SafetyLit Update: 30 September 2002

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30 September 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.

Characteristics of intoxicated trauma patients.

Blondell RD, Looney SW, Hottman LM, Boaz PW. J Addict Dis 2002; 21(4):1-12.

Correspondence: Richard Blondell, University of Louisville School of Medicine, Department of Family and Community Medicine, KY, USA; (email: Richard.Blondell@louisville.edu).

Of 1320 patients who were hospitalized for injuries, a total of 315 were known to be intoxicated with alcohol at the time of trauma. A retrospective chart review was performed to determine which biopsychosocial markers correlated with increasing severity of alcohol use disorders in a sample of 184 (58.4%) of these 315 patients. Markers associated with increased severity were: an increased mean corpuscular volume (MCV; p = 0.007), previous legal problems (p = 0.023), previous alcohol rehabilitation (p < 0.001), previous attendance at self-help meetings (p < 0.001), admitting to having an alcohol problem (p < 0.001), and a willingness to change drinking behavior (p < 0.001). Routine toxicology screening tests, simple questions about previous alcohol or drug abuse treatment, and direct questions about the patient's own perception of the severity of disease and readiness to change drinking behavior can identify many victims of major trauma who could potentially benefit from a referral for alcohol rehabilitation. (Copyright © 2002 American Society of Addiction Medicine)
Assessment of public opinion on legislation to deter drunk driving.

Aekplakorn W, Suriyawongpaisal P. J Med Assoc Thai 2002; 85(7): 814-819.

Correspondence: W. Aekplakorn, Community Medicine Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, THAILAND; (email: unavailable).

Existing legislative measures on blood-alcohol control of drivers failed to show a substantial effect in reducing the incidence of crash injury and mortality. Recently, a government initiative to limit locations and operating time (service hours) of nighttime entertainment venues was introduced. A telephone interviewed-survey of 500 random-samples to assess public opinion on the initiative and other legislative measures was conducted in Bangkok. The results showed that 88 per cent of the respondents supported the idea of prohibiting alcohol sale to youngsters aged < 21 years old and 91 per cent agreed to limit the operating time of pubs, bars and nightclubs to no later than 2 a.m. The majority asserted that laws against drink driving were seldom enforced. More than half of the respondents agreed with the ideas of restricting medical care benefit for injured drunk drivers, and of prosecuting the related alcohol-sellers. Eighteen per cent of male respondents had drunk alcohol and driven in the past one month. A telephone survey is an efficient tool for providing timely information for policy decisions. More stringent enforcement of laws against drunk drivers should be implemented in parallel with traffic safety programs and other social control initiatives.
Increased risk of serious injury following an initial prescription for diphenhydramine.

Finkle WD, Adams JL, Greenland S, Melmon KL. Ann Allergy Asthma Immunol 2002; 89(3): 244-250.

Correspondence: William Finkle, Consolidated Research, Inc, Los Angeles, California 90024, USA; (email: bill@consolidated-research.com).

BACKGROUND: Diphenhydramine may be associated with excess risk of injury relative to nonsedating H1-receptor antagonists.

OBJECTIVE: This study sought to compare the risk of injury in patients exposed to diphenhydramine with the risk of injury in patients exposed to loratadine.

METHODS: A retrospective cohort study of injury was carried out in 12,106 patients whose initial antihistamine prescription was for diphenhydramine and in 24,968 patients whose initial antihistamine prescription was for loratadine. Data were taken from a health care claims database that included employees, dependents, and retirees who filed claims from January 1991 through December 1998. Rates of six serious injuries in the diphenhydramine cohort after and before the first prescription were compared with rates in the loratadine cohort after and before the first prescription.

RESULTS: In the 30 days after the first antihistamine prescription, the rate of all injuries was 308 per 1,000 person-years in the diphenhydramine cohort versus 137 per 1,000 person-years in the loratadine cohort. The rate ratio estimate adjusted for age and gender using Poisson regression was 2.27 (95% confidence limits [CL] 1.93, 2.66). In the corresponding 30 days of the preceding year, the injury rates in the diphenhydramine and loratadine cohorts were 128 and 125 per 1,000 person-years, and the adjusted rate ratio was 1.02 (CL 0.83, 1.26). Thus, the cohorts appeared to have similar preprescription injury rates. The differences between the cohorts declined with time from prescription: For all injuries, the estimated percentage decline in the rate ratio was 4.1% per day (CL 3.3, 4.9), and the estimated time from the initial prescription until the diphenhydramine cohort returned to baseline risk was 32.3 days (CL 26.9, 37.6).

CONCLUSIONS: If these associations are causal, the percentage of the injuries attributable to diphenhydramine was 55% (CL 41, 65), implying a substantial number of excess injuries and costs incurred as the result of diphenhydramine use. The high use rates of this drug and the high incidence of injury suggest that further study of the association between injury and type of antihistamine is needed. (Copyright © 2002 American College of Allergy, Asthma, & Immunology)
Increased mortality among previously apprehended drunken and drugged drivers.

Skurtveit S, Christophersen A, Grung M, Morland J. Drug Alcohol Depend 2002; 68(2): 143.

Correspondence: Svetlana Skurtveit, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, NORWAY; (email: svetlana.skurtveit@fhi.no).

Most studies in the field of impaired driving have focused on the hazards imposed on society by the impaired drivers, whereas little attention has been paid to the future outcome of the drivers. The aim of the study was to identify mortality rates and causes of death among drunken and drugged drivers during the years after apprehension. Prospective cohort study on apprehended drunken and drugged drivers, follow-up period: 7.5 years, outcome variable: death. Apprehended drivers 20-39 years old who provided samples positive for alcohol (n=2531) or drugs other than alcohol (n=918) constituting the total national samples of these two driver categories in 1992. The mortality rate among male drunken drivers was higher than in an age-matched Norwegian population (standardized mortality ratio, SMR=3.7 (95% Cl 2.9-4.7). The SMR for drugged drivers was 18.1 (14.9-21.8) for men and 27.9 (14.4-48.8) for women. In a subgroup of male drugged drivers using heroin, SMR was 39.8 (28.8-53.6). The dominant causes of death among drunken and drugged drivers were drug poisoning/overdose, accidents and suicide. Apprehension for drunken or drugged driving and subsequent analytical verification, is an indicator of increased risk of future premature death in the age group 20-39 years, particularly for drugged drivers. To our knowledge this is a new finding, and studies to confirm it should be carried out in other countries. If verified, the results should lead to the consideration of new public health approaches towards apprehended impaired drivers.(Copyright © 2002 Elsevier Science)
Long-term trends in drinking habits among Swedish teenagers: National School Surveys 1971-1999.

Andersson B, Hansagi H, Damstrom Thakker K, Hibell B. Drug Alcohol Rev 2002; 21(3):253-260.

Correspondence: Barbro Andersson, Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, SWEDEN.

