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30 December 2002
We are unable to provide photocopies of any the articles and reports abstracted below. Where possible, links have been provided to the publisher of the material and contact information for the corresponding author is listed. Many of the journals provide copies (usually for a fee) of reports online. Please consider asking your library to subscribe to the journals from which these abstracts have been gathered.
See item #1 under Violence -
Cannabis and driving: a new perspective.
O'Kane CJ, Tutt DC, Bauer LA. Emerg Med 2002; 14(3): 296-303.
Correspondence: Douglas C. Tutt, Health Promotion Unit, Central Coast Health, PO Box 361, Gosford, New South Wales 2250, AUSTRALIA; (email: dtutt@doh.health.nsw.gov.au)
Cannabis and driving is an emerging injury-prevention concern. The incidence of driving while affected by cannabis is rising in parallel with increased cannabis use in the community. Younger drivers are at particular risk. Improvements in research methodology, technology and laboratory testing methods have occurred in the last 10 years. These cast doubt on earlier results and conclusions. Studies now show that cannabis has a significant impairing effect on driving when used alone and that this effect is exaggerated when combined with alcohol. Of particular concern is the presence of cannabis as the sole psychoactive drug in an increasing number of road fatalities and the lack of any structural response to this problem. A review of testing methods, laboratory and real driving studies, and recent epidemiological studies is presented. Suggestions for methods of further data collection and future public policy are made. (Copyright © 2002 Blackwell Publishing)
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The magnitude and correlates of alcohol and drug use before traumatic brain injury.
Bombardier CH, Rimmele CT, Zintel H. Arch Phys Med Rehabil 2002; 83(12): 1765-1773.
Correspondence: Charles H Bombardier, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA; (email: chb@u.washington.edu).
OBJECTIVE: To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent traumatic brain injury (TBI). DESIGN: Survey. SETTING: Acute inpatient rehabilitation program.
PARTICIPANTS: A total of 142 (91%) of 156 consecutive admissions who met inclusion criteria and were screened.
INTERVENTIONS: Not applicable. Main Outcome Measures: Alcohol and drug use questionnaires, alcohol problem questions, toxicology results, readiness to change, and treatment preference questions.
FINDINGS: Subjects were on average 37 years old, 80% were men, and 80% were white. Fifty-nine percent of the sample was considered "at-risk" drinkers and, as a group, subjects reported a high degree of preinjury alcohol-related problems. Thirty-four percent reported recent illicit drug use, and 42 (37%) of 114 cases with toxicology results were positive for illicit drugs. Motivation to change alcohol use correlated positively with greater self-reported alcohol consumption and problem severity. Most at-risk drinkers wanted to change on their own, whereas a minority were interested in treatment or Alcoholics Anonymous.
DISCUSSION: Both alcohol abuse and drug use are common before TBI. Inpatient brain injury rehabilitation represents an important opportunity to identify and intervene in substance abuse problems. (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)
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Housemaids and non-fatal occupational injuries.
Santana VS, Amorim AM, Oliveira R, Xavier S, Iriart J, Belitardo L. Rev Saude Publica 2003; 37(1): 65-74.
Vilma S Santana, Rua Padre Feijó, 29 - 4o andar, Canela, 40110-170 Salvador, BA, BRAZIL; (email: vilma@ufba.br).
OBJECTIVE: To estimate the annual incidence of non-fatal work injuries according to sociodemographic and occupational variables among housemaids.
METHODS: A community-based survey was conducted in a population of 1,650 women aged 10 to 65 years who reported a paid occupation randomly selected in a household sample of the city of Salvador, Brazil. Data was collected through individual questionnaires on living and work conditions and health status. Fisher Exact test was performed for frequency analysis.
FINDINGS: It was estimated an overall annual incidence of non-fatal work injuries in the study population of 5.0%, which was statistically significant (p < 0.05) higher among housemaids (7.3%) than in the group with other occupations (4.5%). Half of the injuries among housemaids were not related with long-term disabilities, and 38.1% women referred not being able to work for two weeks on average after the injury.
DISCUSSION: Housemaids represent a major contingent of the work force in Brazil and other Latin America countries. The high incidence of non-fatal work injuries in this working group reveals its public health relevance and the need for preventive programs. (Copyright © 2002 Faculdade de Saúde Pública da Universidade de São Paulo)
See Item #1 under Suicide -
Scenarios of typical occupational injuries in lumber industry.
[Article in Portuguese]
Souza V, Blank VL, Calvo MC. Rev Saude Publica 2002; 36(6): 702-708.
Correspondence: Vera Lúcia Guimarães Blank, Depto de Saúde Pública, Centro de Ciências da Saúde da Universidade Federal de Santa Catarina, Campus Universitário – Trindade, 88040-900 Florianópolis, SC, BRAZIL; (email: vblank@repensul.ufsc.br).
OBJECTIVE: To describe the scenarios of typical occupational injuries in lumber industry.
METHODS: All occupational injuries reported to a INSS (National Institute of Social Security) center in Lages, SC, Brazil from January 1997 to January 1999 were identified. A descriptive cross-sectional study was carried out and 254 injury report forms were analyzed. Multivariate analysis was conducted using Factorial Analysis of Correspondence (FAC), Hierarchical Ascendant Classification (HAC) and Partition to identify the scenarios of typical occupational injuries.
