons, general surgeons involved in trauma care and pediatric emergency physicians have offered leadership to expand the emergency medical system for children to include life-threatening illness, as well as injuries. Thus, the organization of regional emergency medical services for children permits the highest quality management of children with life-threatening injuries and illness. This then is the final product: an inclusive, comprehensive emergency medical system for children for all life threatening conditions, both trauma and serious illness. (Copyright © 2002 Elsevier Science)

No reports this week

Occupational risks in Latin America and the Caribbean: economic and health dimensions.

Giuffrida A, Iunes RF, Savedoff WD. Health Policy Plan 2002; 17(3): 235-246.

Correspondence: Antonio Giuffrida, Organization for Economic Cooperation and Development, Social Policy Division - Health Policy Unit, 2 rue Andre Pascal, 75775 Paris, Cedex 16, FRANCE (email: antonio.giuffrida@oecd.org)

This study analyzes health and economic aspects of occupational safety in Latin America and the Caribbean. Work-related injuries and illnesses represent a primary health risk in the region. Specific factors negatively affect work safety in the region: the structure of the labor market, the lack of adequate resources for enforcement, prevention and research, the hazard profile, as well as the presence of vulnerable groups in the workforce. This study estimates that between 27 270 and 73 500 occupational fatal accidents occur in the region each year. It also calculates that the economic costs of these hazards represent between 2 and 4% of regional Gross Domestic Product. The paper concludes by discussing public policies that could address this problem and improve compliance with appropriate safety standards in the region. (Copyright © 2002 Oxford University Press)

Child pedestrian injuries at tram and bus stops.

Unger R, Eder C, Mayr JM, Wernig J. Injury 2002; 33(6): 485-488.

Correspondence: Johannes Mayr, Department of Pediatric Surgery and Austrian Committee for Injury Prevention in childhood, University of Graz, Auenbruggerplatz 34, A 8036, Graz, AUSTRIA; (email: johannes.mayr@kfunigraz.ac.at).

In order to analyse these injuries and to create guidelines for prevention, injuries at bus or tram stops were analyzed retrospectively. Medical records were analyzed and questionnaires were sent to the parents in order to obtain detailed information about the mode and physical sequelae or post-traumatic behavioral disturbances of the injury. Thirty children of a median age of 9.5 years (2.7-15.3 years) were treated within a 6-year period. Sixteen out of 30 children (53.3%) were injured on their way to school and 3 (10.0%) on their way to kindergarten. Nine out of 30 children (30%) were injured when crossing the street from behind the bus or the tram. Five children (16.7%) were injured by buses, 6 (20.0%) by trams and 19 (63.3%) by passing motorized vehicles. Twelve (40.0%) were injured in the presence of accompanying adults. In 17 of 30 cases (56.7%) the visibility of the vehicle and/or the child was obstructed. The median Injury Severity Score (ISS) was 4.5 (1-75) and the mortality rate 2 out of 30 (6.7%), both children had been killed at bus stops alongside country roads. Nine out of 28 surviving children (32.1%) suffer from minor physical sequelae and 6 (21.4%) from post-traumatic behavioral disturbances. Crossing the road from behind a bus in the area of a stop alongside a country road is extremely dangerous. It is mandatory to increase the safety at bus stops along country roads. (Copyright © 2002 Elsevier Science)

Paracetamol pack size restriction: the impact on paracetamol poisoning and the over-the-counter supply of paracetamol, aspirin and ibuprofen.

Sheen CL, Dillon JF, Bateman DN, Simpson KJ, MacDonald TM. Pharmacoepidemiol Drug Saf 2002; 11(4):329-331.

Christopher L. Sheen, Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK; (email: chris@memo.dundee.ac.uk).

BACKGROUND: Self-poisoning occurs with over-the-counter (OTC) drugs, particularly paracetamol (acetaminophen). In 1998, OTC pack sizes of paracetamol were reduced.

OBJECTIVES: We have studied the effect of this pack size restriction on OTC supply of paracetamol, aspirin and ibuprofen.

METHODS: IMS Health UK provided data on the UK sales of paracetamol, aspirin and ibuprofen. The total mass and number of packs of each drug supplied were compared for the years 1998, 1999 and 2000.

FINDINGS: The mass of aspirin and paracetamol sold fell, that of ibuprofen increased. The number of paracetamol packs sold was unchanged, the analgesic dose of aspirin fell and ibuprofen supply increased.

DISCUSSION: It seems that the paracetamol pack size reduction has not achieved as large an overdose rate reduction as might have been expected. Instead, a shift to the use of ibuprofen may lead to an increase in gastrointestinal adverse events and continue the burden on healthcare resources. (Copyright © 2002 John Wiley & Sons)

Helmet use: a survey of 4 common childhood leisure activities.

Forjuoh SN, Fiesinger T, Schuchmann JA, Mason S. Arch Pediatr Adolesc Med 2002; 156(7): 656-61.

Correspondence: Samuel N. Forjuoh, Department of Family Medicine, Scott and White Santa Fe Center, 1402 W Ave H, Temple, TX 76504 (email: sforjuoh@swmail.sw.org).

OBJECTIVE: To compare the distribution and observation of helmet use patterns among 4 common childhood leisure activities-bicycle riding, in-line skating, skateboarding, and scooter riding-in a setting with no helmet use legislation.

METHODS: A cross-sectional, unobtrusive, direct observation of children engaged in 1 of the 4 activities was conducted during an 8-week period. The study was performed in eight communities of at least 1000 persons each in a 2-county Central Texas area. MAin outcome measures were prevalence of activity, helmet use, and correct helmet use.