The purpose of the study is to describe the long-term trends in drinking habits among Swedish students aged 15-16 years. Data were collected from 1971 to 1999, using self-administered questionnaires from nationally representative random cluster samples of school classes, totalling on average 6000 students per year.The highest proportion of alcohol consumers among both boys and girls, about 90%, was seen in the 1970s; this percentage decreased to about 80% in the 1980s and remained at that level through the 1990s. The estimated average annual consumption of pure alcohol was 4 litres for boys in 1977. It fell to 2.1 litres in 1988 and rose to 3.9 litres in 1999. The tendency was similar for girls, with 3.5 litres consumed in 1977, about 1.5 litres in the 1980s and 2.3 litres in 1999. Also frequent binge drinking and intoxication were reported by the largest proportions in the 1970s; the figures decreased in the 1980s and rose again among both boys and girls in the first part of the 1990s. Hence, although fewer of the students in this age group are alcohol consumers at the end of the 1990s compared with the 1970s, those who drink are approaching the high consumption levels of the 1970s. The beverages of choice are beer and spirits. (Copyright 2002 Taylor & Francis)

No reports this week

Lightning-associated injuries and deaths among military personnel --- United States, 1998--2001.

Silverberg MJ, A Frommelt A, Lange JL, Brundage JF, Rubertone MV, Jones BH, Winterton BS. MMWR 2002; 51(38): 859-862.

Full article, with tables, figures, and editorial comment, available on-line: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5138a3.htm.

After flooding, lightning is the second leading cause of weather-related death in the United States; approximately 300 injuries and 100 deaths are associated annually with lightning strikes in the United States (1--4). To characterize lightning-associated injuries and deaths among U.S. Armed Forces personnel, the U.S. Army and CDC analyzed data from the Defense Medical Surveillance System (DMSS). This report summarizes the results of that analysis, which indicate that the highest lightning-related injury rates during 1998--2001 occurred among male U.S. military members who were aged < 40 years, single, with a high school education or less, stationed near the Gulf of Mexico or the East Coast, and in the U.S. Army. The findings suggest that the risk for lightning-associated injury depends primarily on the frequency, timing, duration, and nature of outdoor exposure to thunderstorms. Military personnel should be aware of severe weather onset and take reasonable precautions to protect themselves and their companions from exposure to lightning.

DMSS maintains hospitalization and ambulatory clinic visit data on U.S. Armed Forces personnel (both active-duty and reserve) and links health data with personnel data (e.g., age, race, sex, education, occupational specialty, and duty station). This analysis considered lightning-associated injuries or deaths among active-duty and reserve military personnel that occurred during 1998--2001. A lightning-associated injury or death was defined as a hospitalization or ambulatory clinic visit in the 50 states and the District of Columbia that was assigned a primary or secondary diagnosis of "effects from lightning, shock from lightning, or struck by lightning" according to the International Classification of Diseases, Ninth Clinical Modification (ICD-9-CM) code 994.0. Because isolated cloud-to-ground lightning strikes could not be distinguished from multiple lightning strikes at the same time and location, it was assumed that two or more lightning-associated injuries or deaths at the same time and location were caused by a single lightning strike. Descriptive statistics were analyzed, including event date, location, percentage of strikes causing injury resulting in hospitalization or death, casualties per strike, and military status (i.e., active or reserve) of affected persons. Because accurate denominator data were not available for reserve personnel, lightning casualty rates and relations of selected demographic factors to those rates were calculated for active-duty personnel only. Military personnel comprise a highly mobile population, and many duty assignments last for < 1 year; therefore, lightning-associated casualty rates were expressed as casualties per 100,000 person years. Rate ratios and 95% confidence intervals (CIs) were based on Poisson regression. The descriptive nature of this report precluded calculating adjusted estimates.

During 1998--2001, a total of 142 lightning strikes caused 350 service member injuries and one service member death at U.S. military installations in the United States (Figure); 64 (18.0%) persons required hospitalization. The majority (123 [86.6%]) of lightning strikes injured either one or two persons; 12 (8.5%) strikes injured three to nine persons; and seven (4.9%) strikes injured >10 persons, including one that injured 44 persons during an outdoor training exercise. Three fourths (106 [74.6%]) of lightning strikes occurred during May--September, with a peak (71 [50.0%]) during July--August. Lightning strikes occurred more often near the coasts, particularly in southern and eastern areas. Active-duty personnel constituted the majority (246 [70.1%]) of lightning-associated casualties. Overall, the lightning strike casualty rate was 5.8 per 100,000 person years (Table 1). By state, Louisiana (39.6), Georgia (25.2), and Oklahoma (23.5) had the highest rates. Comparisons among age groups showed a strong inverse relation between age and risk for lightning-associated injury (Table 2). Men were 3.3 times more likely than women to be struck by lightning. Service members with a high school education or less and those in combat-related occupations (e.g., infantry or artillery) were at higher risk than their counterparts. Among the services, the Army had the highest lightning casualty rate (9.5), and the Navy had the lowest (1.4); the Army-to-Navy rate ratio was 7.0 (95% CI=4.4--11.7).

See report under Violence
The relationship between employees' perceptions of safety and organizational culture.

O'Toole M. J Safety Res 2002; 33(2): 231-243.

Correspondence: Michael O'Toole, Manufacturing Engineering Tech and Supervision, Purdue University Calumet, 2200 169th Street, Hammond, IN 46322, USA; (email: mol@calumet.purdue.edu).

BACKGROUND: With limited resources to help reduce occupational injuries, companies struggle with how to best focus these resources to achieve the greatest reduction in injuries for the optimal cost. Safety culture has been identified as a critical factor that sets the tone for importance of safety within an organization.

METHOD: An employee safety perception survey was conducted, and injury data were collected over a 45-month period from a large ready-mix concrete producer located in the southwest region of the United States.

RESULTS: The results of this preliminary study suggest that the reductions in injuries experienced at the company locations was strongly impacted by the positive employee perceptions on several key factors. Management's commitment to safety was the factor with the greatest positive perception by employees taking the survey.

DISCUSSION: This study was set up as a pilot project and did not unitize an experimental design. That weakness reduces the strength of these findings but adds to the importance of expanding the pilot project with an appropriate experimental design. Management leadership has been identified, along with several other factors, to influence employee perceptions of the safety management system. Those perceptions, in turn, appear to influence employee decisions that relate to at-risk behaviors and decisions on the job. The results suggest that employee perceptions of the safety system are related to management's commitment to safety, which, in turn, appear to be related to injury rates. Management should focus on how to best leverage these key factors to more positively impact injury rates within their companies. (Copyright National Safety Council published by Elsevier Science)
A reliability study of potential risk factors for acute traumatic occupational hand injuries.

Lombardi DA, Sorock GS, Lesch MF, Hauser R, Eisen EA, Herrick RF, Mittleman MA. Am J Ind Med 2002; 42(4): 336-343.

