SafetyLit Update: 25 November 2002

Other Information

Publications Available
On-Line from IPW Sites

25 November 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.

Association between use of sedatives or hypnotics, alcohol consumption, or other risk factors and a single injurious fall or multiple injurious falls: a longitudinal general population study.

Stenbacka M, Jansson B, Leifman A, Romelsjo A. Alcohol 2002; 28(1): 9-16.

Correspondence: Marlene Stenbacka, Karolinska Institutet, Department of Clinical Neuroscience, Magnus Huss Clinic, Karolinska Hospital, 171 76, Stockholm, SWEDEN,; (email: marlene.stenbacka@spo.sll.se).

In this study, we investigated the association between risk factors, including use of sedatives or hypnotics or alcohol consumption, and injurious falls leading to hospitalization or death among 4,023 subjects (1,828 men and 2,195 women) aged 20-89 years in Stockholm County, Sweden. Questionnaire data obtained from the 1984-1985 Stockholm Health of the Population Study (SHPS) were linked to official data registers on hospitalization and mortality. Of the 4,023 subjects, 330 (121 men and 209 women) had been treated for or died of injurious falls during the 12-year follow-up period. High age was significantly associated with injurious falls among both men and women. Multivariate analyses showed that women who had used sedatives or hypnotics during the 2 weeks before an injurious fall were at increased risk [relative risk of 1.83 (95% confidence interval, 1.10-3.06)] for two or more injurious falls, but not for a single fall accident. High alcohol consumption and earlier self-reported injurious falls were significantly associated with injurious falls for women younger than 60 years of age and with earlier self-reported falls and living alone for men in the same age category. Among older women (>60 years of age), high alcohol consumption and use of sedatives or hypnotics were significantly associated with injurious falls, whereas living alone and earlier self-reported accidents were significant predictors for men in the same age category. These results support a cautious prescribing policy for sedatives and hypnotics, as well as an awareness of high alcohol consumption and its association with injurious falls. (Copyright © 2002 Elsevier Science).
Amphetamine derivative related deaths in northern Greece.

Raikos N, Tsoukali H, Psaroulis D, Vassiliadis N, Tsoungas M, Njau S. Forensic Sci Int 2002; 128(1-2): 31-34.

Correspondence: Heleni Tsoukali, Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University, 54126, Thessaloniki, GREECE; (email: elpa@med.auth.gr).

Until 1997, only one amphetamine related derivatives (AMPs) fatality had been reported in Greece. Since then, amphetamine (AMP) or AMPs have been found in seven out of 1500 post-mortem toxicological cases. The cause and manner of death of these seven cases were: 3,4-methylenedioxy-N-methamphetamine (MDMA) and 3,4-methylenedioxy-N-ethylamphetamine (MDEA) poisoning (n=1), drowning in water (n=4), cranial injuries caused by a traffic accident (n=1) and heart failure (n=1).In the case where the use of AMP or AMPs was considered, the immediate cause of death post-mortem toxicological analysis revealed 2 g/ml MDMA and 0.7 g/ml MDEA in blood. MDMA was identified in two cases of drowning (2 g/ml in blood in the first case and 1.7 g/g in liver in the second case) and in the traffic accident case (0.4 g/g in liver). Methamphetamine was detected in two cases of drowning (2.5 g/ml in blood in the first case and 6 g/g in liver in the second case). AMP was found in the heart failure case (0.2 g/g in liver). Alcohol was present, together with AMP or AMPs, in four cases. These findings indicate an increase in the illegal abuse of AMPs in Greece. Because of this, we now routinely screen for AMPs. (Copyright © 2002 Elsevier Science)
Making the transition from high school to college: the role of alcohol-related social influence factors in students' drinking.

Read JP, Wood MD, Davidoff OJ, McLacken J, Campbell JF. Subst Abus 2002; 23(1): 53-65.

Correspondence: Jennifer P. Read, Center for Alcohol and Addiction Studies, Brown University, Box G-BH, Providence, Rhode Island 02912, USA; (email: Jennifer_Read@Brown.edu).

Using a sample of entering college freshmen (N = 311), the purposes of this study were to examine 1) whether perceived norms for college student alcohol use and problems differed by gender and level of intended Greek involvement (Greek intent); 2) associations between perceived norms, Greek intent, and alcohol use and problems; and 3) whether relations between perceived norms, Greek intent, and alcohol use and problems were moderated by gender. Results revealed no differences in levels of perceived norms for alcohol use and problems as a function of gender or intention to affiliate with a Greek letter organization. Perceived norms demonstrated consistent, significant associations with both alcohol use and problems, while Greek intent demonstrated significant associations only with alcohol problems. Examination of gender effects in associations between perceived norms, Greek intent, and alcohol use and problems revealed a number of differences in these relations. Specifically, Greek intent was significantly associated with measures of alcohol use and problems for men, but not for women. Likewise, the association between perceived norms and alcohol use and problems were significant for men, but not for women. Finally, although perceived norms were a significant predictor of heavy drinking for both men and women, the association was much stronger among male students. These findings suggest that alcohol prevention interventions may benefit from specifically targeting perceived norms among incoming students who are at highest risk (i.e., male pledges). (Copyright © 2002 Association for Medical Education and Research in Substance Abuse)

No reports this week

No reports this week

Occupational injuries among Boston bicycle messengers.

Dennerlein JT, Meeker JD. Am J Ind Med 2002; 42(6): 519-525.

Correspondence: Jack Dennerlein, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; (email: jax@hsph.harvard.edu).

BACKGROUND: Urban bicycle couriers may have a high incidence of injuries. Most messengers work as contractors and hence their injuries are not well documented. METHODS: To quantify injury rates and severity among urban bicycle couriers a convenience sample of 113 couriers in the city of Boston completed a two-page self-administered survey. RESULTS: Most working couriers have suffered at least one injury resulting either in days lost from work (70%) and in visits to a health-care professional or hospital (55%). The annual incidence rate for injuries resulting in days away from work was 47/100-bike couriers. Bone fractures accounted for the most days lost from work, followed by dislocations, sprains, and strains. Collisions and avoiding collisions with motor vehicles, including being "doored," and collisions with pedestrians accounted for the majority (66%) of events leading to injury. Twenty-four percent of messengers reported wearing a helmet on a regular basis, and 32% have health insurance. CONCLUSIONS: Urban bicycle messengers are a poorly documented, largely unstudied workforce who suffer a very high rate of occupational injury. (Copyright © 2002 Wiley-Liss)
A Comprehensive Method for the Assessment of Industrial Injury Events

Smith CS, Silverman GS, Heckert TM, Brodke MH, Hayes BE, Silverman MK, Mattimore LK. J Prev Interv Commun 2002; 22(1): 5-20.