FINDINGS: Of 841 children observed, most rode bicycles (74.8%); only 4.2% rode skateboards. They included 127 children estimated to be younger than 6 years (15.1%) and 495 estimated to be aged between 6 and 12 years (58.9%). Most were male (67.3%) and observed in urban communities (61.7%). The locations of highest concentration of the 4 activities were minor streets for bicycle riding, playgrounds for in-line skating, and sidewalks for skateboarding and scooter riding. The rate of overall helmet use was 13.6% and did not vary significantly by activity: in-line skating, 18.2%; skateboarding, 14.3%; bicycle riding, 13.5%; and scooter riding, 11.5%. However, the observed correct helmet use prevalence of 72.6% differed significantly by activity. Most children riding scooters wore their helmets incorrectly. Helmet use was positively associated with helmet use by accompanying children and/or adults.

CONCLUSIONS: While bicycle riding was the most popular activity observed, helmet use was most prevalent among in-line skaters and least prevalent among scooter riders, many of whom also wore them incorrectly. Observed helmet use was influenced mostly by adult and peer helmet use, indicating that public education and interventions should target children and their parents as well as scooter riders. (Copyright © 2002 American Medical Association)
Tug of war: introduction to the sport and an epidemiological injury study among elite pullers.

Smith J, Krabak B. Scand J Med Sci Sports 2002; 12(2): 117-124.

Correspondence: Jay Smith, Assistant Professor of Physical Medicine and Rehabilitation, Mayo Clinic Sports Medicine Center and Mayo Graduate School Of Medicine, Rochester, MN USA; (email: unavailable).

The objective of this study was to describe injury patterns among elite tug of war athletes, using a survey method. The setting was the World Tug of War (TOW) Championships in 1998. All 990 male and female athletes asked to participate. Demographic data, participation history, and injury history during TOW, including injury number and type, were collected. A total of 252 (187 males and 65 females) athletes completed the survey (25% response rate). Although males had been competing longer than females (9.3 +/- 6.9 years vs. 6.5 +/- 5.0 years, t-test, P < 0.005), the percentage of males (64/187 = 32%) and females (24/65 = 37%) females reporting TOW injuries was similar. Strains and sprains comprised over half of all injuries, and the back (42%), shoulder-upper limb (23%), and knee (17%) were most commonly injured. Injury patterns were similar among males and females. Elite TOW athletes represent a diverse age range (15-55 years) of males and females who have competed for 5-10 years. About one-third will have suffered past TOW-related injuries, typically involving sprains or strains of the low back, shoulder girdle-upper extremity, and knee. The possibility of an increased injury rate among female TOW athletes warrants further study. Considerations for future research are discussed. (Copyright © 2002 Blackwell Publishers)
Dentofacial trauma in sport accidents.

Tuli T, Hachl O, Hohlrieder M, Grubwieser G, Gassner R. Gen Dent 2002; 50(3):274-279.

Correspondence: Tarkan Tuli, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Innsbruck, AUSTRIA; (email: csac2629@uibk.ac.at).

Trauma due to sports shows a tremendous impact to a site of the body which is not coverable. The purpose of this study was to document the overall rates of dentofacial injuries sustained in 42 different sports and to determine the distribution of main injury types among sports and the most common injury type in frequent kinds of sport. The results indicate that sport accidents were responsible for six times as many facial injuries as work accidents and accounted for three times more injuries than violence or traffic accidents. Sports with high speed and high impact resulted more in facial bone fractures, whereas sports with low speed and low impact ended more in dental injuries. (Copyright © 2002 Academy of General Dentistry)

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, P.O. Box 5000, FIN-90014, 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)

Socioeconomic differences in injury risks in childhood and adolescence: a nation-wide study of intentional and unintentional injuries in Sweden.

Engstrom K, Diderichsen F, Laflamme L. Inj Prev 2002; 8(2):137-142.

Correspondence: Karin Engstrom, Karolinska Institutet, Department of Public Health Sciences, Stockholm, SWEDEN; (email: karin.engstrom@phs.ki.se).

OBJECTIVE: To measure socioeconomic differences in injuries among different age groups of children and adolescents.

METHODS: Subjects: Children under 20 living in Sweden between 1990 and 1994 (about 2.6 million). Design: A cross sectional study based on record linkage between 15 Swedish national registers. Children were divided into four age groups and allocated to four household socioeconomic status groups. Absolute and relative risks were compiled using children of high/intermediate level salaried employees as the comparison group. Four diagnostic groups were considered: fall, traffic, interpersonal violence, and self inflicted injuries.

FINDINGS: Injury incidences were relatively low and socioeconomic differences negligible in the 0-4 year olds. Thereafter, significant socioeconomic differences were observed in all diagnostic groups except falls. The highest absolute differences were in traffic injuries, especially among 15-19 year olds, and in self inflicted injuries among 15-19 year old girls. Relative differences were highest in both categories of intentional injuries for the age group 10-14. Social circumstances in the household other than family socioeconomic status affected the social pattern of intentional but not that of unintentional injuries.

CONCLUSIONS: Socioeconomic differences in injury risks are not necessarily constant over age. Inequalities are particularly high in absolute terms among adolescents 15-19 years old for traffic injuries and in relative terms among 10-14 year olds for intentional injuries. (Copyright © 2002 BMJ Publishing Group)

Residential fire related deaths and injuries among children: fireplay, smoke alarms, and prevention.

Istre GR, McCoy M, Carlin DK, McClain J. Inj Prev 2002; 8(2):128-32.

Correspondence: Gregory R. Istre, Injury Prevention Center of Greater Dallas, P.O. Box 36067, 5000 Harry Hines Blvd., Suite 101, Dallas, TX 75235, USA; (email: unavailable).

BACKGROUND: The aim of the study was to describe the epidemiology of residential fire related deaths and injuries among children, and identify risk factors for these injuries through a linked dataset for the city of Dallas, Texas.

METHODS: Data for all residential fires were linked with fire related injury data, using fire department records, ambulance transports, hospital admissions, and medical examiner records, for children 0-19 years of age. Causes of fires, including fireplay (children playing with fire or combustibles), arson and other causes, were determined by fire department investigation.