Correspondence: David A. Lombardi, Liberty Mutual Research Center for Safety and Health, Hopkinton, MA (email: david.lombardi@libertymutual.com).

BACKGROUND: A reliability study of transient workplace exposures was conducted within a case-crossover study of acute traumatic occupational hand injuries. Exposures examined included features of work equipment (unusual performance of equipment or materials, glove use), work practices (performing an uncommon work task, using an unusual work method), and worker-related factors (being rushed, distracted, ill, or working overtime).

METHODS: Interviewers administered a follow-up questionnaire about exposure up to 4 days after the initial interview. The reliability of the usual frequency of exposure in the past month, exposure reported at the time of the injury, and the degree to which subjects had confidence in the accuracy of their memory for exposure was assessed.

RESULTS: The test-retest reliability for the estimated number of hours of exposure during the past month was high for six of the eight potential risk factors (intraclass correlation coefficients (ICC) ranging from 0.84-0.99). ICC for the frequency per month and minutes per exposure, used to calculate the estimated number of hours per month, ranged from 0.12-0.99 and 0.49-0.99, respectively. Agreement of reported exposure at the time of the injury, evaluated using the kappa statistic, ranged from substantial agreement to perfect agreement (0.65-1.0). However, for some factors, there was little or no reported exposure. Most subjects (74-100%) reported being "very confident" or "certain" in their memory for each exposure.

CONCLUSIONS: These findings suggest that the frequency and duration of unusual transient workplace exposures can be reliably recalled by subjects interviewed by telephone within 4 days of an injury. (Copyright © 2002 Wiley-Liss)

An examination of the relationship between cycle training, cycle accidents, attitudes and cycling behavior among children.

Colwell J, Culverwell A. Ergonomics 2002; 45(9): 640-648.

Correspondence: John Colwell, Department of Psychology and Speech and Language Therapy, De Montfort University, Leicester LE7 9SU, UK; (email: unavailable)

Around 40% of 10-11-year-old children receive cycle training every year in the UK, but concern has been expressed over the efficacy of training courses. One argument is that accidents occur too infrequently to be a viable evaluative criterion, and attitudes and behavior have been suggested as alternatives. A questionnaire that measured a number of variables including accidents, attitudes, and behavior was completed by 336 participants from two schools in the London Borough of Bromley. At least one cycling injury had been sustained by 58.3% of respondents, requiring hospital treatment in 19.1% of cases. Girls reported fewer accidents than boys. No relationship between training and accidents was found. A principal components analysis (PCA) of the attitudes items produced a 'safe attitudes' factor. Girls displayed 'safer' attitudes, but there was no evidence that training produced safer attitudes. A PCA of the cycling behavior scales produced two factors, 'safe cycling' and 'showing off'. Safe cyclists who obeyed basic safety rules were less likely to sustain cycle injuries, but showing off was not related to accidents. Girls were less likely to show off, but the safe behavior gender difference did not reach significance. Training did not relate to either factor. (Copyright © 2002 Taylor and Francis)
Safety education of pedestrians for injury prevention: a systematic review of randomized controlled trials: Discussion.

Reading R. Child Care Health Dev 2002; 28(5): 432-433.

Correspondence: Richard Reading, University of East Anglia Norwich Norfolk NR4 7TJ, UK; (email: r.reading@uea.ac.uk).

Responding to:

Duperrex O, Bunn F & Roberts I. (2002) British Medical Journal, 324, 1129-1131.

Objectives: To quantify the effectiveness of safety education of pedestrians.

Design: Systematic review of randomized controlled trials of safety education programs for pedestrians of all ages.

Main outcome measures: Effect of safety education on pedestrians' injuries, behavior, attitude and knowledge, and on pedestrian/motor vehicle collisions.

Results: We identified 15 randomized controlled trials of safety education programs for pedestrians; 14 trials targeted children, and one targeted institutionalized adults. None assessed the effect of safety education on the occurrence of pedestrian injury, but six trials assessed its effect on behavior. The effect of pedestrian education on behavior varied considerably across studies and outcomes.

Conclusions: Pedestrian safety education can change observed road crossing behavior, but whether this reduces the risk of pedestrian injury in road traffic crashes is unknown. There is a lack of good evidence of effectiveness of safety education for adult pedestrians, especially elderly people. None of the trials was conducted in low- or middle-income countries.

DISCUSSION: Although the three approaches to injury reduction, education, environmental change and legislation are described as complementary, they are usually considered separately. Those involved in local injury prevention programs often feel constrained to thinking solely or largely about educational interventions because the options of environmental change and influencing legislation and enforcement may seem beyond their capacity to influence. This paper shows that the evidence about the effect of such interventions is weak at best, and there is no evidence of an effect on injury reduction. A cautionary tale, perhaps, and it should focus more effort on changing the road environment, vehicle design and legislative change and enforcement of existing law to improve the safety of roads. However, there are questions about whether conventional randomized trials are the best way of evaluating complex interventions that may be part of a more general strategic approach to health promotion. Contamination of intervention to control subjects, national or local policy changes midway through the trial, the Hawthorne effect, and the difficulty of long-term follow-up observations can all sabotage the best efforts of trialists. (Copyright © 2002 Blackwell-Synergy).

No reports this week

Soccer-related craniomaxillofacial injuries.

Cerulli G, Carboni A, Mercurio A, Perugini M, Becelli R. J Craniofac Surg 2002; 13(5): 627-630.

Correspondence: Giulio Cerulli, Via dei Giuochi Istmici n16, 00194, Rome, ITALY; (email: giuliocerulli@hotmail.com).

The authors assessed the rate of craniomaxillofacial fractures in soccer and the areas where they occur, describing above all the injury pattern of this sport. Over a 5-year period (1995-2000) 46 cases of 329 with fractures associated with different sports activities have been surgically operated at the maxillofacial surgery department of the Policlinico "Umberto I" Hospital, University "La Sapienza" of Rome. All data collected have been selected on the basis of sex, age, anatomic site of the fracture, and the practiced sport. Information on injury patterns, severity, and play circumstances have been documented. The department examined 7 sports disciplines, but soccer was responsible for sports-related maxillofacial fractures in 34 of 46 cases (73.9%). All 34 fractures occurred to men. In soccer, the zygomatic and nasal regions are mainly involved. In fact the authors examined zygomatic fractures in 15 cases and nasal fractures in 10 cases. Direct contact between players generally causes soccer-related maxillofacial fractures: head-elbow impacts (21 cases) or head-head impacts (14 cases). The male:female ratio is 6.6:1, while the average age is 25 years for males and 23 years for females. In comparison with other sports (rugby, football, etc.) where physical contact occurs more frequently and the higher incidence of traumatic events justifies the use of protective measures, soccer is not a particularly violent sport. In soccer, maxillofacial traumas are caused by violent impacts between players that take place mainly when the ball is played with the forehead. In this moment there can be an elbow-head impact or a head-head impact. The authors believe that the low incidence of fractures, severity of the lesions, and discomfort caused by possible protective masks make their use unjustified. The data collected during this study witness that in soccer 21 of 34 cases of maxillofacial fractures are caused by elbow-head impacts. This fact suggests a preventive strategy against violent behavior in soccer play. Because the use of any sort of helmet proved impossible, the introduction of more severe penalties and a greater respect for the rules of the game by the players could reduce the percentage of impacts during matches. Impacts cause the most serious and frequent lesions in the maxillofacial region. (Copyright © 2002 Lippincott Williams & Wilkins)
Mechanisms of snowboarding-related severe head injury: shear strain induced by the opposite-edge phenomenon.