Correspondence: Gary S. Silverman, Bowling Green State University, Environmental Health Department, 1415 E Wooster Street, Bowling Green, OH 43403-4004, USA; (email: silverma@bgnet.bgsu.edu).

Because work-related injuries are infrequent and often poorly documented, injury event operationalizations beyond recorded rates would be beneficial. This study describes a method that uses self-reported and recorded events. Researchers interviewed workers and obtained recorded events from personnel files to develop the near miss and unreported injury events measures. The self-reported event measures, with other safety variables and demographics,were then administered to two groups of plant workers (N = 115 and N = 120). Results indicated that self-reported events differed from recorded events and are related to other work injury variables (e.g., work hazards, overtime). An expanded safety protocol such as this one may provide additional tools to investigate the injury event process. (Copyright © 2002 Hayworth Press)

See also: abstract #1 under Occupational Issues
A local bicycle helmet ‘law’ in a Swedish municipality - the structure and process of initiation and implementation.

Nolén S, Lindqvist K. Inj Control Saf Promot 2002; 9(2): 89-98.

Correspondence: Sixten Nolén, Swedish Road and Transport Research Institute (VTI), Linköping, SWEDEN; (email: sixten.nolen@vti.se).

On May 1, 1996, the Municipality of Motala in Sweden introduced a local bicycle helmet ‘law.’ It is, however, not an official law in a legal sense, but a municipally endorsed recommendation supported by promotional activities. This ‘law’ applies to children (ages 6-12), although the objective is to increase helmet use among cyclists of all ages.

The study is a qualitative evaluation of the structure and process during initiation and implementation of the Motala bicycle helmet law. The aim was to describe the activities that were carried out, which actors took part and the opinions of the most closely involved actors. The results are based on analysis of written material and on interviews with eight of the actors.

The mass media focused much attention on the bicycle helmet law, especially during the first six months after its introduction. The name helmet law was presumably of significance in this context. It is essential that relevant target groups provide sufficient support and that committed individuals initiate and promote the work, which, however, must not become dependent on a single individual. All issues concerning bicycle helmets should be coordinated with the law. Also, continuous engagement of the municipal government and a strategy for the control and follow-up of the law are needed. Local bicycle helmet laws of this type have a potential to produce a long-lasting effect on helmet use, provided some of the problems encountered can be avoided and some of the promotional activities are intensified. (Copyright © 2002 Swets & Zeitlinger)

See Abstract #6 under Violence

Sports injuries among children in six European union countries.

Belechri M, Petridou E, Kedikoglou S, Trichopoulos D; Sports Injuries European Union Group. Eur J Epidemiol 2001; 17(11): 1005-1012.

Correspondence: Maria Belechri, Department of Hygiene and Epidemiology, Athens University Medical School, GREECE; (email: unavailable).

Since sports participation entails the risk of injuries that account for substantial morbidity and disability, the existence of adequate epidemiological information is essential for the development of sound preventive strategies. In this study, we present data on the occurrence of sports injuries among children in six European countries, namely Austria, Denmark, France, Greece, The Netherlands, and the United Kingdom. An operational definition for sports injuries was developed, and comparable data from the European Home and Leisure Accident Surveillance System, an established injury surveillance system operating in 12 European union countries, were collected from the participating member states, during a 1-year period (1998). Sports injuries were examined in schools, in organized and unorganized settings, and in specific types of sports by demographics and injury descriptive variables. Sports injuries represent a quantitatively important and sufficiently serious problem in European union countries, accounting for an estimated annual number of about a quarter of a million outpatient visits in two of the participating countries, which provide national estimates. It is evident, that sport injuries are not only common but also injuries of considerable severity, since a large fraction represents fractures, while approximately 4% of the total require hospitalization. Football and basketball among male children are, in declining order, the two sports responsible for the most frequent injuries in the European union countries, whereas gymnastics and volleyball prevail among females. The study indicates the importance of injury surveillance in describing the epidemiology of sports injuries and provides an estimate of the magnitude and the profile of sport injuries that take place annually in European union countries. (Copyright © 2001 Kluwer Academic Publishers)
Mortality and morbidity in white water rafting in New Zealand.

O'Hare D, Chalmers D, Arnold AN, Williams F. Inj Control Saf Promot 2002; 9(3): 193-198.

Correspondence: David O'Hare, University of Otago Medical School, Department of Psychology, Dunedin, NEW ZEALAND; (email: ohare@psy.otago.ac.nz).

OBJECTIVES: This study provides the first descriptive overview of fatal and non-fatal injury associated with white water and other recreational river rafting in New Zealand. The current study sought to identify the nature and causes of hospitalisable injuries and to identify the causes of fatal injuries to white water rafters.

METHODS: The data were obtained from the New Zealand Health Information Service (NZHIS) mortality and morbidity files. Mortality data for the period from 1983 to 1995 and morbidity data from 1983-1996 were used. Participants- Members of the public who took part in white water and other recreational river rafting activities throughout the above periods.

FINDINGS: Of the 33 fatalities, over 80% were male. Almost all the fatalities involved drowning, more than a third resulting from the raft capsizing. Nearly half of the 215 hospitalizations resulted from fractures, victims spending an average of 3.3 days in hospital. The effects of submersion, and intracranial injuries were the next most common categories.

DISCUSSION: In relation to fatalities, the potentially modifiable risk factors involve improved resistance to raft capsizing, and equipment and skills required to stay afloat. In relation to injuries, the potentially modifiable risk factors relate mainly to preventing slipping and falling through the design of footwear, protective equipment, and procedures for entry and egress. (Copyright © 2002 Swets & Zeitlinger)

The annual societal cost of alcohol misuse in Scotland.

Varney SJ, Guest JF. Pharmacoeconomics 2002; 20(13): 891-907.

Correspondence: Julian F. Guest, CATALYST Health Economics Consultants, 34b High Street, Northwood, Middlesex HA6 1BN, UK; (email: catalyst@dial.pipex.com).

OBJECTIVE: To estimate the annual socioeconomic burden imposed by alcohol misuse on Scottish society.

DESIGN AND SETTING: Resource use attributable to alcohol misuse was obtained from appropriate databases, published literature and a Working Party on Social Work Caseload and Alcohol Misuse. Unit resource costs at 2001/2002 prices were applied to the resource use estimates to determine the annual direct cost attributable to alcohol misuse. Indirect costs arising from excess unemployment, absenteeism from work and premature mortality were also estimated as was the human cost of alcohol misuse arising from premature mortality among the non-working population.