FINDINGS: From 1991-98, 76 children were injured in residential fires (39 deaths, 37 non-fatal). The highest rates occurred in the youngest children (<5 years) and in census tracts with lowest income. Fireplay accounted for 42% (32/76) of all injuries, 62% (15/24) of deaths in children 0-4 years, and 94% (13/14) of deaths from apartment and mobile home fires. Most of the fireplay related injuries (27/32, 84%) were from children playing with matches or lighters. Most started in a bedroom. Smoke alarms showed no protective efficacy in preventing deaths or injuries in fires started by fireplay or arson, but there was significant protective efficacy for a functional smoke alarm in fires started from all other causes (p < 0.01).

CONCLUSIONS: Residential fire related injuries among children in Dallas occurred predominantly in the youngest ages (<5 years) and in poor neighborhoods. Most of the deaths, especially those in apartments and mobile homes, resulted from fireplay. Smoke alarms appeared to offer no protection against death or injury in fireplay associated fires, possibly from the nature of the child's behavior in these fires, or from the placement of the smoke alarm. Prevention of childhood residential fire related deaths may require interventions to prevent fireplay in order to be successful. (Copyright © 2002 BMJ Publishing Group)
Randomized factorial trial of falls prevention among older people living in their own homes.

Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S. BMJ 2002; 325(7356): 128-132.

Correspondence: Leslley Day, Accident Research Centre, PO Box 70A, Monash University, Clayton, Victoria 3800, AUSTRALIA; (email: Lesley.Day@general.monash.edu.au).

OBJECTIVES: To test the effectiveness of, and explore interactions between, three interventions to prevent falls among older people.

METHODS: Design: A randomized controlled trial with a full factorial design. Setting: Urban community in Melbourne, Australia. Participants: 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half lived alone. Interventions: Three interventions (group based exercise, home hazard management, and vision improvement) delivered to eight groups defined by the presence or absence of each intervention. Main outcome measure: Time to first fall ascertained by an 18 month falls calendar and analyse with survival analysis techniques. Changes to targeted risk factors were assessed by using measures of quadriceps strength, balance, vision, and number of hazards in the home.

FINDINGS: The rate ratio for exercise was 0.82 (95% confidence interval 0.70 to 0.97, P=0.02), and a significant effect (P < 0.05) was observed for the combinations of interventions that involved exercise. Balance measures improved significantly among the exercise group. Neither home hazard management nor treatment of poor vision showed a significant effect. The strongest effect was observed for all three interventions combined (rate ratio 0.67 (0.51 to 0.88, P=0.004)), producing an estimated 14.0% reduction in the annual fall rate. The number of people needed to be treated to prevent one fall a year ranged from 32 for home hazard management to 7 for all three interventions combined.

DISCUSSION: Group based exercise was the most potent single intervention tested, and the reduction in falls among this group seems to have been associated with improved balance. Falls were further reduced by the addition of home hazard management or reduced vision management, or both of these. Cost effectiveness is yet to be examined. These findings are most applicable to Australian born adults aged 70-84 years living at home who rate their health as good.

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)
Incidence and nature of farm-related injuries among Pennsylvania Amish children: Implications for education.

Hubler CL, Hupcey JE. J Emerg Nurs 2002; 28(4):284-288.

Correspondence: Judith E. Hupcey, School of Nursing, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA; (email: jxh37@psu.edu).

BACKGROUND: Farming is a dangerous occupation and results in injuries not only to farm workers, but also to families living on farms. Children raised on a farm are at particular risk because the farm is a place where they live, play, and work. Farming is the main Amish occupation, and because Amish farming techniques differ from those used on other us farms, it is important that health care providers recognize the causes of injuries that may occur on Amish farms. However, little is documented about farm-related injuries in Amish children, so we decided to document the incidence and nature of these injuries in Pennsylvania.

METHODS: This study was done by reviewing the die Botschaft, a weekly newspaper written by the Amish. All references to farm-related injuries among children in Pennsylvania were recorded.

FINDINGS: During a 5-month period, a total of 89 injuries, including 5 fatalities, were found: male children sustained 64 injuries, and female children sustained 25 injuries. Falls were the most commonly reported mechanism of injury, followed by incidents involving livestock. Both types of events most often resulted in an orthopedic injury.

CONCLUSIONS: Injury to children in the Amish community is a significant problem that needs to be addressed and evaluated by the Amish themselves and in coordination with other health care providers, including emergency nurses. With the information obtained in this study, injury prevention strategies tailored to the Amish way of farming could be developed and implemented. (Copyright © 2002 Elsevier Science)

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)

Is occupation relevant in suicide?

Koskinen O, Pukkila K, Hakko H, Tiihonen J, Vaisanen E, Sarkioja T, Rasanen P. J Affect Disord 2002; 70(2):197-203.

Correspondence: Pirkko Räsänen, University of Oulu, Department of Psychiatry, Peltolantie 5, FIN-90220, Oulu, FINLAND (email: pirkko.rasanen@oulu.fi).

BACKGROUND: The seasonality of suicide rates and methods of suicide may be related to changes in weather and conditions of employment. Particularly the amount of occupational outdoor exposure could show differences in the distribution of suicides by season and the selection of suicide method, in addition to age at the time of death.

METHODS: The data consisted of all death certificates (n=1359) of completed suicides in the province of Oulu, Finland, during the years 1988-1999. For male subjects included in this study, four occupational groups were identified according to decreasing occupational outdoor exposure. The mean ages, the distribution of suicide methods and the seasonal variation in suicides for each occupational group were analyzed.

FINDINGS: Farmers were significantly older at the time of suicide than construction or indoor workers, and farmers employed significantly more violent methods than the other occupational groups. In the spring, farmers had a significant peak in the rate of suicides. In the winter, forest workers had a significant trough in the rate of suicides. In the summer, indoor workers had a significant peak in the rate of suicides. The analyses were restricted to males due to the low number of females in the study population.