FINDINGS: There were identified five scenarios of occupational injuries: 1) workers' falls (40 reports); 2) overexertion in lifting or pushing objects (5 reports); 3) objects or machine parts falling or being ejected from running machines (76 reports); 4) crushing of soft tissue body parts (56 reports); and 5) body contact with running saw machines (77 reports).
DISCUSSION: Multivariate analysis allowed describing the most typical injuries related to specific types of accidents, and provided a better understanding of the circumstances for their occurrence. (Copyright © 2002 Faculdade de Saúde Pública da Universidade de São Paulo)
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High-pressure water injection injury: emergency presentation and management.
Subramaniam RM, Clearwater GM. Emerg Med (Fremantle) 2002; 14(3): 324-327.
Correspondence: Rathan Subramaniam, Academic and Research Division, Department of Radiology, Waikato Hospital, Hamilton, NEW ZEALAND; (email: subramar@waikatodhb.govt.nz).
Presentations of high-pressure water blaster injuries to the emergency department are varied. Though these injuries are sometimes described as a 'benign variant' of high-pressure injection injuries, external appearances can be deceptive. These injuries can produce an unexpected pattern of severe internal injury and infectious complications. Such injuries are surgical emergencies and must be evaluated quickly and thoroughly in the emergency department. We review the current literature of these injuries and present the first reported case involving a forearm injury. (Copyright © 2002, Blackwell Publishing)
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Mortality and cancer incidence of workers in Finnish road paving companies.
Kauppinen T, Heikkila P, Partanen T, Virtanen SV, Pukkala E, Ylostalo P, Burstyn I, Ferro G, Boffetta P. Am J Ind Med 2003; 43(1): 49-57.
Correspondence: Timo Kauppinen, Finnish Institute of Occupational Health, Topeliuksenkatu 41aA, FIN 00250 Helsinki, FINLAND; (email: tkau@occuphealth.fi).
BACKGROUND: This study, a component of the International Agency for Research on Cancer (IARC) Multicentric Study on Cancer Risk Among European Asphalt Workers, aimed at identifying major mortality risks among workers in Finnish road paving companies.
METHODS: The Finnish cohort was comprised of 9,643 men and women from six road paving companies. The mortality of men employed during at least one season (5,676) was followed up from 1964 until end of 1994; an average of 17 years. Standardized mortality ratios (SMR) and relative risks (RR), the latter based on multivariate Poisson regression models were estimated by occupational group and by various metrics of occupational exposures.
FINDINGS: All-cause mortality was elevated (SMR 1.11, 95% confidence interval, CI 1.03-1.20), mainly due to excesses in accidents, poisonings, and violence (1.29; CI 1.12-1.49), and lung cancer (1.38; 1.03-1.81). Workers exposed to bitumen fumes had a slightly elevated mortality from lung cancer (1.16; 0.69-1.83). Multivariate Poisson regression models with 15-year lag period suggested trends by cumulative exposure to coal tar, organic vapors, silica dust, diesel exhaust, and bitumen fume.
DISCUSSION: The elevated mortality from external causes among Finnish building/ground construction workers was probably due to living conditions and related lifestyles. Some evidence was found for a risk of lung cancer due to occupational exposure, but the confirmation of these findings would require a longer follow-up and improved control for confounding. (Copyright © 2003, Wiley-Liss)
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A prospective study and review of pre-morbid characteristics in children with traumatic brain injury.
Demellweek C, Baldwin T, Appleton R, Al-Kharusi A. Pediatr Rehabil 2002; 5(2): 81-89.
Correspondence: Colin Demellweek, Department of Psychology, Alder Hey Children's Hospital, Eaton Road, Liverpool L12 2AP, UK; (email: unavailable)
The pre-morbid characteristics of 32 children requiring inpatient rehabilitation following moderate or severe head injuries were studied prospectively. Teachers completed Rutter and modified Conners questionnaires on the pre-head injury behavioral characteristics of each child and also rated the pre-morbid learning ability of the children on a four-point scale. The children's socioeconomic status was determined using their postcode at the time of the injury. Behavioral questionnaires were returned for 25 of the 32 children. Five of the 25 children obtained total behavior problem scores on the Rutter teacher scales indicative of pre-morbid psychopathology. The general learning ability of five children was rated as being far below average. The children had a higher mean socioeconomic deprivation score than for the geographic area in which the rehabilitation unit is sited. The incidence of pre-morbid behavior problems in the study population with moderate or severe traumatic brain injury may be somewhat higher than in the local population, but this did not appear to be a major risk factor in sustaining a head injury. However, adverse environmental conditions, linked to socioeconomic deprivation, did appear to be important risk factors that contributed to a pedestrian road traffic accident. (Copyright © 2002, Taylor & Francis)
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Work with pesticides and organophosphate sheep dips.
Coggon D. Occup Med 2002; 52(8): 467-470.
Correspondence: David Coggon, MRC Environmental Epidemiology Unit, Community Clinical Sciences, University of Southampton, Southampton, UK; (email: dnmc@mrc.soton.ac.uk).