MAIN OUTCOME MEASURES AND RESULTS: The annual health care cost of managing alcohol misuse was estimated to be pound 95.6 million. Hospital admissions (57%) and accident and emergency attendances (10%) accounted for the greatest health service costs. Social work services including the Children's Hearing System were estimated to cost pound 85.9 million whilst the criminal justice system was estimated to cost pound 267.9 million. Indirect costs were estimated to account for pound 404.5 million. The human cost of premature mortality among the non-working population was estimated to be pound 216.7 million.

CONCLUSIONS: Alcohol misuse imposes a substantial burden on Scottish society, costing pound 1071 million per year at 2001/2002 prices, which is greater than many prevalent illnesses such as stroke, depression and diabetes mellitus. In terms of the statutory agencies, alcohol misuse imposes a greater burden on the criminal justice system than both the health service and social work services. However, the greatest burden is on the individual and society as a whole arising from lost productivity. (Copyright © 2002 Adis International)
Pediatric maxillofacial fractures: their etiological characters and fracture patterns.

Iida S, Matsuya T. J Craniomaxillofac Surg 2002 Aug;30(4): 237-241.

Correspondence: Seiji Iida, Department of Oral and Maxillofacial Surgery Osaka University, Graduate School of Dentistry 1-8 Yamadaoka, Suita, Osaka, 565-0871 JAPAN; (email: iida@dent.osaka-u.ac.jp).

OBJECTIVE: Pediatric maxillofacial fractures are not common and carry different clinical features when compared with adults. To clarify the differences of etiology and patterns of fractures in pediatric patients, a clinical retrospective analysis was performed.

METHODS: One hundred seventy-four pediatric patients younger than 16 years of age treated in the First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital during a 15-year period were analyzed. Age, sex, fracture patterns, incidence, common locations of the mandibular fractures and treatment were studied according to the patients' charts and radiographs.

FINDINGS: The ratio of boys to girls was 2:1 and the largest age subgroup was 15-years old. The most common cause of injury was bicycle accidents (26%), followed by falls (25%). The distribution of causes and ages revealed that the incidence of the fall-related injuries decreased in patients older than 10 years, and assaults became a common cause in patients older than 12 years. The yearly distribution showed a decrease of the group between 6 and 10 years and of bicycle-related accidents in the last 5-year period (1992-1996). Mandibular fractures were most common (56%), followed by fractures of the alveolar process (31%). Condylar fracture was common in children younger than 14 years, especially in those below 6 years. Fractures of the mandibular angle were the most common in those above 13 years.

DISCUSSION: These results document that the etiological characters and patterns of pediatric maxillofacial fractures gradually shifted towards those found in adolescents. (Copyright © 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science)
Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care.

Chiara O, Scott J, Cimbanassi S, Marini A, Zoia R, Rodriguez A, Scalea T, Milan Trauma Death Study Group. Injury 2002; 33(7): 553-562.

Correspondence: Osvaldo Chiara, Istituto di Chirurgia d'Urgenza, Universita degli Studi di Milano-IRCCS Ospedale, Maggiore, via Francesco Sforza 35, 20122, Milan, ITALY; (email: ochiara@yahoo.com

In Italy, a comprehensive regional study of trauma deaths has never been performed. We examined the organization and delivery of trauma care in the city area of Milan, using panel review of trauma deaths. Two panels evaluated the appropriateness of care of all trauma victims occurred during 1 year, applying predefined criteria and judging deaths as not preventable (NP), possible preventable (PP), and definitely preventable (DP). Two hundred and fifty-five deaths were reviewed. Blunt trauma were 78.04% and motor vehicle crashes accounted for over 50%. Most victims (73.72%) died during pre-hospital settings and 91.1% died within the first 6h, principally because of central nervous system injuries in blunt and hemorrhage in penetrating trauma. Panels judged 57% of deaths NP, 32% PP, 11% DP (inter-panel K-test 0.88). Preventable deaths were higher after in-hospital admission. Main failures of treatment were lack in airway control or intravenous infusions in pre-hospital and mismanagement with missed injuries in emergency department. The high rate of avoidable deaths in Milan supports the need of trained pre-hospital personnel and of well equipped referring hospitals for trauma. (Copyright © 2002 Elsevier Science)
The psychological burden of injury: an 18 month prospective cohort study.

Mason S, Wardrope J, Turpin G, Rowlands A. Emerg Med J 2002; 19(5): 400-404.

Correspondence: Suzanne Mason, Department of Accident and Emergency Medicine, Northern General Hospital Trust, Herries Road, Sheffield S5 7AU, UK; (email: s.mason@sheffield.ac.uk).

OBJECTIVES: To determine the prevalence of post-trauma psychological problems among a cohort of male accident and emergency department patients admitted to hospital. To identify the changes in their psychological symptoms over an 18 month follow up period.

METHODS: A prospective cohort study of male accident and emergency department patients who were admitted for treatment of an injury. Baseline interview recorded demographic details and accident details. Standardized questionnaires measured baseline psychological state and personality type. Follow up at six weeks, six months, and 18 months after injury was by face to face interview or postal questionnaire and recorded progress since injury, and documented psychological status through the use of standardized questionnaires to detect psychiatric disorder and symptoms of post-traumatic stress disorder (PTSD).

FINDINGS: 210 male patients were recruited into the study. Psychiatric disorder was identified in 47.6% of responders at six weeks, and 43.4% at six months after injury. This improved significantly at 18 months. PTSD symptoms were moderate in 25%-30% and severe in 5%-14% and did not change significantly over the study period. A significant relation was found between previous psychiatric history and psychological symptoms at 18 months after injury. No relation was identified between injury severity and psychological status after injury.

DISCUSSION: This study finds a high prevalence of psychological distress in male accident and emergency department patients after injury. Although some symptoms resolve over the follow up period, a proportion remain and may be related to previous psychiatric history. There was no relation identified between severity of injury and psychological morbidity. (Copyright © 2002 Emergency Medical Journal - BMJ Publishing Group)

Crash Scene Photography in Motor Vehicle Crashes without Air Bag Deployment.

Newgard CD, Martens KA, Lyons EM. Acad Emerg Med 2002; 9(9): 924-929.

Correspondence: Craig D. Newgard, Department of Emergency Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Mailcode CR-114, Portland, OR 97201-3098, USA; e-mail: newgard@ohsu.edu.

OBJECTIVE: To determine whether vehicle characteristics, measured using crash scene photography, are associated with anatomic patterns of injury and severity of injury sustained in motor vehicle crashes (MVCs) without air bag deployment.