Nakaguchi H, Tsutsumi K. J Neurosurg 2002; 97(3): 542-548.

Correspondence: Hiroshi Nakaguchi, Department of Neurosurgery, Suwa Central Hospital, Chino city, Nagano, JAPAN; (email: hnakaguchi@hi-ho.ne.jp).

OBJECT: To date, there has been no published study in which the focus was on the mechanisms of head injuries associated with snowboarding. The purpose of this study was to identify these mechanisms.

METHODS: The patient population consisted of 38 consecutive patients with snowboarding-related major head injuries who were treated at two hospitals in Japan, where for years many winter sports injuries have been treated. The skill level of the snowboarder, the cause of the accident, the direction of the fall, the site of impact to the head, and the condition of the ski slope were examined. The injuries were classified as coup, contrecoup, or shear injuries.

RESULTS: The predominant features of snowboarding-related major head injuries included: falling backward (68% of cases), occipital impact (66% of cases), a gentle or moderate ski slope (76% of cases), and inertial injury (76% of cases [shear injury in 68% and contrecoup injury in 8% of the patients]). Acute subdural hematoma frequently occurred after a patient fell on the slope (p = 0.025), fell backward (p = 0.0014), or received an occipital impact (p = 0.0064). Subcortical hemorrhagic contusions frequently occurred after the patient fell during a jump (p = 0.0488), received a temporal impact (p = 0.0404), or fell on the jump platform (p = 0.0075). Shear injury frequently occurred after a fall that occurred during a jump or after simple falls on the ski slope, and contact injury was frequently seen after a collision (p = 0.0441).

CONCLUSIONS: The majority of severe head injuries associated with snowboarding that occur after a simple fall on the slope are believed to involve the opposite-edge phenomenon, which results from a fall backward on a gentle or moderate slope causing occipital impact. The use of a device to protect the occiput is proposed to reduce head injuries associated with snowboarding. (Copyright © 2002 American Association of Neurological Surgeons)

Accuracy of Race Coding on American Indian Death Certificates, Montana 1996-1998.

Harwell TS, Hansen D, Moore KR, Jeanotte D, Gohdes D, Helgerson SD. Public Health Rep 2002; 117(1): 44-49.

Correspondence: Todd S. Harwell, Montana Department of Public Health and Human Services, Cogswell Bldg., C-317, PO Box 202951, Helena, MT 59620, USA; (email tharwell@state.mt.us).

OBJECTIVES: The purpose of this study was to describe the consistency of coding of American Indians on Montana death certificates and to identify the characteristics of American Indians in Montana associated with consistent classification on death certificates.

METHODS: The Billings Area Indian Health Service (IHS) patient registration file was linked with Montana Department of Health and Human Services death certificate files for 1996-1998.

RESULTS: A total of 769 Montana residents who had died in 1996-1998 were matched to the IHS registration file. Of these decedents, 696 (91%) were consistently classified as American Indian on the death certificate. Seventy-two (99%) of the 73 decedents not classified as Indian were classified as white. American Indians living in counties on or near the seven Montana reservations were more likely to be consistently classified than Indians living in other counties (95% vs. 70%); those with less than 12 years of education (93% vs. 88%) were more likely to be consistently classified than those with 12 or more years of education. Decedents whose cause of death was suicide were less likely than those with other causes of death to be consistently classified (72% vs. 95%). In contrast, a higher percentage of those with an alcohol-related cause of death than of those with other causes of death were consistently classified, although this difference was not statistically significant.

CONCLUSIONS: The mortality rates for Montana American Indians are underestimated overall, and are differentially under- and overestimated for selected conditions.

A retrospective study of selected oral and maxillofacial fractures in a group of Jordanian children.

Qudah MA, Bataineh AB. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94(3): 310-314.

Correspondence: Mansour A. Qudah, Faculty of Dentistry, Jordan University of Science and Technology, PO Box 3030, Irbid, JORDAN; (email: mans1967@yahoo.com).

OBJECTIVES: The purpose of this study was to review the etiology, incidence, and treatment of selected oral and maxillofacial fractures in children in Jordan.

METHODS: Study Design. This retrospective review of patient records and radiographs was conducted during the 5-year period between 1996 and 2001. Age, gender, etiology, anatomic site, and treatment methods were reviewed.

FINDINGS: During the 5-year period, 227 patients with 274 maxillofacial fractures were treated. The age range was from 1 to 15 years (mean age, 11.2 years). Of the patients, 70% were male, with the peak incidence rate occurring in the 10-year-old to 12-year-old age group. The mandible was the most frequent bone of fracture, with 169 cases (74.5%), followed by the alveolar process in 28 cases (12.3%), the maxilla in 27 cases (11.9%), and the zygomatic complex in 3 cases (1.3%). Of the fractures, 52% were from accidental falls, 20% from road traffic accidents, 17% from assaults, 8% from sport injuries, and 3% from other causes, such as horse kick. Most patients (82.3%) were treated with closed reduction (45.2% with eyelet wiring and 54.8% with arch bars and intermaxillary fixation). Only 17.7% of patients were treated with open reduction and fixation. All maxillary fractures were treated with orbital and circumzygomatic suspension with interdental wiring and intermaxillary fixation. The 3 cases of zygomatic complex fractures were kept under observation without the necessity of surgical intervention.

DISCUSSION: Accidental falls were found to be the leading cause of maxillofacial fractures in our environment, and males were 3 times more affected than females. (Copyright © 2002 Mosby)
Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future.

Kannus P, Palvanen M, Niemi S, Parkkari J, Jrvinen M. Bone 2002; 31(3): 430-433.

Correspondence: Pekka Kannus, UKK Institute, Kaupinpuistonkatu 1, FIN-33500 , Tampere, FINLAND; (email: email: klpeka@uta.fi).