DISCUSSION: The novel finding in this study was that the seasonality of violent suicides was most strongly seen as a spring peak and a winter trough among outdoor workers. The recognition of typical risk factors of different occupations, such as outdoor exposure, and occupational-related susceptibility towards certain suicide methods could benefit in the prevention of suicides. (Copyright © 2002 Elsevier Science)
Life events preceding suicide by young people.

Cooper J, Appleby L, Amos T. Soc Psychiatry Psychiatr Epidemiol 2002; 37(6): 271-275.

Correspondence: Jayne B. Cooper, School of Psychiatry and Behavioral Sciences, Department of Psychiatry, Withington Hospital, West Didsbury, Manchester, M20 8LR, England, UK; (email: jayne.b.cooper@man.ac.uk).

BACKGROUND: Life events are often reported to precede suicide. This paper aims to determine the frequency, timing and type of life events preceding suicide by young people and those with and without a mental illness.

METHODS: Informants, usually family members, were interviewed for a sample of young (less than 35 years) suicides. Information was recorded on events occurring in the 6 months before death. Equivalent information was obtained for living controls who had been matched for age and gender and obtained through the general practices of the suicides.

FINDINGS: Suicide was associated with life events in the previous 3 months, and particularly in the previous week. Specifically, interpersonal and forensic (being arrested, charged or sentenced) events distinguished suicides and controls. The number of life events in the different time periods under study did not distinguish suicides with and without severe mental illness, although more suicides without a severe mental illness had a reported life event in the week before their death.

DISCUSSION: Adverse life events frequently precede suicide in young people with and without severe mental illness. However, recent life events may have a lesser causal role in those with severe mental illness. Clinical and health promotion measures to improve the way that young people cope with interpersonal problems and other crises may be an important part of any suicide prevention strategy.(Copyright © 2002 Steinkopff Verlag)
Risk factors for suicide attempts among African American women experiencing recent intimate partner violence.

Thompson MP, Kaslow NJ, Kingree JB. Violence Vict 2002; 17(3): 283-295.

Correspondence: Martie P. Thompson, Centers for Disease Control and Prevention, Atlanta, GA, USA; (email: mpthomp@clemson.edu

The purposes of this study were to identify risk factors for suicide attempts among 200 African American abused women (100 attempters, 100 nonattempters) and to test a cumulative risk model to determine if a woman's likelihood of making a suicide attempt increased as the number of risk factors increased. Results revealed that attempters were significantly more likely than nonattempters to report high levels of depressive symptoms, hopelessness, drug abuse, and childhood abuse and neglect. Results from the cumulative risk model revealed a linear association between the number of risk factors and the odds of making a suicide attempt. Compared to women with no risk factors, women with two risk factors, women with three risk factors, and women with four to five risk factors were 10, 25, and 107 times, respectively, more likely to attempt suicide. The identification of risk variables highlights the importance of designing interventions to address these factors in order to reduce the risk of suicidal behavior in abused, African American women. (Public Domain please credit the journal and the government agency)
Prevention of youth suicide: how well informed are the potential gatekeepers of adolescents in distress?

Scouller KM, Smith DI. Suicide Life Threat Behav 2002; 32(1):67-79.

Correspondence: David I Smith, Department of Psychology and Disability Studies, Pleanty Road, Bundora 3083, AUSTRALIA; (email: david.smith@rmit.edu.au).

Australia has one of the higher rates of suicide among young people. Although a role for doctors and teachers in the prevention of youth suicide has been suggested, no prior Australian study has assessed adequately the level of suicide knowledge held by these professionals. Knowledge about adolescent suicide was investigated using the Adolescent Suicide Behavior Questionnaire, a 39-item instrument developed for the purpose. The stratified random sample comprised 404 general practitioners and 481 teachers from 56 secondary schools. General practitioners and teachers scored, on average, 71% and 59% of the questionnaire items correct, respectively. There was wide individual variability: The number of items correct ranged from 4 to 38 for general practitioners and 0 to 34 for teachers. Strengths and deficits in knowledge across the two professions are discussed in terms of the potential gatekeeping role of these professionals in suicide prevention. (Copyright © 2002 American Association of Suicidology)
Assault victimization and suicidal ideation or behavior within a national sample of U.S. adults.

Simon TR, Anderson M, Thompson MP, Crosby A, Sacks JJ. Suicide Life Threat Behav 2002; 32(1):42-50.

Correspondence: Thomas R. Simon, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, GA 30341-3724, USA; (email: tsimon@cdc.gov).

Data from a nationally representative sample of 5,238 U.S. adults were used to examine the extent to which physical assault victimization was associated with suicidal ideation or behavior (SIB). The results from multivariable logistic regression analyses indicate that physical assault victimization was positively associated with SIB after adjusting for sociodemographic characteristics and alcohol use (OR = 3.6; 95% CI = 2.4-5.5). Those who were injured during the most recent physical assault (OR = 2.7; 95% CI = 1.2-6.0) and those who were assaulted by a relative (OR = 3.4; 95% CI= 1.0-11.0) or intimate partner (OR = 7.7; 95% CI = 2.7-22.5) were significantly more like to report SIB than victims who were not injured or were assaulted by a stranger. Also, those who were victimized but not injured (OR = 5.6; 95% CI = 3.8-8.2) and those who were victimized by a stranger (OR = 2.9; 95% CI = 1.4-6.0) were more likely to report SIB than non-victims. These results highlight the need for legal, medical, mental health, and social service providers to address the co-occurrence of violent victimization and suicidal ideation, particularly, but not exclusively, victimization by family members and intimates. (Public Domain please credit the journal and the government agency)

Age and distraction by telephone conversation in task performance: implications for use of cellular telephones while driving.