METHODS: A prospective observational study was conducted over 22 months, using 12 fire departments serving two hospitals. Two vehicle photographs (exterior and interior) were taken at each MVC. Vehicular variables were assigned by grading the photographs with a standardized scoring system, and outcome information on each patient was collected by chart review.

FINDINGS: Five hundred fifty-nine patients were entered into the study. Frontal crashes and increasing passenger space intrusion (PSI) were associated with head, facial, and lower-extremity injuries, while rear crashes were associated with spinal injuries. Restraint use had a protective effect in head, facial, and upper and lower extremity injuries, yet was associated with higher odds of spinal injury. Lack of restraint use, increasing PSI, and steering wheel deformity were associated with an increased hospital length of stay and hospital charges, yet only steering wheel deformity was associated with increasing injury severity when adjusting for other crash variables.

DISCUSSION: Out-of-hospital variables, as obtained from crash vehicle photography, are associated with injury site, injury severity, hospital length of stay, and hospital charges in patients involved in MVCs without air bag deployment. (Copyright © 2002 Society for Academic Emergency Medicine)

Study of the effectiveness of the US safety standard for child resistant cigarette lighters.

Smith LE, Greene MA, Singh HA. Inj Prev 2002; 8(3): 192-196.

Correspondence: Linda E. Smith, Hazard Analysis Division, Directorate for Epidemiology, US Consumer Product Safety Commission, Bethesda, MD 20814, USA; (email: lsmith@cpsc.gov).

OBJECTIVE: The purpose of this research is to evaluate the effectiveness of the US Consumer Product Safety Commission's (CPSC) Safety Standard for Cigarette Lighters, which requires that disposable cigarette lighters be resistant to operation by children younger than age 5.

METHODS: Fire data on children playing with lighters were solicited from selected US fire departments for incidents occurring from 1997-99, to identify the proportion of such fires caused by children younger than age 5 playing with cigarette lighters. These data were compared with similar data from 1985-87. An odds ratio was used to determine if there was a significant decrease in cigarette lighter fires caused by children younger than age 5 compared to children ages 5 and older. To estimate fires that would have occurred without the standard, the odds ratio, adjusted for population, was applied to 1998 national estimates of fires occurring. National estimates of 1998 fire losses were based on data from the National Fire Incident Reporting System and the National Fire Protection Association to which the 1997-99 age and lighter type distributions were applied. The difference between the fire losses that would have occurred and those that did occur represented fire losses prevented.

FINDINGS: In the post-standard study, 48% of the cigarette lighter fires were started by children younger than age 5, compared with 71% in the pre-standard study. The odds ratio of 0.42 was statistically significant (p < 0.01). This represented a 58% reduction in fires caused by the younger age group compared to the older age group. When applied to national fire loss data, an estimated 3300 fires, 100 deaths, 660 injuries, and $52.5 million in property loss were prevented by the standard in 1998, totaling $566.8 million in 1998 societal savings.

DISCUSSION: The CPSC standard requiring child resistant cigarette lighters has reduced fire deaths, injuries, and property loss caused by children playing with cigarette lighters and can be expected to prevent additional fire losses in subsequent years. (Copyright © 2002 INjury Prevention - Published by BMJ Publishing Group)
Falls and Fear of Falling: Which Comes First? A Longitudinal Prediction Model Suggests Strategies for Primary and Secondary Prevention.

Friedman SM, Munoz B, West SK, Rubin GS, Fried LP. J Am Geriatr Soc 2002; 50(8): 1329-1335.

Correspondence: Susan M. Friedman, Highland Hospital, 1000 South Avenue, Box 58, Rochester, NY 14620, USA; (email: susan_freedman@urmc.rochester.edu).

OBJECTIVES:Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors.

DESIGN: A 20-month, population-based, prospective, observational study.

SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation.

PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher.

MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors.

FINDINGS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P < .0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P < .0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling.

DISCUSSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified. (Copyright © 2002 American Geriatrics Society - Blackwell Publishing)
Hot surface temperatures of domestic appliances.

Bassett M, Arild A. Inj Control Saf Promot 2002; 9(3): 161-167.

Correspondence: Malcolm Bassett, Consumers' Association, Department of Consumer Safety, UK; (email: malcolm.bassett@which.co.uk).

BACKGROUND: Domestic appliances are burning people. In the European Union, accidents requiring hospital treatment due to burns from hot objects account for between 0 and 1% of all such accidents. Young children are particularly at risk. These reported accidents requiring hospital treatment are also likely to be a small proportion of the total number of burns from hot objects.

METHODS: Laboratory tests carried out on products are used to demonstrate the state of the art and also show how consumer expectations could be changing. A survey into accidents, based on a written questionnaire following telephone contact, provide information on non-hospital cases.

FINDINGS: Results of tests on products show that there are significant differences in the temperatures of touchable surfaces, even in products of the same type. Typically, these differences are due to variations in design and/or materials of construction. Some products are hot enough to burn skin. Accident research indicates that non-hospital medical practices are treating burn injuries, which are therefore not being included into the current accident statistics.

DISCUSSION: For products with the same function, some types of design or materials of construction are safer, with lower surface temperatures. Many product standards have no or unnecessarily high limits on surface temperatures. Many standards do not address the realities of who is using their products, for what purpose or where they are located. Some standards use unreasonable general limitations and exclusions that allow products with higher surface temperatures than they should have. Many standards rely on the experience factor for avoiding injury that is no longer valid, with the increased availability of safer products of the same type. A major field of work ahead is to carry out more surveys and in-depth studies of non-fatal accidents and injuries. (Copyright © 2002 Swets & Zeitlinger)

No reports this week

See abstract #3 under Alcohol & Other Drugs

Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide.

Willis LA, Coombs DW, Cockerham WC, Frison SL. Soc Sci Med 2002; 55(6): 907-920.

Correspondence: Latesa M Willis, Department of Sociology, School of Public Health, University of Alabama, Birmingham 35294-3350, USA; (email: sybiz@uab.edu).