To increase knowledge about recent trends in the number and incidence of various low-trauma injuries among elderly people, we selected, from the National Hospital Discharge Register, all patients >/=60 years of age who were admitted to hospitals in Finland (5 million population) for primary treatment of a first low-trauma ankle fracture during 1970-2000. In each year of the study, the age-adjusted and age-specific incidence of fracture was expressed as the number of patients per 100,000 persons. The predicted numbers and incidence rates of fractures until the year 2030 were calculated using a regression model. For the study period, the number and incidence of low-trauma ankle fractures in Finnish persons >/=60 years of age rose substantially: the total number of fractures increased from 369 in 1970 to 1545 in 2000, a 319% increase, and the crude incidence increased from 57 to 150, a 163% increase. The age-adjusted incidence of these fractures also rose in both women (from 66 in 1970 to 174 in 2000, a 164% increase) and men (from 38 in 1970 to 114 in 2000, a 200% increase). The regression model indicates that, if this trend continues, there will be about three times more low-trauma ankle fractures in Finland in the year 2030 than there was in 2000. In conclusion, the number of low-trauma ankle fractures in elderly Finns is rising rapidly at a rate that cannot be explained simply by demographic changes and, therefore, potentially effective preventive measures, such as prevention of slippings, trippings, and falls in elderly people, and use of ankle supports, should be urgently studied. (Copyright © 2002 Elsevier Science)

Assault-related admissions to hospital in Central Australia.

Williams GF, Chaboyer WP, Schluter PJ. Med J Aust 2002; 177(6): 300-304.

Correspondence: Ged F Williams, NT Department of Health and Community Services, Alice Springs Hospital, PO Box 2234, Alice Springs, NT 0871, AUSTRALIA; (email: ged.williams@nt.gov.au).

OBJECTIVES: To determine the number of assault-related admissions to hospital in the Central Australia region of the Northern Territory over a six-year period.

METHODS: Design and setting- Retrospective analysis of all patients admitted to Alice Springs Hospital (ASH) and Tennant Creek Hospital (TCH) from July 1995 to June 2001, where the primary cause of injury was "assault". Main outcome measures- Frequency of assault-related admission to hospital; demographic characteristics of the victims.

FINDINGS: In the six years, there were 2449 assault-related admissions to ASH and 545 to TCH. Adults aged 25–34 years were most frequently hospitalised for assault, in a proportion greater than their proportion in the NT population. Females represented 59.7% of people admitted to ASH and 54.7% to TCH, greater than their proportion in the NT population. Aboriginals comprised 95.2% of ASH and 89.0% of TCH admissions, and were admitted in a significantly greater proportion than their proportion in the NT population (P < 0.001). The age-adjusted hospital admission rate resulting from assault has increased (P = 0.002) at an average rate of 1.6 (SE, 0.2) per 10 000 people per year. The proportion of assault-related admissions associated with alcohol has also increased significantly (P < 0.001).

DISCUSSION: The frequency of assault-related admissions to hospital, especially among the Aboriginal population, suggests that this major public health issue is escalating.

Traumatic deaths in Jamaica: a coroner's (medico-legal) autopsy study from the University Hospital of the West Indies.

Escoffery CT, Shirley SE. Med Sci Law 2002; 42(3): 185-191.

Department of Pathology, University of the West Indies, Mona, Kingston 7, Jamaica.

This study reviewed the trauma-related deaths in a coroner's (medico-legal) autopsy series at the University Hospital of the West Indies and represents only the second such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed during the 15-year period January 1, 1983 to December 31, 1997 were reviewed retrospectively, and the clinico-pathological characteristics of trauma-related deaths were analyzed. Trauma accounted for 470 (28.7%) of the 1,640 coroner's autopsies and the causes of death in descending order of frequency were motor vehicle accidents [MVAs] (44.9%), blunt injuries (17.7%), burns (16.8%), firearm injuries (13.6%) and stab injuries (7.0%). The 21-30 age group was the most commonly affected and the overall male: female ratio was 4:1. The distribution of injuries (excluding burns) by anatomical region was head and neck (43.8%), chest (8.9%), abdomen and pelvis (4.3%), extremities (0.9%) and multiple sites (25.3%). Forty-nine (23.2%) of the victims of MVAs were documented to have been pedestrians. Blunt trauma was most commonly due to accidental falls followed by assaults. Flame burns accounted for 90% of burn cases. There were seven (1.5%) cases of suicide overall. In this series the majority of trauma-related deaths occurred in young males and were due to MVAs. Strategies aimed at reducing trauma-related mortality should therefore emphasize road traffic safety programs, particularly targeting the young. (Copyright © 2002 Chiltern Publishing)
The influence of outside temperature and season on the incidence of hip fractures in patients over the age of 65.

Chesser TJ, Howlett I, Ward AJ, Pounsford JC. Age Ageing 2002; 31(5): 343-348.

Correspondence: Timothy J. S. Chesser, Departments of Orthopaedics and Care of the Elderly, Frenchay Hospital, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE, UK; (email: tim.chesser@north-bristol.swest.nhs.uk).

BACKGROUND:it is often assumed that hip fractures occur more commonly in winter, but the evidence is conflicting. It is important to clarify this issue to aid planning of health resources and understanding of the etiology of these fractures in the elderly.

OBJECTIVES: to determine whether the incidence of fractures altered with the daily temperature, seasons or months of the year.

METHODS: Over a five-year period we studied 818 patients, over the age of 65, who presented to one district general hospital with a fracture of the proximal femur.

FINDINGS: No significant difference was found in the incidence of fractures with different temperatures, changes of temperature, season or month of the year. Also, there was no significant difference in the characteristics of patients (age, sex, pre-injury mobility, residence, functional and mental scores) presenting in different seasons or temperature ranges. Patients presenting in winter months had a significantly longer inpatient stay, which may have been due to the strain on the social services over this time.

DISCUSSION: Other factors must be analyzed when considering the etiology of hip fractures in the elderly. There may be no extra demand on surgical facilities or other acute resources to treat hip fractures during the winter months in southern England. (Copyright © 2002 British Geriatrics Society)

Exercise and older adults: changing behavior with the transtheoretical model.

Burbank PM, Reibe D, Padula CA, Nigg C. Orthop Nurs 2002; 21(4): 51-61.

Correspondence: Patricia M. Burbank, College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA; (email: pburbank@uri.edu).

The loss of muscle strength, decreased flexibility and range of motion, and decreased sense of balance that frequently accompany aging contribute to falls and functional decline. Even in advanced old age, one can improve strength, decrease the risk of falls, improve cardiorespiratory fitness, and improve ability to live independently. The Transtheoretical Model (TTM) of behavior change is an internationally recognized model that holds much promise for health behavior changes of all types. This article outlines the effects of exercise on age-related changes in the musculoskeletal system and describes the TTM as a model useful to help older adults change their exercise behavior. Research studies are documented that support the effectiveness of the TTM in changing behavior. Application of the model is described with specific examples illustrated in two case studies. (Copyright © 2002 National Association of Orthopaedic Nurses)

New York State child agricultural injuries: How often is maturity a potential contributing factor?