Lyda L, Osborne VM, Coleman P, Rienzi B. Percept Mot Skills 2002 Apr;94(2):391-4. (Journal is not on-line. Mailing address: PO Box 9229, Missoula, Montana 59807-9229, USA)

Correspondence: Beth M. Rienzi, Department of Psychology, California State University, 9001 Stockdale Highway Bakersfield, CA 93311-1099, USA; (email: brienzi@csub.edu).

Predicted to diminish task performance were (a) distraction by telephone conversation and (b) older age. 38 participants pointed to letters on a randomized or alphabetized letter matrix during distraction by telephone conversation or no distraction. In a within-subjects design, telephone conversation negatively affected completion time but there were no age differences. Implications for cellular telephone use while driving are discussed. (Copyright © 2002 Perceptual and Motor Skills)
Identifying Unsafe Driver Actions that Lead to Fatal Car-Truck Crashes.

Kostyniuk LP, Streff FM, Zarajsek J. Washington, DC: AAA Foundation for Traffic Safety, 2002.

Correspondence: Lidia P. Kostyniuk, University of Michigan, Transportation Research Institute, 2901 Baxter Road, Ann Arbor, Michigan 48109-2150 USA; (email: lidakost@umich.edu).

Available online (76 pages): HERE.

BACKGROUND: In the United States, each year about 5,000 persons are killed and about 140,000 are injured in crashes involving trucks with a gross vehicle weight of more than 10,000 pounds. In collisions between passenger vehicles and large trucks, the structural properties and greater mass of large trucks put the occupants of the card at a disadvantage -- 98% of the deaths in fatal two-vehicle crashes involving a car and a large truck were among occupants of the car. Many crashes between cars and large trucks occur because a maneuver performed by one of the vehicles is unanticipated by the other. In some cases, a maneuver performed by a car near a large truck may carry a higher crash risk than the same maneuver performed near another car. Similarly, a large truck may perform a maneuver that carries low risk of a crash near another truck in the traffic stream, but a higher risk when performed near a smaller vehicle. Most research aimed at understanding the causes of crashes between cars and trucks indicates that the actions of car drivers contribute more to car-truck crashes than do the actions of truck drivers.

OBJECTIVES: The purpose of this study is to explain the unsafe driver actions and conditions that are more likely in fatal crashes between cars and large trucks than in fatal crashes between cars and to identify strategies for educating motorists in safe driving practices that will help them avoid such crashes.

METHODS: The study analyzed two-vehicle crashes in the 1995-1998 Fatality Analysis Reporting System (FARS) database to compare car-car crashes with car-truck crashes. The research was conducted in three stages. The first stage sought to identify driving maneuvers or actions of cars and large trucks that have a higher chance of resulting in fatal car-truck collisions than fatal collisions with a similar vehicle. The second stage involved discerning patterns associated with these driving actions through a detailed examination of actual crash reports. the third stage involved exploring ways that the risks associated with the identified driving actions may be effectively communicated to motorists.

FINDINGS: Stage one- Most driver factors are equally likely to be recorded for fatal car-truck crashes as for fatal car-car crashes. Moreover, drivers who get involved in fatal crashes probably drive in the same manner around trucks as they do around other cars. Four factors (out of 94) were found to be more likely to occur in fatal car-truck crashes than in fatal car-car crashes: following improperly; driving with vision obscured by rain, snow, fog, or dust; driving while drowsy or fatigued; improper lane changing. However, these four factors were recorded for only about 5% of the car-truck crashes. Stage two- The results of this analysis showed that there are many more unsafe actions by car drivers than by truck drivers. More than half of the fatal car-truck crashes in which a driver fell asleep were head-on crashes and more than one-quarter of these occurred between 3 and 6 a.m. Drowsy or fatigued driving and following inappropriately were more likely to be reported for male than female car drivers. Car drivers in crashes in which their vision was obstructed tended to be older than the other drivers. Car drivers who were drowsy were likely to be younger than other drivers. Younger truck drivers were more likely than older truck drivers to follow inappropriately, exceed the speed limit, and use alcohol or drugs. Stage three- Effective educational efforts could include: Teaching motorists hot to operate around large trucks, focusing instruction on the four unsafe factors; creating an interactive Web site that educates drivers about the dangers associated with driving near trucks and allows then to test their knowledge; and personal computer-based driving simulations, demonstrations, or computer games showing interactions between cars and large trucks.

DISCUSSION: The findings from this study, although limited to fatal crashes, are consistent with studies of car-truck crashes that were not limited to fatal crashes. Three of the four driver factors that were found in this study to be more likely to be associated with fatal car-truck crashes than with car-car crashes were among those considered by safety experts to be dangerous and frequent near trucks. A key finding of this study is that most of the 94 unsafe driver acts were about as likely in fatal car-truck crashes as in fatal car-car crashes. Therefore general safe driving practices are also relevant around large trucks. However, programs to educate drivers in safe practices need to emphasize that driving mistakes around trucks can have much more severe consequences.
Protan colour vision deficiency and road accidents.

Cole BL. Clin Exp Optom 2002; 85(4):246-253.

Correspondence: Barry Leighton Cole, Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, 3010, AUSTRALIA; (email: b.cole@optometry.unimelb.edu.au).

BACKGROUND: Protans are precluded from holding a commercial driver's licence in Australia because they have a substantially reduced ability to see red lights and have more road accidents involving signal lights. This exclusion has been in place since 1994 but is likely to be abandoned following a current review of medical standards for commercial drivers. This paper reviews the level of risk of road accidents due to protan colour vision deficiency. It also addresses the question of whether it is fair to regard all protans as having a higher risk of road accident because some protans might have a sensitivity to red light that is as good as that of some people with normal colour vision.

METHODS: Data of two studies by Verriest and co-workers are re-analysed to estimate the degree of overlap of the protan and colour normal distributions of sensitivity to red light.