African-Americans have typically registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African-Americans between the ages of 15 and 19 (National Center for Injury Prevention and Control, Mortality Statistics, 1998, Atlanta, GA). Today, young African-American males are as likely to commit suicide as their White counterparts. To date, the research conducted regarding this phenomenon has been inconclusive and existing suicide interventions appear to have no effect on reducing this behavior among young African-Americans. This paper synthesizes classical (Durkheim, Suicide, 1979, Free Press, New York) and postmodern (Beck, Risk Society: Towards a New Modernity, 1992, Sage, London; Bauman, Modernity and Ambivalence, Cornell University Press, Ithaca, 1991) social theories in order to provide a more complete theoretical explanation for the increase in the suicide rate among adolescent African-American males. Postmodern society is typified by: (1) institutional deconstruction; (2) decreased collectivism; (3) increased normlessness and helplessness; and (4) exacerbated personal risk for stress. It is therefore possible to hypothesize that postmodernity characteristically loosens the bonds between the individual and society, thereby increasing vulnerability to depression, related pathologies (such as substance abuse), and suicide. African-Americans tend to be more affected/vulnerable because they are concentrated in resource-poor, low income areas, and institutions that provided social support (family, religious, community) and protected individuals from societal risk factors, have gradually been dissolving in postmodern societies. We argue that young African-American males of today are more exposed to stressors which increase psychological distress thus increasing depression and related pathological behaviors such as suicide. The main reason behind this increase is found in the inability of institutions to offer protection from psychological distress. Overall, this paper presents a postmodern, macro-level framework to explain the increase in suicide among African-American male adolescents. (Copyright © 2002 Elsevier Science)
Fatal and non-fatal repetition of self-harm: Systematic review.

Owens D, Horrocks J, House A. Br J Psychiatry 2002; 181: 193-199.

Correspondence: David Owens, Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, 15 Hyde Terrace, Leeds LS2 9LT, UK; (email: d.w.owens@leeds.ac.uk).

BACKGROUND: Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions.

OBJECTIVES: To estimate rates of fatal and non-fatal repetition of self-harm.

METHODS: A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria.

FINDINGS: Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide.

DISCUSSION: After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population. (Copyright © 2002 The Royal College of Psychiatrists)
Evidence that latitude is directly related to variation in suicide rates.

Davis GE, Lowell WE. Can J Psychiatry 2002; 47(6): 572-574.

Correspondence: George E. Davis, Augusta Mental Health Institute, Augusta, Maine, USA; (email: george.davis@state.me.us).

OBJECTIVES: To use available suicide-rate data from 20 countries to see patterns and relations more clearly.
METHODS: We obtained raw suicide rates from the Organization for Economic Cooperation and Development (OECD) database from 1960 through 1997 and calculated averages and standard deviations.

FINDINGS: There is a positive linear relation between the variation in suicide rate and geographic latitude.

DISCUSSION: The variation in light-dark cycles is superimposed upon human mood. (Copyright © 2002 Canadian Psychiatric Association)
Exposure to violence and suicide risk in adolescents: a community study.

Vermeiren R, Ruchkin V, Leckman PE, Deboutte D, Schwab-Stone M. J Abnorm Child Psychol 2002; 30(5):529-537.

Correspondence: Robert Vermeiren, Department of Child and Adolescent Psychiatry, UCKJA Middelheimhospital, University of Antwerp, BELGIUM; (email: rvermeiren@europemail.com).

The prevalence of violence exposure is relatively unexplored in adolescents in European communities, and reports on the association between exposure to community violence and suicidal behavior are rare. The aim of this study was to investigate (1) the prevalence of community violence in a European urban adolescent sample, (2) the relationship between exposure to community violence and suicidal ideation/deliberate self-harm, and (3) the influence of depressive symptoms and aggressive behavior on this relationship. Self-report surveys were administered to a representative school-based sample of 1509 adolescents in Antwerp (Belgium). The prevalence rate of violence exposure was still high but lower than that reported in U.S. communities. Suicidal ideation and deliberate self-harm were both related to violence exposure. The gender-specific influence of depressive symptomatology and aggressive behavior on the association between exposure to violence and suicidal behavior suggests the need for further research. (Copyright © 2002 Plenum Publishing)

Pediatric motor vehicle related injuries in the Navajo Nation: the impact of the 1988 child occupant restraint laws.

Phelan KJ, Khoury J, Grossman DC, Hu D, Wallace LJ, Bill N, Kalkwarf H. Inj Prev 2002; 8(3): 216-220.

Correspondence: Kieran J. Phelan, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, TCHRF 7548, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA; (email: kj.phelan@chmcc.org).

BACKGROUND: Navajo motor vehicle mortality is the highest among the 12 Indian Health Service (IHS) administrative areas. In July 1988, the Navajo Nation enacted a primary enforcement safety belt use and a child restraint law.

OBJECTIVE: Assess the impact of the laws on the rate and severity of pediatric (0-19 years) motor vehicle injury resulting in hospitalizations in the Navajo Nation.

METHODS: Hospitalizations associated with motor vehicle related injury discharges were identified by International Classification of Diseases, 9th revision, CM E codes, 810-825 (.0,.1) from the Navajo IHS hospital discharge database. Age specific rates for the period before the law, 1983-88, were compared with those after enactment and enforcement, 1991-95. Severity of injury, measured by the abbreviated injury scale (AIS) score and new injury severity score (NISS), was determined with ICDMAP-90 software. Wilcoxon rank sum and chi(2) tests were used for analysis.

FINDINGS: Discharge rates (SE) for motor vehicle injury (per 100 000) decreased significantly in all age groups: 0-4 years (62 (7) to 28 (4)), 5-11 years (55.3 (6) to 26 (4)), and 15-19 years (139 (14) to 68 (7)); p=0.0001. In children 0-4 years, the median AIS score decreased from 1.5 (1,3) (25th, 75th centile) to 1 (1,2), p=0.06, and the median NISS decreased from 3.5 (1,9) to 2 (1,5), p=0.07. The proportion of children with NISS scores > 4 decreased significantly for the 0-4 year age group (p=0.03).

DISCUSSION: Concurrent with enactment of the Navajo Nation occupant and child restraint laws there was a reduction in the rate of motor vehicle related hospital discharges for children. Severity of injury declined in very young Navajo children. The effect of enactment and enforcement of this Native American child occupant restraint law may serve as an example of an effective injury control effort directed at Native American children. (Copyright © 2002 Injury Prevention - BMJ Publishing Group)
Trends in road injury hospitalization rates for Aboriginal and non-Aboriginal people in Western Australia, 1971-97.

Cercarelli LR, Knuiman MW. Inj Prev 2002; 8(3): 211-215.

Correspondence: Rina Cercarelli, Injury Research Centre, Department of Public Health, University of Western Australia Department of Public Health, University of Western Australia, 35 Sterling Hwy, Crawley, WA 6009, AUSTRALIA; (email: rina@dph.uwa.edu.au).

OBJECTIVE: To examine trends in road injury hospitalization rates for Aboriginal and non-Aboriginal people in Western Australia.

METHODS: Data from the Western Australian Hospital Morbidity Data System for the years between 1971 and 1997 were analyzed. Poisson regression models were fitted to determine whether the trends were significant.