Mason C, Earle-Richardson G. Am J Ind Med 2002; Suppl 2: 36-42.

Correspondence: Christine Mason, Northeast Center for Agricultural and Occupational Health, One Atwell Road, Cooperstown, NY 13326, USA; (email: cmason@nycamh.com).

BACKGROUND: Children living or working on New York farms face unique hazards and experience on-farm injuries related to these. The New York Community Partners for Healthy Farming (CPHF) surveillance provided a unique source of information for analyses of risk factors-particularly age-for these events.

METHODS: Agricultural injuries recorded by the state's agricultural nurse surveillance (CPHF) program over a 6-year period were analyzed. Injuries were classified by type, severity, and possible contributing factors, including whether the age of the victim was below the "job appropriate age limits" designated by the investigators using materials from the North American Guidelines for Children's Agricultural Tasks (NAGCAT).

FINDINGS: Of the 164 recorded injuries to persons aged 1-18 years, 29 were fatalities, 18 were disabling, and 55% occurred while working. Leading injury types were tractor run-over (12) and overturns (11). Of those injured while working, 35% were under the "job appropriate age limits." Tasks of loading hay (square bales) (100%, 3), fieldwork with trailed implements (100%, 3), and feeding calves (100%, 2) most frequently involved very young victims. Grouped by injury source, injuries involving non-powered wagons had the highest frequency of under-age victims (82%, 9).

DISCUSSION: The frequency of problems with job appropriate ages suggests that some children on NY farms may be developmentally inappropriate for the tasks to which they are being assigned. The NAGCAT Guidelines are a needed tool for child agricultural injury prevention in New York.(Copyright © 2002 Wiley-Liss)
Theater as a mechanism for increasing farm health and safety knowledge.

Elkind PD, Pitts K, Ybarra SL. Am J Ind Med 2002; Suppl 2: 28-35.

Correspondence: Pamela Dee Elkind, Center for Farm Health & Safety, Department of Sociology, Eastern Washington University, 314 Patterson Hall, Cheney, WA 99004-2429, USA; (email: pelkind@ewu.edu).

BACKGROUND: The agricultural industry has one of the highest injury and fatality rates of all industries in the US. Hispanic farm workers constitute the largest percentage of farm workers on Eastern Washington farms. Literacy levels, language skills, and migration patterns need to be considered when developing farm health and safety education. Theater was chosen as a method to provide health education and farm safety training to farm workers and their families living in a three county region of Eastern Washington.

METHODS: The most urgent health and safety education needs of Hispanic farm workers were identified by a series of focus groups and key informant interviews. The resulting data was used to develop four Spanish one-act plays, which were presented in each of the three counties. To test the effectiveness of theater as an educational tool each of the plays was accompanied by pre-and post-play self-report questionnaires. These were analyzed using two-tailed Chi-square (chi sq) tests of significance and a one-tail Marginal Homogeneity statistic.

FINDINGS: A total of 301 persons completed pre-test post-test questionnaires; 185 were farm workers and 115 were local community members. Thirteen of seventeen questions designed to measure information gained directly from the plays showed a significant degree of positive knowledge change (P = < 0.10). Follow-up interviews conducted 2 months after play viewing suggest that participants retain some of the health and safety messages in the plays.

DISCUSSION: The hypothesis, "appropriate farm health and safety knowledge increases as a result of attendance at a one-act Spanish play enacted by a community players' group" was validated since 13 of 17 questions showed a significant degree of positive knowledge change. Overall, participants indicated that they liked the plays, recalled the story lines easily, and would attend additional plays if given the opportunity. (Copyright © 2002 Wiley-Liss)
Development of grain threshers based on ergonomic design criteria.

Kumar A, Mohan D, Patel R, Varghese M. Appl Ergon 2002; 33(5): 503-508.

Correspondence: Dinesh Mohan Transportation Research & Injury Prevention Programme, Indian Institute of Technology, Delhi, Hauz Khas, New Delhi-110016, India (email: dmohan@cbme.iitd.ernet.in).

Threshers are used extensively on Indian farms for threshing grains, but are involved in a significant proportion of limb crush injuries. International safety standards are somewhat difficult to enforce because manufacture of machines is done at widely dispersed local workshops. Locally made machines are used for crop production and post-harvesting operations, with a great deal of manual work. This technical note reports the results of a study to develop a cost effective, improved design for safe operation of threshers based on ergonomic principles. (Copyright © 2002 Elsevier Science)

See abstracts under Alcohol & Other Drugs
See abstracts under Violence

Suicide and political regime in New South Wales and Australia during the 20th century.

Page A, Morrell S, Taylor R. J Epidemiol Community Health 2002; 56(10): 766-772.

Correspondence: Richard Taylor, School of Public Health, Edward Ford Building, A27, The University of Sydney, NSW, 2006, AUSTRALIA; (email: richardt@pub.health.usyd.edu.au).

BACKGROUND: Australia has had a two party parliamentary political system for most of the period since its Federation in 1901, dominated either by a social democratic (Labor) or a conservative ideological perspective.

OBJECTIVE: This paper investigates whether such political differences at Federal and State levels have influenced suicide rates in the state of New South Wales (NSW) for the period 1901-1998.

METHODS: Federal government type, NSW State government type, and combinations of both Federal and NSW State government type were examined. Poisson regression models were stratified by sex and controlled for the effects of age, annual change in gross domestic product, sedative availability, drought, and both world wars.

FINDINGS: When both Federal and NSW State governments were conservative the relative risk of suicide for NSW men was 1.17 (p < 0.001) and for women 1.40 (p < 0.001) compared with both governments being Labor (1.00). A statistically significant linear trend (p < 0.001) in suicide risk was evident across the continuum of Federal/State government combinations, from both Labor (lowest), to mixed (intermediate), to both conservative (highest).

DISCUSSION: Significantly higher suicide risk was associated with conservative government tenures compared with social democratic incumbents. Results are discussed in terms of the differences underpinning conservative and social democratic government programmed ideology, and their relevance to Durkheim's theories of suicide, social regulation, and integration. (Copyright © 2002 Journal of Epidemiology and Community Health)
Suicide differentials in Australian males and females by various measures of socio-economic status, 1994-98.

Page A, Morrell S, Taylor R. Aust N Z J Public Health 2002; 26(4): 318-324.

Correspondence: Andrew Page, School of Public Health, A27 - Edward Ford Building, University of Sydney, NSW 2006 AUSTRALIA; (email: apage@health.usyd.edu.au).

OBJECTIVES: To investigate Australian suicide differentials in males and females by three area-based measures of socio-economic status (SES).

METHODS: Suicide data for 1994-98 were used to investigate area-based gradients of SES for the Index of Relative Socio-Economic Disadvantage (IRSED) (an overall measure of SES), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO), using Poisson regression models adjusting for age, country-of-birth and urban-rural residence.