FINDINGS: Field trial data show that protans have a very reduced visual range for red signals compared to colour normal observers but there is considerable variability among both classes of observers and the distributions do overlap. However, some variability is due to differences in observers' choices of a detection criterion, their speed of response and the measurement method. A laboratory study of the spectral sensitivity of protan and colour normal subjects that largely removes these sources' variability shows that all protans have a sensitivity to red light that is less than that of the least sensitive colour normal.

DISCUSSION: It is reasonable to conclude that all protans, regardless of the severity of their defect, have a lesser ability to see red signals than colour vision normal observers and for that reason will have a higher risk of road accident.
Driver age differences in day and night gap acceptance capabilities.

Dissanayake S, Lu JJ, Yi P. IATSS Res 2002; 26(1): 71-79.

Correspondence: Sunanda T. Dissanayake, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620 USA; (email: dissanay@eng.usf.edu).

BACKGROUND: Performance of Two-way Stop-controlled (TWSC) intersections is greatly affected by the gap acceptance capabilities of drivers. However, there have been no detailed studies conducted regarding driver age differences in gap acceptance capabilities under different light conditions.

OBJECTIVES: This study was conducted to fill the lack of information in that area, by considering three driver age groups (old, middle, and young), two maneuvers (left-turn, and through), and two light conditions (daytime, and nighttime).

METHODS: Field observations were made at several TWSC intersections and data were collected at these sites regarding available and accepted gaps on the major street and age group of minor street drivers, both during daytime and nighttime.

FINDINGS: Statistical analysis conducted in this study with a 5% level of significance revealed that there were significant differences in gap acceptance capabilities among the three driver age groups under both light conditions. Only older drivers indicated statistically different gap acceptance capabilities depending on the light condition, where they illustrated longer critical gap values during nighttime. (Copyright © 2002 International Association of Traffic and Safety Sciences)
Older driver involvements in police reported crashes and fatal crashes: trends and projections.

Lyman S, Ferguson SA, Braver ER, Williams AF. Inj Prev 2002; 8(2):116-120.

Correspondence: Stephen Lyman, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, VA 22201 USA; (email: slyman@iihs.org).

OBJECTIVES: Older drivers have become a larger part of the driving population and will continue to do so as the baby boomers reach retirement age. The purpose of this study was to identify the potential effects of this population increase on highway safety.

METHODS: Driver involvement rates for all police reported crashes were calculated per capita, per licensed driver, and per vehicle-mile of travel for 1990 and 1995. Also, driver involvement rates for fatal crashes were calculated for 1983, 1990, and 1995. Based on current crash rates per licensed driver and estimates of the future number of licensed drivers, projections of crashes involving drivers aged 65 and older were made for years 2010, 2020, and 2030.

FINDINGS: Driver crash involvement rates per capita decreased with age, but fatal involvement rates per capita increased starting at age 70. The same pattern existed for involvement rates per licensed driver. For both all crashes and fatal crashes, involvement rates per mile driven increased appreciably at age 70. Using projections of population growth, it was estimated that for all ages there will be a 34% increase in the number of drivers involved in police reported crashes and a 39% increase in the number involved in fatal crashes between 1999 and 2030. In contrast, among older drivers, police reported crash involvements are expected to increase by 178% and fatal involvements may increase by 155% by 2030. Drivers aged 65 and older will account for more than half of the total increase in fatal crashes and about 40% of the expected increase in all crash involvements; they are expected to account for as much as 25% of total driver fatalities in 2030, compared with 14% presently.

DISCUSSION: By most measures, older drivers are at less risk of being involved in police reported crashes but at higher risk of being in fatal crashes. Although any projections of future crash counts have inherent uncertainty, there is strong evidence that older drivers will make up a substantially larger proportion of drivers involved in fatal crashes by 2030 because of future increases in the proportion of the population aged 65 and older, and trends toward increased licensure rates and higher annual mileage among older persons. Countermeasures to reduce the anticipated death toll among older drivers should address the increased susceptibility to injury of older vehicle occupants in crashes. (Copyright © 2002 BMJ Publishing Group)
Relation between glare and driving performance.

Theeuwes J, Alferdinck JW, Perel M. Hum Factors 2002; 44(1):95-107.

Correspondence: Jan Theeuwes, Dept of Cognitive Psychology, Vrije Universiteit, Amsterdam, THE NETHERLANDS; (email: j.theeuwes@psy.vu.nl).

The present study investigated the effects of discomfort glare on driving behavior. Participants (old and young; U. S. and Europeans) were exposed to a simulated low-beam light source mounted on the hood of an instrumented vehicle. Participants drove at night in actual traffic along a track consisting of urban, rural, and highway stretches. The results show that the relatively low glare source caused a significant drop in detecting simulated pedestrians along the roadside and made participants drive significantly slower on dark and winding roads. Older participants showed the largest drop in pedestrian detection performance and reduced their driving speed the most. The results indicate that the deBoer rating scale, the most commonly used rating scale for discomfort glare, is practically useless as a predictor of driving performance. Furthermore, the maximum U. S. headlamp intensity (1,380 cd per headlamp) appears to be an acceptable upper limit. (Copyright © 2002 Human Factors and Ergonomics Society)
Injury patterns associated with mortality following motorcycle crashes.

Ankarath S, Giannoudis PV, Barlow I, Bellamy MC, Matthews SJ, Smith RM. Injury 2002; 33(6):473-477.

Correspondence: P. V. Giannoudis, Department of Trauma and Orthopaedics, St. James's University Hospital, Leeds LS9 7TF, UK; (email: pgiannoudi@aol.com).