Pesticides are an important hazard in agriculture. In developed countries their use is strictly regulated. Risk assessment for new pesticides includes comparison of the potential exposures of spray operators and other farm workers with a reference value. Usually, this is derived from toxicological studies in animals with allowance for the uncertainties in extrapolating between and within species. Older pesticides undergo periodic reviews, for which epidemiological data may also be available. Unintentional fatal poisoning by pesticides is extremely rare in Britain. Documented reports of non-fatal acute poisoning are also uncommon, but there may be substantial under-ascertainment of minor incidents. Pesticides have been linked with various chronic diseases, but few associations have been clearly established. A particular concern recently in Britain has been the possibility that organophosphate insecticides can cause chronic neuropsychiatric illness. (Copyright © 2002 Society of Occupational Medicine - Published by Oxford University Press)
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Pesticide illness, farm practices, and neurological symptoms among farm residents in Colorado.
Stallones L, Beseler C. Environ Res 2002; 90(2): 89-97.
Correspondence: Lorann Stallones, Department of Psychology, Colorado State University, Fort Collins, Colorado 80523-1876, USA; (email: lorann.stallones@colostate.edu).
The purpose of this study is to evaluate the association between pesticides and neurological symptoms among a population exposed to organophosphate chemicals as a result of agricultural use. Chronic sequelae of acute pesticide poisoning from organophosphate compounds include a variety of neurological symptoms including restlessness, irritability, and trouble sleeping. Individuals who have had an acute pesticide poisoning have been reported to suffer a wide range of neurological symptoms that occur from weeks to months after the initial episode. Data for this study came from a cross-sectional survey of farmers and their spouses conducted in an eight-county area in north-eastern Colorado. Neurological characteristics were assessed to determine their relationship with previously reported pesticide-related illnesses. Symptoms that were significantly associated with a previous poisoning were difficulty concentrating [OR 2.07, 95% confidence interval (CI) 1.22, 3.50]; relatives noticing person had trouble remembering things (OR 2.54, 95% CI 1.47, 4.39); making notes to remember things (OR 2.18, 95% CI 1.20, 3.97); finding it hard to understand the meaning of newspapers, magazines, and books (OR 1.90, 95% CI 1.01, 3.60); felt irritable (OR 1.84, 95% CI 1.08, 3.12); felt depressed (OR 2.82, 95% CI 1.65, 4.81); had heart palpitations without exertion (OR 2.83, 95% CI 1.22, 6.54); sleeping more than usual (OR 3.58, 95% CI 1.95, 6.58); difficulty moving fingers or grasping things (OR 2.08, 95% CI 1.06, 3.24); and headaches at least once a week (OR 1.85, 95% CI 1.06, 3.24). Stepwise regression was used to identify the best explanatory model of pesticide-related illness. Variables that were associated with increased odds of illness were being male, being depressed, sleeping too much, and using crop organophosphates. (Copyright © 2002, Elsevier Science)
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The use of generalized estimating equations in the analysis of motor vehicle crash data.
Hutchings CB, Knight S, Reading JC. Accid Anal Prev 2003; 35(1): 3-8.
Correspondence: Caroline B. Hutchings, Intermountain Injury Control Research Center, School of Medicine, University of Utah, 615 Arapeen Drive, Suite 202, 84108, Salt Lake City, UT, USA; (email: caroline.hutchings@hsc.utah.edu).
The purpose of this study was to determine if it is necessary to use generalized estimating equations (GEEs) in the analysis of seat belt effectiveness in preventing injuries in motor vehicle crashes. The 1992 Utah crash dataset was used, excluding crash participants where seat belt use was not appropriate (n=93,633). The model used in the 1996 Report to Congress [Report to congress on benefits of safety belts and motorcycle helmets, based on data from the Crash Outcome Data Evaluation System (CODES). National Center for Statistics and Analysis, NHTSA, Washington, DC, February 1996] was analyzed for all occupants with logistic regression, one level of nesting (occupants within crashes), and two levels of nesting (occupants within vehicles within crashes) to compare the use of GEEs with logistic regression. When using one level of nesting compared to logistic regression, 13 of 16 variance estimates changed more than 10%, and eight of 16 parameter estimates changed more than 10%. In addition, three of the independent variables changed from significant to insignificant (alpha=0.05). With the use of two levels of nesting, two of 16 variance estimates and three of 16 parameter estimates changed more than 10% from the variance and parameter estimates in one level of nesting. One of the independent variables changed from insignificant to significant (alpha=0.05) in the two levels of nesting model; therefore, only two of the independent variables changed from significant to insignificant when the logistic regression model was compared to the two levels of nesting model. The odds ratio of seat belt effectiveness in preventing injuries was 12% lower when a one-level nested model was used. Based on these results, we stress the need to use a nested model and GEEs when analyzing motor vehicle crash data. (Copyright © 2003, Elsevier Science)
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The use of multilevel models for the prediction of road accident outcomes.
Jones AP, Jorgensen SH. Accid Anal Prev 2003; 35(1): 59-69.
Correspondence: Andrew P. Jones, School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ, Norfolk, UK; (email: a.p.jones@uea.ac.uk).