FINDINGS: After adjusting for age, country-of-birth and urban-rural residence, significant increasing linear trends in suicide risk from high to low quintiles of SES were evident in males for the IRSED (an average multiplicative increase in suicide risk of 8% per quintile), IER (9% increase) and IEO (5% increase). For females, there was no evident SES gradient for the IRSED after adjusting for age, country-of-birth and urban-rural residence, but a significant positive linear trend from high to low quintiles of SES was found for the IER (6% increase per quintile). A significant decreasing linear trend (increasing suicide risk with increasing SES) was evident for the IEO (30% per quintle).

DISCUSSION: Male suicide is positively associated with all three measures of SES examined. Female suicide is significantly associated with the IER (positive association) and IEO (negative), and because of this is not associated with the overall measure of SES. These findings partly explain why female suicide has been found to be poorly correlated with area-based measures of SES. IMPLICATIONS: Specific components of area-based socio-economic status provide a clearer picture of socio-economic suicide differentials in Australian females, with implications for population-based preventive strategies.

See abstract under Violence

The effect of maternal depressive symptomatology on maternal behaviors associated with child health.

Leiferman J. Health Educ Behav 2002; 29(5): 596-607.

Correspondence: Jenn Leiferman, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg 24061, USA; (email: jleif@vt.edu).

National prevalence rates for depression among women are twofold compared with those of men, with women of childbearing age at greatest risk. Maternal depression not only negatively affects the health of the mother but may also influence the health and development of her offspring. This study examined the relationship between maternal depression and its influence on certain maternal behaviors associated with child health. A nationally representative, longitudinal data set with information on demographic, behavioral, and health care variables obtained from women in 1988 and 1991 was used. The results from logistic regression modeling indicate that maternal depression is associated with maternal behaviors (i.e., an increased likelihood of engagement in smoking, in not administering vitamins to a child, and not restraining children in appropriate car seats). Moreover, race differentials were found among these relationships. The implications of these results suggest the need to screen for depression among mothers of young children. (Copyright © 2002 Society for Public Health Education)
Head injuries in infants: the risks of bouncy chairs and car seats.

Wickham T, Abrahamson E. Arch Dis Child 2002; 86: 168-169.

Correspondence: T Wickham, Department of Paediatric Accident and Emergency, Chelsea and Westminster Hospital, 8 Charwood Close, Shenley, Radlett, Herts WD7 9LH, UK; email: doctimwickham@yahoo.com).

OBJECTIVES: To establish whether the incorrect use of bouncy chairs (BC) and car seats (CS) is a significant cause of injuries in babies.

METHODS: Prospective study over a 12 month period. All babies under the age of 1 year, presenting to the department with a head injury were eligible.

FINDINGS: A total of 131 cases were recorded, 17 (13%) of which were associated with either BC or CS, the second largest etiological group. All BC cases (11/11, 100%) were caused by a fall from a surface with the baby in the chair. In the CS group, 2/6 (33%) were caused by such a fall. The carer was aware in only one of the 13 cases involving a fall from a surface that there was any chance of injury from this mechanism.

DISCUSSION: Falls from inappropriately placed bouncy chairs or car seats form a significant proportion of head injuries in infants, resulting in unnecessary and preventable morbidity. (Copyright © 2002 Archives of Disease in Childhood)
Factors influential in making an injury severity difference to older drivers involved in fixed object-passenger car crashes.

Dissanayake S, Lu JJ. Accid Anal Prev 2002; 34(5): 609-618.

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

To identify factors influencing severity of injury to older drivers in fixed object-passenger car crashes, two sets of sequential binary logistic regression models were developed. The dependent variable in one set of models was driver injury severity, whereas for the other it was the crash severity (most severe injury in the crash). For each set of models, crash or injury severity was varied from the least severity level (no injury) to the highest severity level (fatality) and vice versa. The source of data was police crash reports from the state of Florida. The model with the best fitting and highest predictive capability was used to identify the influence of roadway, environmental, vehicle, and driver related factors on severity. Travel speed, restraint device usage, point of impact, use of alcohol and drugs, personal condition, gender, whether the driver is at fault, urban/rural nature and grade/curve existence at the crash location were identified as the important factors for making an injury severity difference to older drivers involved in single vehicle crashes. (Copyright © 2002 Elsevier Science)
Situational Factors in Seat Belt Use by Teenage Drivers and Passengers.

Williams AF, Shabanova VI. Traffic Inj Prev 2002; 3(3): 201-204.

Correspondence: Allan F. Williams, Insurance Institute for Highway Safety, 1005 North Glebe Road, Arlington, Virginia 22201, USA; (email: awilliams@iihhs.org).

Drivers with high crash risk such as teenagers have relatively low seat belt use, which contributes to their injuries. This article addresses whether belt use is lower in driving situations with higher crash risk (such as when teenagers transport passengers), further contributing to the problem. Belt use was investigated in a variety of situations among fatally injured drivers and their passengers, using 1995-99 data from the Fatality Analysis Reporting System. For drivers of all ages, belt use was lower at night and with alcohol present. For teenagers, but not adults, driver belt use decreased with increasing number of passengers. Driver belt use was lowest when teenage drivers were transporting passengers in their twenties, and many of these crashes involved driver alcohol use. Driver belt use was highest when teenage drivers were transporting passengers age 30 and older, many of whom could be parents. Passenger belt use also decreased among teenagers as the number of passengers in the vehicle increased. Transporting passengers up to age 29 should be restricted in graduated licensing systems, and restrictions should not be waived unless a licensed passenger older than that is present. Most existing passenger restrictions do not conform to this. (Copyright © 2002 Taylor & Francis)
Previous convictions or accidents and the risk of subsequent accidents of older drivers.

Daigneault G, Joly P, Frigon JY. Accid Anal Prev 2002; 34(2):257-61.

Correspondence: Geneviève Daigneault, Reseau de Sante Richelieu-Yamaska, Departement des Soins longues durees, St. Hyacinthe, Quebec, CANADA; (email: gedaigneault@hotmail.com).

The over-involvement of elderly drivers in collisions has a potentially adverse effect on highway safety. The question for most experts in traffic research is whether we can predict the individual risk of accidents and which variables are the best predictors, especially for this population. For a better understanding of the elderly drivers' problems, this study aimed to describe the most common types of accidents in the elderly population of drivers living in Quebec (> or = 65 years of age). The second objective of the study was to analyse the relationship between previous accidents or convictions and the risk of subsequent accidents. The results show that: (1) elderly drivers are characterized by error accidents involving more than one car, especially at intersections, (2) prior accidents are a better predictor for accident risk than prior convictions and (3) these trends steadily increase with each age group (drivers 65 years old to 80 years or more). The results are discussed in relation to the literature on risk behavior of the elderly drivers. (Copyright © 2002 Elsevier Science)
Traffic accidents: a qualitative approach from Campinas, Sao Paulo, Brazil.