All patients involved in motorcycle crashes admitted to various hospitals in the Yorkshire region of UK between January 1993 and December 1999 were retrospectively reviewed to identify the factors that are likely to predict a reduced survival. Of the 1239 patients requiring hospital admission, 74 died. The probability of reduced survival was estimated by a logistic regression model using independent variables such as head injury, thoracic trauma, abdominal injury, spinal injury and pelvic fracture and a compound variable of pelvic fracture combined with a long bone fracture. The odds ratio for head injury was 0.349, chest injury 0.39, abdominal injury 0.42, and the compound variable (pelvis plus a long bone fracture) 0.576. The mean injury severity score (ISS) in the fatal group was 35.96 compared to 12.2 in the group that survived (P < 0.01). There was a significant difference in the Glasgow coma scale (GCS) between patients wearing a helmet and those that did not wear any protective headgear (P=0.0007). Head injury followed by chest and abdominal trauma were found to predict a reduced survival rate. Use of helmets should continue to be compulsory. Chest and abdominal injuries should be diagnosed and treated early to reduce mortality. (Copyright © 2002 Elsevier Science)
Non-fatal injuries sustained in road traffic accidents: a pilot study in provincial hospitals in Chon Buri, Thailand.

Jirojwong S, Rudtanasudjatum K, Watcharavitoon P, Sathitsathien W, Sangjun S. Southeast Asian J Trop Med Public Health 2002; 33(1): 193-200.

Correspondence: Sansnee Jirojwong, Nursing and Health Studies, Central Queensland University, Rockhampton, AUSTRALIA; (email: s.jirojwong@cqu.edu.au).

The characteristics of patients with non-fatal road traffic injuries who received care from non-referral hospitals are described; an assessment of the difference between the characteristics of patients who received care at a referral hospital and those of patients who were treated at non-referral hospitals is made. A retrospective study, conducted in Chon Buri Province, Thailand, reviewed information from two sources: 324 records from eight non-referral hospitals and the 1999 Injury Surveillance Report of Chon Buri Hospital, a referral hospital. A data collection tool was designed to retrieve information from the non-referral hospitals. Data were analyzed descriptively and analytically. The majority of the patients of the non-referral hospitals were male (71.1%) motorcyclists (84.2%), and received ambulatory care (83.9%). Young patients had a higher risk of being admitted to these hospitals. Non-motorcyclists, pedestrians, and nonlocal persons were more likely to receive care from the referral hospital. The results were similar to those of previous studies. The different characteristics of patients who receive care at referral--and non-referral hospitals need to be taken into account when designing traffic accident reduction programs. (Copyright © 2002 Southeast Asian Ministers of Education Organization)
Accident mitigation on congested rural two-lane highways.

Fitzpatrick K, Harwood DW, Potts IB. ITE Journal 2002; 72(4): 42-44.

Correspondence: Kay Fitzpatrick, Texas Transportation Institute, Texas A&M University System 3135 TAMU, College Station, TX 77843-3135 USA; (email: k-fitzpatrick@tamu.edu).

The majority of the U.S. highway system consists of two- and three-lane rural roads, which represent four times the highway mileage of urban roads on the U.S. highway system. A substantial mileage of these roads carries relatively low traffic volumes and has few operational problems. Some of these rural highways, however, are becoming congested due to developing communities in exurban areas, heavy recreational travel, seasonal residences and special events. Increased congestion and travel demands can lead to an increased number of accidents.

The Accident Mitigation Guide For Congested Rural Two-Lane Highways was developed under a National Cooperative Highway Research Program project to provide one comprehensive document that a practitioner can use to investigate several potential countermeasures for improving safety or operations on rural 2-lane highways. The investigation of implemented countermeasures found the following: 1. Lower-cost treatments can be highly successful in reducing accidents or improving operations along congested rural two-lane highways. 2. Public participation played a significant role in the development and selection of countermeasures at several sites. 3. Information on the selection and installation of the treatment is not always well-documented. In addition, detailed before and after studies of the effectiveness of the treatments are also sparse. (Copyright © 2002 Institute of Transportation Engineers)

Suicide preceded by murder: the epidemiology of homicide-suicide in England and Wales 1988-92.

Barraclough B, Harris EC. Psychol Med 2002; 32(4):577-584.

Correspondence: Brian Barraclough, University of Southampton Mental Health Group, Royal South Hants Hospital, Brintons Terrance, Southampton, UK; (email: bhb2@soton.ac.uk).

BACKGROUND: We describe for the first time the epidemiology of homicide-suicide incidents for England and Wales. Previous descriptions have been of incidents in London (1946-62) and Yorkshire and Humberside (1975-1992).

METHODS: Death certificates were obtained for all who died in homicide-suicide incidents in England and Wales (1988-1992) that were reported by the police to the Home Office. Incidents were included in the analysis if the interval between death or fatal injury of victim and suspect was 3 or fewer days.

FINDINGS: Three hundred and twenty-seven people died in 144 incidents (180 victims and 147 suspects). Eighty per cent of incidents had one victim and one suspect. Three incidents were also suicide pacts between two suspects killing their children. Eighty-eight per cent of incidents exclusively involved members of the same family, 9 % acquaintances or strangers, and 3 % both family and acquaintances or strangers. Seventy-five per cent of victims were female, 85% of suspects male. The victims of male suspects were predominantly their womenfolk, past and present, and their children, and of female suspects their young children. Car exhaust and firearms accounted for 40% of victim and 50% of suspect deaths. Of all homicides during 1988-1992, 3 % of male, 11% of female and 19% of child deaths occurred in homicide-suicide incidents. Similarly, of all suicides, 0.8% of male and 0.4% of female deaths occurred in homicide-suicide incidents.

DISCUSSION: Homicide-suicide in England and Wales is mostly 'a family matter', men of predominantly lower social class killing their kin, and pre-menopausal mothers their young children, before they kill themselves. A few men kill strangers during a crime and then themselves. (Copyright © 2002 Cambridge University Press)
Domestic violence compared to other health risks. A survey of physicians' beliefs and behaviors.