FINDINGS: The rate of hospitalization due to road injury for Aboriginal people (719.1 per 100 000 population per year) over the time period examined was almost twice as high as that for non-Aboriginal people (363.4 per 100 000 population per year). Overall, the results showed that while hospitalizations from road injury involving non-Aboriginal people have been decreasing by 6.7% per three year period since 1971, the rates of hospitalization for Aboriginal people have been increasing by 2.6% per three year period. Both of these trends were statistically significant. The alarming increasing trend observed for Aboriginal people was more pronounced in males, those aged 0-14 years and over 45 years, and for those living in rural areas.

DISCUSSION: As the rates of road injury for Aboriginal people are higher than for non-Aboriginal people, and are also following an increasing trend, road safety issues involving Aboriginal people need to be addressed urgently by health and transport authorities. (Copyright © 2002 Injury Prevention - BMJ Publishing Group)
Crash reconstruction and injury-mechanism analysis using event data recorder technology.

Donnelly BR, Galganski RA, Lawrence RD, Blatt A. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 331-351.

Correspondence: BR Donnelly, Veridian Engineering Division, Buffalo, New York, USA.

Sophisticated onboard crash-event data recorders (EDRs) that log key vehicle dynamics information can be used to improve crash reconstruction, model occupant response, study the mechanisms of injury, and estimate occupant injury probabilities in near-real time. Such an EDR was developed and utilized as part of the Automatic Collision Notification (ACN) system for the National Highway Traffic Safety Administration. This paper presents the results of a study in which the reconstruction of an actual crash was augmented using EDR/ACN-supplied three-dimensional acceleration and other data in a vehicle occupant model configured using the Articulated Total Body (ATB) computer code. ATB-generated occupant-motion imagery and body-region acceleration response information provided valuable insights that permitted crash-reconstruction specialists to ascertain the true nature of the collision and identify the probable cause of an injury suffered by one of the victims. The authors also posit that the use of EDR data from an ACN-type system as inputs to occupant crash-response modeling may be someday support crash-victim emergency medical treatment and triage. (Copyright © 2001 Association for the Advancement of Automotive Medicine)
The relationship of AIS to peak virtual power.

Neal-Sturgess CE, Hassan A, Cuerden R. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 141-157.

Correspondence: Clive E. Neal-Sturgess, Automotive Safety Centre, University of Birmingham, UK; (email: C.E.N.Sturgess@bham.ac.uk).

All injuries require an expenditure of energy. Here it is postulated that injury severity is proportional to Peak Virtual Power (PVP). PVP is compared to AIS scores for frontal impact with belted drivers, for all types of injuries and all body regions, from the Co-operative Crash Injury Study (CCIS) and NASS-CDS databases. The excellent correlations obtained show that the AIS score is linearly proportional to Peak Virtual Power, which is proportional to delta V3 for restrained occupants, and delta V2 for unrestrained occupants. Therefore, although phenomenological, AIS appears to measure a physical quantity. It is concluded that there appears to be a "Master Curve" of AIS versus mean delta V for car occupants, implying that the amount of power for a given injury level is a constant, irrespective of injury type. There appear to be significant differences between the AIS scores for abdominal injuries between CCIS and NASS-CDS, and detailed case studies should be conducted to resolve the differences. (Copyright © 2001 Association for the Advancement of Automotive Medicine)
Comparison of seat belt force-limiting methods using the MADYMO multi-body/finite element program.

Sieveka EM, Kent RW, Crandall JR. Annu Proc Assoc Adv Automot Med Conf 2001; 45: 11-21.

Correspondence: Jeff Crandall Automobile Safety Laboratory, University of Virginia, Charlottesville, Virginia, USA; (email: jeffc@Virginia.EDU).

Belt force can be limited by a device in the belt retractor hardware or with force-limiting as an integral part of the webbing force/strain properties. In this research, MADYMO multi-body/finite element models of a 50th percentile Hybrid-3 male passenger in an airbag-equipped 4-door mid-size sedan were set up to compare occupant injury response under loading 1) from a baseline standard (non-force-limiting) belt system, 2) from a retractor-based force-limiting system, and 3) from a webbing-based force-limiting system. Chest acceleration was similar for the two force-limiting designs but the peak was approximately 10% greater for the standard belt. The magnitude of the head acceleration was similar for all three belts while the duration of these accelerations was much narrower for the force-limiting belts. Chest compression was similar for both force-limiting methods, and was about 60% less than the standard belt case. Compared to the baseline system and the retractor-based system, webbing-based force-limiting allowed greater pelvic excursion and a corresponding increase in femur force. It is concluded that webbing-based force limiting has some potential for reducing head and chest responses but these reductions must be evaluated with respect to other considerations such as submarining potential, non-frontal impact response, and future concepts like programmable force limiting. (Copyright © 2001 Association for the Advancement of Automotive Medicine)
Road rage: drivers' understandings and experiences.

Lupton D. J Sociology 2002; 38(3): 275-290.

Correspondence: Deborah Lupton, Centre for Cultural Research into Risk, Charles Sturt University, Bathurst (email: dlupton@csu.edu.au).

The phenomenon of road rage has attracted much media attention since the mid-1990s, but little research has been conducted into how motorists have incorporated the concept into their experiences and understandings of driving. This article reports the findings from a qualitative study on road rage, which used in-depth interviews with 77 people living in Sydney to investigate the meanings given to road rage and aggressive driving. The research showed that driving was a potent source of autonomy, pleasure and self-expression among motorists, meanings that were often frustrated by the travails of negotiating the road system. The concept of road rage had become integrated into the interviewees' accounts of driving, and they were uniformly condemning of it. Road rage was represented as a response to the stresses of urban living, not only driving in a crowded road system but also the pressures exerted by such factors as a competitive work environment and lack of time. A strong gender and social class difference was noted in the ways in which the inter-viewees described their emotional responses to driving frustrations. The findings revealed that the expression of anger in road rage is negatively conceptualized because of the challenges it poses to the idea of the 'civilized' body/self, but also that such expression is seen as understandable in the context of an urban environment replete with stress.
Abdominal Injury Patterns in Motor Vehicle Accidents: A Survey of the NASS Database from 1993 to 1997.

Lee JB, Yang KH. Traf Inj Prev 2002; 3(3): 241-246.