[Article in Portuguese]

Queiroz MS, Oliveira PC. Cad Saude Publica 2002; 18(5): 1179-787.

Correspondence: Marcos S. Queiroz, Centro de Memória, Universidade Estadual de Campinas. Rua das Orquídeas 587, Campinas, SP 13085-370, BRAZIL; (email: msq44@uol.com.br)

This article takes an interdisciplinary qualitative approach to the problem of traffic accidents in Campinas, Sao Paulo, Brazil. The authors begin by analyzing the "municipalization" (i.e., decentralization to the municipal level) of transport and traffic management in Campinas based on social representations by members of the local government's technical staff. Data demonstrate a significant drop in traffic accident mortality in Campinas in the last ten years. The findings illustrate how new transport and traffic policies had several positive effects. Special attention is given to the objectives, strategies, and obstacles dealt with by local government in the "municipalization" of traffic. The paper concludes by emphasizing the need for specific public policies to revitalize urban mass transportation, including special traffic safety educational programs.

See abstract under Reports of Injury Occurrence
Robbers on board: exposure to violence, insecurity, and other health hazards among mass transportation workers and passengers in Salvador, Bahia, Brazil.

[Article in Portuguese]

Paes-Machado E, Levenstein C. Cad Saude Publica 2002; 18(5): 1215-1227.

Correspondence: Eduardo Paes-Machado, Instituto de Saúde Coletiva da Universidade Federal da Bahia. Rua Padre Feijó 29, 4o andar, Salvador, BA 40110-170, BRAZIL; (email: epm@ufba.br).

This paper examines the impact of violent crime on working conditions, health, and security for bus drivers and ticket takers in the mass transportation system in Salvador, Bahia, Brazil. The research included 195 interviews with workers, labor union officials, passengers, management, and police. In the last ten years there have been 20,572 robberies in a fleet of 2,400 buses operated by 10,151 workers, with 67 deaths and more than US$500,000 in company losses. Perpetrators are typically poor, unemployed youths, the majority of whom first offenders, seeking easy money primarily for leisure pursuits. The average "take" from such robberies is minimal. The authors observed a pattern of bus robberies as a psychological power game which, for bus workers, apart from physical injuries and fatalities, generates fear, identity conflicts, tense relations with passengers, and labor conflicts involving the recovery of stolen fares and worker and passenger security issues. The article also outlines and evaluates the efficiency of security measures including the use of lethal force by police.
Workplace homicides in Chicago. Risk factors from 1965 to 1990.

Beauchamp Hewitt J, Levin PF, Misner ST. AAOHN J 2002; 50(9): 406-412.

Correspondence: Jeanne Beauchamp-Hewett, University of Wisconsin-Milwaukee, School of Nursing, Milwaukee, WI, USA; (email: jbhewitt@csd.uwm.edu).

Using data from police records, this study examined risk factors related to 940 workplace homicides occurring in Chicago between 1965 and 1990. Black men were predominantly both victims (49%) and offenders (75%). The median age for victims was 42 years, but only 25 years for offenders. Women (40%) were more likely than men (6%) to be killed by intimates. Firearms were involved in 83% of all homicides, and robbery was the primary motive (62%). Workplace homicides occurred most frequently in taverns (22%). Alcohol use by tavern workers was involved in 48% of the homicides. Wide disparity in the number of workplace homicides occurred in Chicago's 77 community areas. Strategies to deter robbery and alcohol use, as well as to prevent domestic violence in the workplace, need to be implemented and evaluated. Occupational health nurses play a pivotal role in effective violence prevention. (Copyright © 2002 American Association of Occupational Health Nurses)
Jewish-Arab violence: perspectives of a dominant majority and a subordinate minority.

Eshel Y, Moran M. J Soc Psychol 2002; 142(5): 549-565.

Correspondence: Yochi Eshel, Department of Psychology, University of Haifa, ISRAEL; (email: yeshel@psy.haifa.ac.il).

In two studies, the authors investigated intergroup violence as perceived by Israeli Jews and Israeli Arabs. University and junior high school students judged Jewish-Arab clashes, which ended in shots fired at a crowd of either Jewish or Arab demonstrators. The authors hypothesized that judgments of these shootings would be contingent on 3 variables: the origin of the respondent, the origin of the shooter, and the level of danger to the shooter. The results tended to support those hypotheses: (a) Both Jewish and Arab respondents justified shootings by members of their own group more readily than those by members of the other group. (b) Jewish judgments of violence were associated more closely than Arab judgments with the danger that the demonstrators posed to the shooter. (c) The Jewish respondents referred to self-defense more often than did the Arab respondents to justify their judgments, whereas the Arab respondents referred more often to intergroup considerations. Those differences may reflect the disagreement between the majority and the minority on the issue that each group should take into consideration in cases of international violence.
Adolescents carrying handguns and taking them to school: psychosocial correlates among public school students in Illinois.

Williams S, Mulhall P, Reis J, De Ville J. J Adolesc 2002; 25(5):551-567.

Correspondence: Sunyna S. Williams, Department of Community Health, University of Illinois at Urbana-Champaign, 1206 South Fourth Street, Champaign, IL 61820, USA; (email: william5@uiuc.edu).

The current study sought to examine psychosocial correlates of adolescents carrying a handgun and taking a handgun to school. Survey participants were approximately 22,000 6th, 8th, and 10th grade public school students from throughout Illinois. Results showed that the strongest correlates of handgun carrying behaviors were variables directly associated with handguns and violence, both behaviors and beliefs, as well as delinquency variables. These findings have many implications for intervention by parents, schools, and policy makers to reduce the incidence of adolescent handgun carrying and taking a handgun to school. (Copyright © 2002 The Association for Professionals in Services for Adolescents. Published by Elsevier Science)
Do criminals go to the hospital when they are shot?

May JP, Hemenway D, Hall A. Inj Prev 2002; 8(3): 236-238.

Correspondence: John P May, Medical Director, South Florida Reception Center, 14000 NW 41st Street, Miami, FL 33178, USA; (email: Drjpmay@aol.com).

OBJECTIVES: To determine whether criminals go to the hospital when they are shot. Such information is needed to check on the accuracy of using hospital emergency room data to estimate non-fatal gunshot wounds.

SETTING:: Five jails across the US.

METHODS: A survey of inmates being booked into jail, administered by in-house health care staff.

FINDINGS: Over 90% of over 300 criminals who had been wounded sometime before their incarceration reported going to a hospital for treatment after being shot. These results are consistent with previous findings from one jail.

DISCUSSION: Jail inmates who had previously been shot were likely to have been treated in a hospital. This limited finding is consistent with the proposition that hospital/emergency department data may miss only a small percentage of gunshot wounds to criminals. (Copyright © 2002 BMJ Group Publications)

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