Gerbert B, Gansky SA, Tang JW, McPhee SJ, Carlton R, Herzig K, Danley D, Caspers N. Am J Prev Med 2002; 23(2):82-90.

Correspondence: Barbara Gerbert, Barbara Gerbert, PhD, Professor and Chair, Division of Behavioral Sciences, University of California San Francisco, 350 Parnassus Avenue, Suite 905, , San Francisco, California 94117, , USA; (email: gerbert@itsa.ucsf.edu).

BACKGROUND: Physicians routinely confront patient risk behaviors once considered private, including tobacco use, alcohol abuse, and HIV/STD-risk behavior. We compared physicians' behaviors and beliefs on screening and intervention for domestic violence with each other risk.

METHODS: Survey of nationwide, random sample of 610 primary care physicians from the American Medical Association Physician Masterfile.

FINDINGS: Fewer primary care physicians screened for domestic violence than for other risks (p < 0.001); once domestic violence was identified, however, physicians intervened with equal or greater frequency than for other risks. Fewer believed that they knew how to screen or intervene for domestic violence compared with other risks, and significantly fewer believed that domestic violence interventions were successful compared with interventions for tobacco and HIV/STD risks (Bonferroni adjusted p < 0.001).

DISCUSSION: Lower domestic violence screening rates may reflect physicians' beliefs that they do not know how to screen or intervene, and that interventions are less successful for domestic violence than for other risks. We may improve screening rates by educating physicians that a simplified role, as for other risks, can be effective for domestic violence. (Copyright © 2002 Elsevier Science)
Newborn kidnapping by cesarean section.

Burgess AW, Baker T, Nahirny C, Rabun JB Jr. J Forensic Sci 2002; 47(4): 827-830.

Correspondence: Ann W. Burgess, Boston College, Cushing Hall 414, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA; (email: ann.wolbertburgess.1@bc.edu).

A study of 30 cases of violence from a total sample of 199 cases of infant abductions between the years 1983 and 2000 included a subsample of six (or 20%) where the kidnapping was by cesarean section. The six cases are classified by type of crime. Four cases were classified as personal cause homicide, subtype cesarean section homicide; one case classified as personal cause, subtype domestic homicide, and one case classified as a criminal enterprise homicide. The behavioral profiles of the abductors included a confidence style approach to the victim mother, deception, and planning of the cesarean section. The forensic psychodynamics suggest a dual motive to cement a failing partner relationship and to fulfill a childbearing and delivery fantasy. Cesarean section murder suggests a new category of personal cause homicide. (Copyright © 2002 American Academy of Forensic Sciences)
Variations in age-specific homicide death rates: A cohort explanation for changes in the age distribution of homicide deaths.

O'Brien RM, Stockard J. Soc Sci Res 2002; 31(1): 124-150.

Correspondence: Bob O'Brien, Department of Sociology, University of Oregon, Eugene, OR 97403, USA; (email: bobrien@oregon.uoregon.edu).

An age-period-cohort characteristic model previously used to explain age-period-specific rates of homicide arrests for those 15 to 49 from 1960 to 1995 is applied to measures of age-period-specific homicide deaths. The extension of this model to the examination of homicide victimization is significant because we are able to test the utility of the model across a longer time span (1930 to 1995) and a wider range of ages (10 to 79) and disaggregated by sex and race (Whites and non-Whites). Although the results indicate that past and recent shifts in age-period-specific rates of homicide deaths are associated with specific characteristics of cohorts, there are some important differences across race and sex groupings in the effects of these characteristics. The effects of the cohort variables examined in our model are independent of age and period, often substantively large, and last throughout the life course. The results are consistent with Durkheimian explanations of lethal violence, hypotheses from victimization theory, and basic tenets of cohort theory. (Copyright © 2002 Elsevier Science)
Missing the target: a comparison of buyback and fatality related guns.

Kuhn EM, Nie CL, O'Brien ME, Withers RL, Wintemute GJ, Hargarten SW. Inj Prev 2002; 8(2):143-146.

Firearm Injury Center, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee 53226, USA; (email: ekuhn@mcw.edu).

OBJECTIVES: To determine whether the firearms recovered in buyback programs in a large urban community are the types most closely associated with firearm fatalities in the same geographic area.

METHODS: The type, caliber, and manufacturer of 941 handguns recovered in Milwaukee County 1994-96 buyback programs were compared with 369 homicide related and 125 suicide related handguns used in Milwaukee during 1994-97.

FINDINGS: Buyback handguns differed substantially from those used in homicide and suicide. One third of buyback handguns were semiautomatic pistols versus two thirds of homicide related handguns (p < 0.001) and 40% of suicide related handguns (p=NS). Over 75% of buyback handguns were small caliber compared with 24% of homicide and 32% of suicide handguns (p < 0.001). The top two manufacturers of buyback handguns represented 30% of these guns but only 5% of fatality related handguns (p < 0.001). Companies currently out of business manufactured 15% of buyback handguns versus 7% of fatality related handguns (p < 0.001).

DISCUSSION: Handguns recovered in buyback programs are not the types most commonly linked to firearm homicides and suicides. Although buyback programs may increase awareness of firearm violence, limited resources for firearm injury prevention may be better spent in other ways. (Copyright © 2002 BMJ Publishing Group)
Violence and globalization in Latin America

Briceno-Leon R, Zubillaga V. Current Sociology 2002; 50(1): 19-37.

Correspondence: Roberto Briceno-Leon, Laboratorio de Ciencias Sociales, Apartado Postal 47.795, Caracas 1041-A, VENEZUELA; rbriceno@reaccium.ve).

Most countries of Latin America, including those such as Uruguay, with very low homicide rates there occurred a major growth of violence since the 1980s. This change came at the close of a decade of recession and economic contraction, as well as of a transformation and reduction of the state which led to rising unemployment and spreading poverty--a process which continues to the present. (Copyright © 2002 International Sociological Association)

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