An important problem in road traffic accident research is the resolution of the magnitude by which individual accident characteristics affect the risk of fatality for each person involved. This article introduces the potential of a recently developed form of regression models, known as multilevel models, for quantifying the various influences on casualty outcomes. The application of multilevel models is illustrated by the analysis of the predictors of outcome amongst over 16,000 fatally and seriously injured casualties involved in accidents between 1985 and 1996 in Norway. Risk of fatality was found to be associated with casualty age and sex, as well as the type of vehicles involved, the characteristics of the impact, the attributes of the road section on which it took place, the time of day, and whether alcohol was suspected. After accounting for these factors, the multilevel analysis showed that 16% of unexplained variation in casualty outcomes was between accidents, whilst approximately 1% was associated with the area of Norway in which each incident occurred. The benefits of using multilevel models to analyse accident data are discussed along with the limitations of traditional regression modeling approaches. (Copyright © 2003, Elsevier Science)
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Economic consequences of injury and resulting family coping strategies in Ghana.
Mock CN, Gloyd S, Adjei S, Acheampong F, Gish O. Accid Anal Prev 2003; 35(1): 81-90.
Correspondence: Charles N. Mock, Kwame Nkrumah University of Science and Technology, Kumasi, GHANA; (email: cmock@u.washington.edu).
The toll of human suffering from illness and injury is usually measured by mortality and disability rates. Economic consequences, such as treatment costs and lost productivity, are often considered as well. Lately, increasing attention has been paid to the economic effects of illness on a household level. In this study, we sought to assess the economic consequences of injuries in Ghana by looking at the effects on households and the coping mechanisms these households employed. Using cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. We sought information on any injury that occurred to a household member during the prior year and that resulted in one or more days of disability time. A total of 1609 injuries were reported for the prior year. Treatment costs and disability days were higher in the urban area than in the rural. Coping strategies were different between the two areas. Rural households were more likely to utilize intra-family labor reallocation (90%) than were urban households (75%). Rural households were also more likely to borrow money (24%) than were urban (19%). Households in both areas were equally likely to sell belongings, although the nature of the belongings sold were different. Although injuries in the urban area had more severe primary effects (treatment cost and disability time), the ultimate effect on rural households appeared more severe. A greater percentage of rural households (28%) reported a decline in food consumption than did urban households (19%). These findings result in several policy implications, including measures that could be used to assist family coping strategies and measures directed toward injuries themselves. (Copyright © 2003, Elsevier Science)
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The influence of extrinsic and intrinsic risk factors on the probability of sustaining an injury.
McLeod R, Stockwell T, Rooney R, Stevens M, Phillips M, Jelinek G. Accid Anal Prev 2003; 35(1): 71-80.
Correspondence: Tim Stockwell, National Drug Research Institute, G.P.O. Box U1987, WA 6845, Perth, AUSTRALIA; t.stockwell@curtin.edu.au
This study was designed to quantify the relative contributions of extrinsic and intrinsic risk factors to the probability of an injury event. A case-control design was used with data collected from injured patients at an emergency department (n=797) and a community sample matched on area of residence and time of injury (n=797). Principal components analysis was used to develop scales for the measurement of 'intrinsic' risk taking tendencies that were slightly modified versions of previously published measures. Two principal components were identified: 'health risk taking' (HRT) and 'adventurous risk taking' (ART). Logistic regression analysis identified variables that significantly predicted membership of the group of injured cases. The main hypothesis was supported by the results: that 'extrinsic' factors such as location, activity, drug and alcohol use and the type of people present at the time of the injury were related to a greater risk of injury than 'intrinsic' variables (health and adventurous risk taking tendencies). The results suggest that injury research and prevention efforts should continue to focus on the identification and modification of situational risk factors for injury rather developing programs that focus on high-risk individuals. High-risk alcohol use, use of prescribed drugs and aspects of work and recreational environments were identified as warranting particular attention. (Copyright © 2003, Elsevier Science)
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Spinal injury patterns resulting from car and motorcycle accidents.
Robertson A, Branfoot T, Barlow IF, Giannoudis PV. Spine 2002; 27(24): 2825-2830.
Correspondence: Angus Robertson, BSc, MRCS (Ed), 57 Bishopthorpe Road, York YO23 1NX, UK; (email: arobertson@rcsed.ac.uk).
OBJECTIVES: To determine spinal injury patterns and clinical outcomes in patients involved in automotive accidents.
METHODS: The records of 22,858 patients collected prospectively as part of the Trauma Audit Research Network (UK) Database (1993-2000). Analysis of the records of 1121 motorcyclists and 2718 car occupants involved in automotive trauma.
FINDINGS: Spinal injury occurred in 126 (11.2%) motorcyclists and 383 (14.1%) car occupants. Victims were predominantly young (mean ages: motorcycle 30.2 years, car 37.8 years) and male (motorcycle 88.9%, car 60.6%). The mean Injury Severity Scores were 18.8 and 15.1, respectively. Isolated spinal injuries occurred in 30 (23.8%) motorcyclists and 130 (33.9%) car occupants. The thoracic spine was most commonly injured in motorcyclists (54.8%), and the cervical spine was most commonly injured in car occupants (50.7%). Multiple regions were injured in 14 (10.3%) motorcyclists and 33 (8.5%) car occupants. Nine motorcyclists and 43 car occupants required spinal surgery. Median hospital stays were 11.5 days (range 0-235 days) and 10 days (range 0-252 days) in the motorcyclists and car occupants, respectively. There were 13 (10.3%) motorcycle- and 26 (6.8%) car-related deaths.