Correspondence: King-Hay Yang, Bioengineering Center, Wayne State University, Detroit, Michigan, USA; (email: king.yang@wayne.edu

The purpose of this study was to determine patterns of abdominal injuries using the publicly available National Automotive Sampling System (NASS) database. Data from the NASS database for the years between 1993 and 1997 were extracted in order to gain an enhanced understanding of abdominal injury patterns resulting from vehicular collisions. The liver was most frequently injured due to contact with components in the front of the passenger compartment, such as the steering assembly and the instrument panel. Injuries to the spleen frequently resulted from contact with components on the left side of the passenger compartment. When considering only contact with components on the sides of the passenger compartment, the liver was injured more frequently due to contact with components on the right side of the passenger compartment while contact with components on the left side of the passenger compartment were more likely to result in injuries of the spleen. A more in-depth survey of the NASS database will be needed to determine if the asymmetrical features of human anatomy must be considered in the design of crash test dummies and mathematical models used in the evaluation of abdominal impact protection in automotive accidents. (Copyright © 2002 Taylor & Francis)
Patients with Coronary Artery Disease Are Active Car Drivers Both Before and Soon After Heart Surgery.

Ahlgren E, Rutberg H, Aren C. Traf Inj Prev 2002; 3(3): 205-208.

Correspondence: Ewa Ahlgren, Heart Center, University Hospital, 581 85 Linköping, SWEDEN; (email: ewa.ahlgren@lio.se).

Cognitive ability is essential for the fitness to drive. Impaired cognitive functions are common after cardiac surgery. Little is known about driving habits and influence of postoperative cognitive decline on driving performance in these patients. The aim of this study was to investigate the extent of driving activity of patients before and after cardiac surgery. Ninety-seven cardiac surgical patients were interviewed about their driving habits before and 12 weeks after surgery. The mean age was 66. Before the operation, 78% were active car drivers. They drove several times a week including longer than 100 km distances. After the operation, 64% continued to drive and most of them (69%) had commenced driving within 6 weeks. The majority (79%) reported unchanged driving habits, while 13 patients (21%) had reduced their driving activity due to the cognitive symptoms they experienced. Patients with coronary artery disease are active car drivers both before and after heart surgery. Further evaluation of the ability of these patients to drive is required if we are to give advice and apply restrictions in the interest of traffic safety. (Copyright © 2002 Taylor & Francis)
Drivers' response to the installation of road lighting. An economic interpretation.

Jorgensen F, Pedersen PA. Accid Anal Prev 2002; 34(5): 601-608.

Bodo Graduate School of Business, Bodo, NORWAY; (email: finn.joergensen@hibo.no).

An economic model of drivers' behavior is introduced in order to explain recently published empirical findings telling us that road lighting increases speed, decreases concentration and reduces accidents. The model, combined with the empirical results, indicate that drivers perceive speed and concentration as complementary safety variables, while common sense suggests that speed and concentration influence real accident rate as substitutable safety means. If this holds, a positive but concave relationship between subjective and objective risks exists, which means that as the objective accident risk rises, it has less influence on perceived risk. (Copyright © 2002 Elsevier Science)
Security measures in traffic and its influence in head injury trauma in Distrito Federal.

[Article in Portuguese]

Farage L, Colares VS, Capp Neto M, Moraes MC, Barbosa MC, Branco JD Jr. Rev Assoc Med Bras 2002; 48(2): 163-166.

Correspondence: Luciano Farage, Departamento de Saude Coletiva, Faculdade de Ciencias da Saude, Universidade de Brasilia, BRAZIL; (email: lucianofarage@bigfoot.com).

BACKGROUND: The study analyzed the effectiveness of safety measures (seat belt, velocity control) in traffic. The parameters were the decrease in number and severity in head injury trauma (HIT).

METHODS: Epidemiological study, based on the evaluation of secondary data about head injury. The data were analyzed between two periods, before (1992) and after (1997) measures implementation.

FINDINGS: We compared the indices (per 100.000 population) of victims in the two periods. In 1992 there were 125.5 victims, and in 1997 there were 155.8. From this total in group 1 we had 26.2 cases of HIT with 5.2 deaths, in 1997 we had 62.1 with 4.1 deaths. About severity: in the first period were 9.6 cases severe or moderate head injury, in group 2 there were 8.1 cases.

DISCUSSION: There was an increase in the number of victims of HIT caused by automobile accidents in this period, however the severity of the trauma showed a small decrease, possibly security measures were not efficiently in reducing the number of cases but may have been successful in reducing deaths related to this accidents. (Copyright © 2002 Associação Médica Brasileira)

What distinguishes unintentional injuries from injuries due to intimate partner violence: a study in Greek ambulatory care settings.

Petridou E, Browne A, Lichter E, Dedoukou X, Alexe D, Dessypris N. Inj Prev 2002; 8(3): 197-201.

Correspondence: Eleni Petridou, Department of Hygiene and Epidemiology, Athens University Medical School, Athens, GREECE; (email: epetrid@med.uoa.gr).

OBJECTIVES: Intimate partner violence (IPV) is an important sociocultural and public health problem. This study aims to assess sociodemographic and injury characteristics of IPV victims among adults in a traditional southern European population.

SETTING: Accident and emergency departments of three sentinel hospitals in Greece participating in the Emergency Department Injury Surveillance System (EDISS).

METHODS: Data on sociodemographic variables, as well as event and injury characteristics were retrieved from the EDISS database during the three year period 1996-98. Out of a total of 27 319 injured women aged 19 years or more, 312 (1.1%) were reported as IPV related and were compared with 26 466 women with unintentional injuries. Among the 35 174 men with injuries 39 (0.1%) were reported as IPV related and were compared with 34 049 men with unintentional injuries. The data were analyzed through simple cross tabulations and multiple logistic regression. Positive predicted values for selected injury characteristics were also calculated.

FINDINGS: IPV is more common in rural than in urban areas of Greece. Women are 10 times more frequently IPV victims but men are also IPV victims; younger women and older men are disproportionately affected by IPV. The relative frequency of the phenomenon increases during the late evening and night hours. Certain types of injuries, notably multiple facial injuries, and presentation of the injured person on his/her own at the emergency department or combinations of predictive characteristics are strongly indicative of IPV.

DISCUSSION: Injuries due to IPV are not uncommon in Greece, not withstanding the traditional structure of the society and the tendency of under-reporting. Certain injury characteristics have high positive predictive values and could be used in screening protocols aiming at the correct identification of the underlying external cause in injuries that may be caused by IPV. (Copyright © 2002 Injury Prevention - BMJ Publishing)
Killed in the act: a descriptive analysis of crime-precipitated homicide.

Copes H, Kerley KR, Carroll A. Homicide Stud 2002; 6(3): 240-257.

Correspondence: John Heith Copes, Justice Sciences, University of Alabama, Birmingham, AL, USA; (email: jhcopes@uab.edu).