DISCUSSION: Spinal injury patterns may reflect differing mechanisms of injury between the restrained car occupant and unrestrained motorcyclist. The motorcyclists were more severely injured, had more extremity trauma, a higher mortality rate, and a spinal injury pattern consistent with forced hyperflexion of the thoracic spine. The predominance of cervical injuries and higher incidence of neck and facial injuries in car occupants may reflect abdominothoracic seat belt restraint. The high frequency of multilevel injuries reaffirms the need for vigilance in patient assessment. (Copyright © 2002 Lippincott Williams & Wilkins)
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Suicide in Israel: 1985-1997.
Nachman R, Yanai O, Goldin L, Swartz M, Barak Y, Hiss J. J Psychiatry Neurosci 2002; 27(6): 423-428.
Correspondence: Marnina Swartz, Director, Department 5B, Abarbanel Mental Health Center, 15 KKL St., Bat-Yam, 59100, ISRAEL; (email: mdybarak@netvision.net.il)
OBJECTIVE: To examine trends in suicide rates in Israel over a 13-year period.
METHODS: All cases of autopsy-confirmed suicide in Israel from 1985 to 1997 were retrospectively reviewed.
FINDINGS: An overall annual increase in suicide rates, with rates in men 3 times higher than those in women, was observed. Suicide rates were highest in the second and third decades of life. Unlike Western countries where gunshot wounds are the most common method of suicide for men and poisoning is most common for women, asphyxiation by hanging was the most common method used by men in Israel, followed by firearm wounds and jumping from heights. In women, however, jumping from heights was the most common method, followed by hanging and poisoning.
DISCUSSION: Increasing rates of suicide may be associated with waves of immigration to Israel, increased substance abuse and depression and the political and social climate. Further study to examine the precipitating factors is warranted. (Copyright © 2002 Canadian College of Neuropsychopharmacology)
See items 1 & 2 under poisoning -
Accidental injuries in agriculture in the UK.
Solomon C. Occup Med 2002; 52(8):461-466.
Correspondence: Christine Solomon, MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, UK; (email: cls@mrc.soton.ac.uk).
The rate of occupational accidents in British agriculture is higher than in most other industries. The most common fatal accidents are those involving vehicles and machinery, falls from a height and electrocution. A substantial proportion of reported non-fatal injuries in agricultural employees is attributable to manual handling, but among self-employed farmers the contribution is much smaller. Few data are available on longer-term determinants of risk, but accidental deaths are most frequent in July, August and September. The main approaches to preventing agricultural accidents are through engineering improvements, and education and training of the workforce. The introduction of roll-over protection structures for tractors has been an important development in recent decades. Other engineering controls include guards for power take off shafts, guard rails to prevent falls, better handling facilities for animals and closed transfer systems for pesticides. Training on safety is available from several sources, but its effectiveness in reducing accidents is uncertain. (Copyright © 2002 Society of Occupational Medicine - Published by Oxford University Press)
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The mental health of farmers.
Gregoire A. Occup Med 2002; 52(8): 471-476.
Correspondence: Alain Gregoire, Rural Mental Health Research, University of Southampton, Tatchbury Mount, Calmore, Southampton, UK. e-mail: alain-gregoire@lineone.net.
Farmers are subject to a number of unique occupational stressors, many of which have been aggravated in recent years by changes in farming practice and by economic factors. These are probably part of the explanation for the high rates of suicide in farmers and farm workers, which in the UK account for the largest number of suicides in any occupational group. Suicide is usually associated with mental illness, which, in farming communities, appears to be particularly stigmatized and poorly understood. This affects health-seeking behavior, which is compounded by the geographical isolation and inaccessibility of many services in rural areas. Our current understanding of these issues suggests a number of potentially valuable interventions. (Copyright © 2002 Society of Occupational Medicine - Published by Oxford University Press)
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Safety words inventory and literacy screener: standardization and validation.
Glascoe FP. Clin Pediatr 2002; 41(9): 697-704.