The authors provide a descriptive analysis of a specific type of homicide that they refer to as "crime-precipitated homicide." This categorization is distinct from both felony homicide and victim-precipitated homicide. Crime-precipitated homicides are those in which the victim was killed while participating in illegal behavior (predatory crimes, vice crimes, or narcotics dealing). Using the Homicides in Chicago, 1965-1995 data set, the authors describe the characteristics of crime-precipitated homicide offenders and victims including age, race, gender, and criminal histories. They also report on characteristics of the homicide event including where the homicides occur, when they occur, the type of weapon used, and the relationship between offenders and victims. (Copyright © 2002 Sage Publications)
Winter is the infanticide season: seasonal risk for child homicide

McCleary R, Chew KSY. Homicide Stud 2002; 6(3): 228-239.

Correspondence: Richard McCleary, University of California, Irvine, California, USA; (email: mccleary@uci.edu).

This study investigates the circannual pattern of U.S. child homicide rates. Analyses of 23,067 child homicide records extracted from 1976 to 1998 FBI Supplemental Homicide Reports reveal a winter peak for infants and toddlers (age less than 2 years) and a summer peak for primary and middle school children (ages 5 to 14). Logistic regressions find distinct risk factors for the two peaks that support the prevailing developmental risk theory. The risk factors suggest guidelines for a more rational allocation of prevention resources both across the year and among different developmental subpopulations. (Copyright © 2002 Sage Publications)
Emergency medicine: competencies for youth violence prevention and control.

Denninghoff KR, Knox L, Cunningham R, Partain S. Acad Emerg Med 2002 Sep;9(9):947-956.

Correspondence: Kurt R. Denninghoff, MD, Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th Street South, JTN 238, Birmingham, AL 35249-7013, USA; (email: kdenning@uabmc.edu).

By any standard one wishes to apply, the impact of violence on the health and safety of the public is significant. The expression of violence among children in the United States has increased significantly during the modern era. Homicide and suicide are the second and third leading causes of death in youths 15-24 years of age. The emergency department (ED) is a common site for the care of these victims, and because victims often become assailants, the emergency care provider needs to know the epidemiology, treatment, and methods for prevention of youth violence in order to curtail the cycle. A multidisciplinary task force was convened by the Centers for Disease Control and Prevention (CDC)-funded Southern California Center of Academic Excellence on Youth Violence Prevention and the Keck School of Medicine at the University of Southern California to define competencies for health professionals in youth violence prevention and control. Three levels of competence were identified: the generalist level, which should be obtained by all health professionals; the specialist level, which should be obtained by health professionals such as emergency medicine providers, who frequently work with populations affected by violence; and a third, or scholar level, to be acquired by health professionals who wish to become experts not only in the care, but also in research and advocacy. This article reports the details of this group's efforts and applies them to emergency care provider education. These competencies should shape the development of curricula for the span of emergency medical training from emergency medical services scholastic training to postgraduate continuous medical education. (Copyright © 2002 Society for Academic Emergency Medicine)
Gender equality and gendered homicides

Whaley RB, Messner SF. Homicide Stud 2002; 6(3): 188-210.

Correspondence: Rachel B Whaley, Western Michigan University (email: rachel.whaley@wmich.edu).

Gender inequality is likely to be associated with a distinctive type of violence—gendered violence. Previous research has demonstrated that rates of rape are related to the relative status of men and women. The authors examine the applicability of two feminist hypotheses, the ameliorative hypothesis and the backlash hypothesis, for lethal violence. Regression analyses for a sample of cities indicate that gender equality is positively related to rates of male killings of females and male killings of other males in southern cities. Conversely, gender equality is negatively associated with male killings of other males in cities located in other regions. These cross-sectional analyses thus offer some support for the backlash hypothesis on gender stratification and violence but also point to the complexity of the structural relationships. (Copyright © 2002 Sage Publishing)
Causes of death among people in custody in Ontario, 1990-1999.

Wobeser WL, Datema J, Bechard B, Ford P. CMAJ 2002; 167(10): 1109-1113.

Correspondence: Wendy L. Wobeser, 3013 Etherington Hall, Queen's University, Kingston ON K7L 3N6, CANADA; (email: WLW@post.QueensU.CA).

BACKGROUND: People in custody are more likely to die prematurely, especially of violent causes, than similar people not in custody. Some of these deaths may be preventable. In this study we examined causes of death (violent and natural) among people in custody in Ontario. We also compared the causes of deaths in 3 custodial systems (federal penitentiaries, provincial prisons and police cells). METHODS: We examined all available files of coroners' inquests into the deaths of people in custody in federal penitentiaries, provincial prisons and police cells in Ontario from 1990 to 1999. Data collected included age, cause of death, place of death, history of psychiatric illness and history of substance abuse. Causes of death were categorized as violent (accidental poisoning, suicide or homicide) or natural (cancer, cardiovascular disease or "other"). Crude death rates were estimated for male inmate populations in federal and provincial institutions. There were inadequate numbers for women and inadequate denominator estimates for police cells. RESULTS: A total of 308 inmates died in custody during the study period; data were available for 291 (283 men, 8 women). Of the 283 deaths involving men, over half (168 [59%]) were from violent causes: suicide by strangulation (n = 90), poisoning or toxic effect (n = 48) and homicide (n = 16). Natural causes accounted for 115 (41%) of the deaths among the men, cardiovascular disease being the most common (n = 62 cases) and cancer the second most common (n = 18). Most (137 [48%]) of the deaths among the men occurred in federal institutions; 88 (31%) and 58 (21%) respectively occurred in provincial institutions and police cells. The crude rate of death among male inmates was 420.1 per 100 000 in federal institutions and 211.5 per 100 000 in provincial institutions. Compared with the Canadian male population, male inmates in both federal and provincial institutions had much higher rates of death by poisoning and suicide; the same was true for the rate of death by homicide among male inmates in federal institutions. The rates of death from cardiovascular disease among male inmates in federal and provincial institutions - 102.7 and 51.7 per 100 000 respectively - were also higher than the national average. INTERPRETATION: Violent causes of death, especially suicide by strangulation and poisoning, predominate among people in custody. Compared with the Canadian male population, male inmates have a higher overall rate of death and a much higher rate of death from violent causes.

The criteria for selecting report for inclusion are simple. If the answer to any of the following questions is "yes", then the report is likely to be included: 1. Do the SafetyLit reviewers find the report interesting? 2. Are SafetyLit readers likely to hear of a report from a colleague? 3. Are SafetyLit readers likely to be questioned about the report from a member of the population they serve? 4. Does the report contain findings that are likely to be used by an adversary to oppose the actions or recommendations of a SafetyLit reader?

If you know of a journal article or a report that you believe should be included in a SafetyLit update, please: Send SafetyLit.org an E-mail Message.

Back to SafetyLit Weekly Update Menu

Rev. 24 Nov 2002