Correspondence: Francis P. Glascoe, Department of Pediatrics, Vanderbilt University; 2100 Pierce Ave, Nashville, TN 37232, USA; (email: frances.p.glascoe@Vanderbilt.edu)
When evaluating a school-aged patient, particularly for such issues as attention deficit disorder, or learning disabilities, health-care providers are encouraged to appraise children's school performance. Although some clinicians seek teachers' comments, recent research suggests that teachers' appraisals have limited value. As a consequence, health-care providers need brief methods, functional for busy primary care clinics, for detecting school problems. Because well-visits also include other services such as anticipatory guidance and safety and injury counseling, it would be helpful for detection tools to facilitate delivery of more than one aspect of well-child care. This study was undertaken to develop a brief method for evaluating school performance for elementary-age children and test its accuracy in identifying children with reading and other academic problems. By using common safety signs as the test stimuli, such a tool should also serve as a springboard to injury prevention counseling. Data were drawn from the standardization and validation data of an individually administered wide-range diagnostic achievement test using a geographically diverse, nationally representative sample of 934 children between 5 and 13 years of age. Children were administered the Comprehensive Inventory of Basic Skills-Revised (CIBS-R), which includes among its 10 subtests a 57-item measure of safety word recognition. Data were collected from previously administered measures of academics and intelligence. Forty-one children were administered the measure twice to assess inter-rater reliability. Logistic regression analyses were deployed using children's performance on the nine other subtests of the CIBS-R as the grouping variable, and as predictors, recognition of 57 safety words/phrases. Of these, 22 safety signs (e.g., "Keep out," "No Trespassing," "Danger") were significant predictors of overall academic performance. An additional seven safety words were added due to their ecological significance (e.g., "High Voltage," "Beware of Dog," "Poison," etc.). Receiver operating characteristic was used to determine cut scores based on children's ages in relation to overall academic performance. Cut scores increased with age and produced sensitivity of 78% (range, 73%-88%) and specificity of 84% (range, 77%-87%) to academic performance above and below the 25th percentile--the point where children typically fail to benefit from group instruction and become eligible for remedial reading programs (such as Title I). Children with performance below cut scores were 11 times more likely to have been retained in grade and five times more likely to receive a teacher rating of below average than were children performing above cut scores. Nevertheless, 72% of children with poor performance were not receiving special education or Title I services. Interrater reliability coefficients were high and ranged from .64 to .98. Extrapolating administration times from data on the CIBS-R as a whole suggests the reduced safety words measure takes 3 to 4 minutes to administer and score. The new measure, called the Safety Word Inventory and Literacy Screener (SWILS), consists of 29 words, takes little time to administer and score, and has a high degree of sensitivity and specificity to academic deficits. Use of the SWILS in primary care should enable clinicians to provide focused safety counseling while also screening for school problems. (Copyright © 2002Westminster Publications)
See item #4 under Risk Factor Prevalence -
Suicide among New York City police officers, 1977-1996.
Marzuk PM, Nock MK, Leon AC, Portera L, Tardiff K. Am J Psychiatry 2002; 159(12): 2069-2071.
Correspondence: Peter M. Marzuk, Department of Psychiatry, Cornell University Medical College; 525 E. 68th Street, New York, NY, USA; (email: pmmarzuk@med.cornell.edu).
OBJECTIVES: The authors assessed the suicide rates of New York City police officers during a recent period.
METHODS: The authors reviewed death certificates of active New York City police officers who died from 1977 through 1996 (N=668); age-, gender-, and race-specific suicide rates among New York City police officers and the city's residents were determined.
FINDINGS: The police suicide rate was 14.9 per 100,000 person-years, compared with a demographically adjusted suicide rate of New York City residents of 18.3 per 100,000 person-years. Suicide rates among male police officers were comparable to their reference population. Female police officers had a higher risk of suicide than female residents of New York, but the number of suicides of female police officers was small.
DISCUSSION: The rate of suicide among New York City police officers is equal to, or even lower than, the suicide rate of the city's resident population. (Copyright © 2002, American Psychiatric Association)
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Their last words: a review of suicide notes in the elderly.
Salib E, El-Nimr G, Yacoub M. Med Sci Law 2002; 42(4): 334-338.
Correspondence: Emad Salib, University of Liverpool, Liverpool, UK; (email: unavailable).
Suicide notes are considered as markers of the severity of a suicide attempt and are said to provide valuable insight into the thinking of suicide victims before the fatal act. However, very few studies have described elderly suicide note-writers and their final thoughts. In this retrospective review of suicide notes obtained from coroners' records in North Cheshire over a period of 13 years from 1989-2001 we examined the content of suicide notes and their clinical significance. Suicide note-writers may not be typical of the average suicide and information elicited from the study of suicide notes may only apply to note-writers and not to suicide in general. However, the absence of a suicide note must not be considered an indicator of a less serious attempt. Future studies of suicide notes need to provide insight into the unique nature of these documents and to allow better understanding of the suicidal mind. (Copyright © 2002, Chiltern Publishing)
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Distractions and the risk of car crash injury: the effect of drivers' age.
Lam LT. J Safety Res 2002; 33(3): 411-419.
Correspondence: Lawrence T. Lam, Royal Alexandra Hospital for Children, Locked Bag 4001, Westmead, Sydney, NSW 2145, AUSTRALIA; (email: lawrencl@chw.edu.au).
BACKGROUND: Motor-vehicle accidents are one of the major causes of injury in most motorized countries. Driver distractions have been suggested as a contributor to traffic accidents. Moreover, age of the driver seems to have a role in the relationship between distractions and car crashes. But very few studies have investigated the effect of driver's age on this relationship.
OBJECTIVES: This exploratory study investigated the association between distractions, both inside and outside the vehicle, and the increased risk of car crash injury among drivers across different ages.
METHODS: This study used a case series design to analyze data routinely collected by the NSW police in Australia. A special focus of this study was on how drivers' age affects the risk of car crash injury, which was determined by using a well-documented risk estimation methodology.
FINDINGS: The results obtained indicated that drivers of all ages, on the whole, are more susceptible to distractions inside the vehicle than distractions coming from outside. Age was shown to affect the relationship between in-vehicle distraction and the risk of car crash injury. A separate analysis was also conducted on hand-held phone usage while driving with results supplementing previous findings reported in the literature.
DISCUSSION: Safety strategies to countermeasure in-vehicle distractions have been suggested and discussed. (Copyright © 2002, Elsevier Science)
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Turning gap acceptance decision-making: the impact of driver distraction.
Cooper PJ, Zheng Y. J Safety Res 2002; 33(3): 321-335.
Correspondence: Peter J. Cooper, Performance Analysis Services Department, Insurance Corporation of British Columbia, Room Yoy, 132 W. Esplanade, North Vancouver, British Columbia, CANADA V7M 1A2; (email: unavailable)
BACKGROUND: A number of studies have found that use of in-car phones by drivers can interfere with the cognitive processing necessary for making appropriate and timely vehicle control decisions. However, the specific linkage between communication-based distraction and unsafe decision-making has not been sufficiently explored.
METHODS: In a closed-course driving experiment, 39 subjects were exposed to approximately 100 gaps each in a circulating traffic stream of eight vehicles on an instrumented test track that was wet about half the time. The subjects were at the controls of an instrumented car, which was oriented in a typical left-turn configuration (traffic-crossing situation in North America) and with parking brake on and the transmission in neutral. The subjects were instructed to press on the accelerator pedal when they felt that a gap was safe to accept. Their performances were monitored and incentives were provided for balancing safe decision-making with expeditious completion of the task. For half of the gap exposures (randomly assigned), each subject was required to listen and respond to a complex verbal message.
FINDINGS: When not distracted, the subjects' gap acceptance judgment was found to be significantly influenced by their age, the gap size, the speed of the trailing vehicle, the level of "indecision," and the condition of the track surface. However, when distracted, the subjects did not factor pavement surface condition into the decision process. On wet pavement, the subjects were judged to have initiated twice the level of potential collisions when distracted by the messages that they did when not distracted.
DISCUSSION: Listening/responding to verbal messages may reduce the capacity of drivers to process adequately all the important information necessary for safe decision-making. The effects of the messages in our study seemed to cause the subjects to misjudge gap size and speed information when operating under the additional disadvantage of adverse pavement condition. Attention to complex messages while making decisions about turning through gaps in an on-coming vehicle stream was associated with significantly increased unsafe decision making by subjects in our experiment when the additional complexity of wet surface condition was introduced. While the results reflected a somewhat artificial situation where the measure was signaled intention to act rather than the act itself, nevertheless, they do strongly suggest a scenario in which mental distraction could contribute to crash risk. With the rapid proliferation of telematics in the vehicle market, even with the laudable objectives represented by the Intelligent Transportation Systems initiative, there is a danger of the primary task of the driver being subordinated to a perceived need to enhance information flow to/from the external "world." Industry and governments need to work together to ensure that apparently desirable in-vehicle communication improvements do not compromise safety. (Copyright © 2002, Elsevier Science)
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Acute mobile phone operation affects neural function in humans.
Croft RJ, Chandler JS, Burgess AP, Barry RJ, Williams JD, Clarke AR. Clin Neurophysiol 2002; 113(10): 1623-1632.
Correspondence: Rodney J. Croft, Brain and Behaviour Research Institute, University of Wollongong, Northfields Ave., Wollongong 2522, AUSTRALIA; (email: rcroft@swin.edu.au).
OBJECTIVES: Mobile phones (MP) are used extensively and yet little is known about the effects they may have on human physiology. There have been conflicting reports regarding the relation between MP use and the electroencephalogram (EEG). The present study suggests that this conflict may be due to methodological differences such as exposure durations, and tests whether exposure to an active MP affects EEG as a function of time.
METHODS: Twenty-four subjects participated in a single-blind fully counterbalanced cross-over design, where both resting EEG and phase-locked neural responses to auditory stimuli were measured while a MP was either operating or turned off.
FINDINGS: MP exposure altered resting EEG, decreasing 1-4 Hz activity (right hemisphere sites), and increasing 8-12 Hz activity as a function of exposure duration (midline posterior sites). MP exposure also altered early phase-locked neural responses, attenuating the normal response decrement over time in the 4-8 Hz band, decreasing the response in the 1230 Hz band globally and as a function of time, and increasing midline frontal and lateral posterior responses in the 30-45 Hz band.
DISCUSSION: Active MPs affect neural function in humans and do so as a function of exposure duration. The temporal nature of this effect may contribute to the lack of consistent results reported in the literature. (Copyright © 2002, Elsevier Science)
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Sustainability assessment of speed regulation of urban traffic.
Mao B, Chen H, Chen S. IATSS Res 2002; 26(2): 18-24.
Correspondence: Baohua Mao, Northern Jiaotong University, Beijing, PEOPLE'S REPUBLIC OF CHINA; (email: unavailable).
Regulation of motor vehicle speed has widely affected the living environment and standard of residents in urban areas. It is believed that lower speed of motor vehicles could decrease the traffic accident rate on roads. However, lower speeds may cause many problems indirectly to social development and the health of residents. The average speed of motor vehicles in urban areas in China may be among the lowest in the world due to its mixed traffic environment and vehicle properties. In most central areas of large Chinese cities, the average speed of motor vehicles has been lower than 25km/h. However, this does not mean a safer system for transportation. For example, the death toll of transportation systems in China has exceeded 70,000 every year and is among the highest in the world.
This paper analyzes the general situation of various speed regulations on motor vehicles in China. A brief review on the relationship between speed and safety on urban transport has been described. Authors believe that the coordination of motor vehicles with bicycles and pedestrians is the most important factor in transport safety, especially in urban areas. A quantitative assessment on indirect effects of speed regulation has then been discussed. The assessment covers four aspects. Firstly, it estimates the additional emissions resulted from speed regulation. Secondly, it calculates the contribution to road traffic density of extra stay of vehicles caused by speed change. Thirdly, it analyses the change of passenger journey time caused by speed regulation in urban areas. Finally, the paper calculates the energy consumption of vehicles related to speed regulation. The paper also discusses the policy on speed regulation from viewpoint of sustainable development of urban society. It concludes that higher speed of motor vehicles is of better sustainability in the current situation of Chinese urban areas. Some suggestions on speed regulation for different situations in China have also been presented. (Copyright © 2002, International Association of Traffic and Safety Sciences)
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Tin cans or assault vehicles? - the role of crashworthiness and non-aggressiveness in vehicle safety design, promotion and regulation.
Tay R. IATSS Res 2002; 26(2): 92-98.
Correspondence: Richard Tay, Centre for Accident Research and Road Safety, Queensland University of Technology, Carseldine, Queensland, AUSTRALIA; (email: r.tay@qut.edu.au).
This paper examines the policy implications of the traditional approach to vehicle safety, which tends to focus on the crashworthiness of a vehicle and its occupant protection capability, and an alternative approach that focuses more on the non-aggressiveness of the vehicle. It is argued that this alternative approach will improve road safety as well as social equity and environmental quality. (Copyright © 2002, International Association of Traffic and Safety Sciences)
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Aggression involving alcohol: relationship to drinking patterns and social context.
Wells S, Graham K. Addiction 2003; 98(1): 33-42.
Correspondence: Samantha Wells, Social, Prevention and Health Policy Research Department, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, London
Ontario N6G 4X8, CANADA; (email: swells@uwo.ca).
OBJECTIVES: The present study examines the relationships between: (1) alcohol involvement/perceived intoxication level of participants and aggression severity; (2) respondent drinking patterns and involvement in alcohol-related aggression; and (3) social context and alcohol-related aggression.
DESIGN: Random digit dialing (RDD) with computer assisted telephone interviewing (CATI) was used to obtain a random sample of Ontario adults aged 18-60 (response rate of 67%).
PARTICIPANTS: Respondents who reported that they had been involved personally in physical aggression in the past 12 months were the focus of the present study.
MEASUREMENTS: Questions were asked regarding the most recent incident of physical aggression, including whether the respondent and opponent drank alcohol prior to aggression, perceived intoxication levels at the time, number of participants, relationship to opponent, social context of aggression, time of day and day of week. Three items were used to assess aggression severity: injury to respondent, use of threats by respondent or opponent and police involvement.
FINDINGS: (1) Injury to respondent and threats by respondent were not associated with alcohol involvement per se, but were significantly related to perceived level of alcohol intoxication; (2) drinking pattern of respondent was significantly associated with alcohol-related aggression but unrelated to aggression that did not involve alcohol; and (3) a number of contextual factors (e.g. gender, number of participants, time of day) were found to be associated with alcohol involvement in aggression.
DISCUSSION: The results suggest that both drinking pattern and contextual factors are important in distinguishing between alcohol-related aggression and non-alcohol-related aggression. As well, alcohol intoxication may be an important predictor of aggression severity. (Copyright © 2003 Society for the Study of Addiction Blackwell Publishing)
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Official records of bullying incidents among young offenders: what can they tell us and how useful are they?
Ireland JL. J Adolesc 2002; 25(6): 669-679.
Correspondence: Jane L. Ireland, Psychology Department, Personality Disorder Unit, Psychological Services, Ashworth Hospital, Parkbourn, Maghull L31 1HW, UK; (email: Irelan-J@ashworth.nwest.nhs.uk).
The present study describes 107 incidents of bullying recorded by staff on "Bullying Incident Reports" (BIRs) at a male Young Offender Institution. The most frequently recorded type of bullying was psychological/verbal. Bullies had been placed on a governor's report prior to the BIR and found guilty on significantly more occasions than victims. Victims were significantly more likely than bullies to be seen as at risk of/actually displaying self-injurious behavior during their incarceration. Most bullying incidents took place in cells/accommodation or in classrooms/the education block. The results are discussed with reference to how useful official records of bullying are as a method of measuring the nature/extent of bullying. (Copyright 2002 The Association for Professionals in Services for Adolescents Published by Elsevier Science)
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Gender differences in the experience of intimate partner violence among active duty U.S. Army soldiers.
Rosen LN, Parmley AM, Knudson KH, Fancher P. Mil Med 2002; 167(12): 959-963.
Correspondence: Leora Rosen, National Institute of Justice, 810 Seventh Street NW, Washington, DC 20531, USA; (email: rosenl@usdoj.gov)
The relationship of intimate partner violence to psychological distress and the mediating or moderating effects of social support were examined among 99 married active duty Army women and 477 married active duty Army men. Although approximately 40% of both the men and the women had experienced physical partner violence in the past year, in neither group was physical violence correlated with psychological distress when controlling for other variables. Among women, psychological abuse inflicted by a partner was significantly associated with greater psychological distress. Among men, poor marital adjustment was associated with greater psychological distress. An unexpected significant interaction effect was found among women indicating that those who were violent toward their partners under conditions of high peer support experienced greater psychological distress.
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