This paper examines the correlates and predictors of driving under the influence behaviors (DUIBs) during the past month by college students. Measures of heavy episodic drinking, monthly drinking frequency, monthly drinking variance, monthly drinks per occasion and reported marijuana use are compared as predictors net of other predictive factors. A cross-sectional telephone survey was conducted with college students by a university social science research laboratory. Respondents attended two large public universities located in the southwestern part of the US. Participants included 803 randomly selected college students. The interview schedule included items from the Core Alcohol and Drug Survey and the College Alcohol Risk Assessment Guide. Several additional last-drinking-event items were also developed for the interview. Bivariate analyses indicate that marijuana use (past year), heavy episodic drinking, reports of DUIBs (driving under the influence or riding with a driver who is under the influence) in the past year, monthly frequency of drinking, the average number of drinks consumed when drinking and age are correlates of DUIBs during the past month. Multivariate analyses indicate past year DUIBs, monthly frequency of drinking and monthly marijuana use predicted recent DUIB.
Escalation of drug use in early-onset cannabis users vs co-twin controls.
Correspondence: Michael T. Lynskey, Missouri Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, 40 N Kings highway, Suite One, St Louis, MO 63108, USA; (email: mlynskey@matlock.wustl.edu).
BACKGROUND: Previous studies have reported that early initiation of cannabis (marijuana) use is a significant risk factor for other drug use and drug-related problems.
OBJECTIVE: To examine whether the association between early cannabis use and subsequent progression to use of other drugs and drug abuse/dependence persists after controlling for genetic and shared environmental influences.
DESIGN: Cross-sectional survey conducted in 1996-2000 among an Australian national volunteer sample of 311 young adult (median age, 30 years) monozygotic and dizygotic same-sex twin pairs discordant for early cannabis use (before age 17 years).
MAIN OUTCOME MEASURES: Self-reported subsequent nonmedical use of prescription sedatives, hallucinogens, cocaine/other stimulants, and opioids; abuse or dependence on these drugs (including cannabis abuse/dependence); and alcohol dependence.
FINDINGS: Individuals who used cannabis by age 17 years had odds of other drug use, alcohol dependence, and drug abuse/dependence that were 2.1 to 5.2 times higher than those of their co-twin, who did not use cannabis before age 17 years. Controlling for known risk factors (early-onset alcohol or tobacco use, parental conflict/separation, childhood sexual abuse, conduct disorder, major depression, and social anxiety) had only negligible effects on these results. These associations did not differ significantly between monozygotic and dizygotic twins.
DISCUSSION: Associations between early cannabis use and later drug use and abuse/dependence cannot solely be explained by common predisposing genetic or shared environmental factors. The association may arise from the effects of the peer and social context within which cannabis is used and obtained. In particular, early access to and use of cannabis may reduce perceived barriers against the use of other illegal drugs and provide access to these drugs.
Since 1999, and particularly the tragic events of September 11, 2001, the federal government has sought to prepare against the threat of bioterrorism by developing a comprehensive national "preparedness and response" program that encompasses state and local health agencies. In fiscal year 1999, approximately $150 million was made available through the Department of Health and Human Services (DHHS) to develop bioterrorism preparedness and response infrastructure in public health departments. Emergency medical services (EMS) funding was not specifically considered in this DHHS program, primarily because EMS is usually funded through traditional first-responder programs in other departments of the U.S. government. This approach may be effective in addressing some EMS needs, but it is insufficient for enhancing the emergency medical infrastructure throughout this country or for linking emergency public health and emergency medical prehospital initiatives. The role of EMS is shifting. As EMS in the future will be expected to be more comprehensive and encompass the urgent aspects of public health preparedness and response, more resources must be applied to the medical control units of EMS systems so that they may provide the most benefit to the public health and medical system. Emergency medical systems and their leadership are poised to play a critical role in national preparedness against bioterrorism. Preparedness funding within the health sector will continue to expand markedly in the near future. However, a well-developed strategy will be necessary to sustain the best linkage between EMS, hospital preparedness, and public health preparedness at the local, state, and federal levels.
OBJECTIVES: Previous studies of injury prevention among the elderly have focused on care by community-based services for the elderly. The plan for this study was to determine whether emergency medical services (EMS) could be a valuable partner in an injury prevention program for the elderly. The purposes of the study were: 1) to determine whether it is feasible to gather injury prevention data prospectively, 2) to determine whether these data suggest the need for further intervention to aid the elderly, and 3) to determine whether retrospective chart data are comparable to prospectively gathered data for evaluating the elderly home environment.
METHODS: Trained fire/EMS chiefs gathered prospective data from the homes of all elderly falls. Patients were included if they were 65 years of age or older. Demographics extracted from the chart were gender, age, and average income based on zip code information from the city office. A 29-question survey was developed based on a literature review. Results were obtained representing information in six categories: environment, appearance, health, violence, access to help, and repeat medical care utilization. Retrospective data were obtained from run reports and from a computerized EMS database. Proportions and 95% confidence intervals were used. A p-value < 0.05 was considered statistically significant.
FINDINGS: There were 70 prospective elderly fall cases evaluated and 74 retrospective charts reviewed, each representing a two-to-four-month period. Prospectively, significant problems were found with the patient's environment in up to 53% of cases, appearance in up to 29%, health in up to 77%, abuse in up to 3%, access in up to 57%, and repeat use in 33-68%. Although there were no differences in the age, income, or percentage transported between the prospective and retrospectively obtained groups, a significantly higher percentage of females were entered prospectively. Retrospective chart review obtained reasonable amounts of data for only four of 29 questions.
DISCUSSION: Prospective analysis is easily gathered and identifies elderly injuries and patterns. A significant number of elderly patients whose homes were visited by EMS need help. Retrospective analysis gleans little injury prevention information.
Correspondence: DA Skelton, University College London Institute of Human Performance, Royal National Orthopaedic Hospital, Stanmore, UK, Sports Medicine Research Unit, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; (email: unavailable).
This review aims to provide the reader with up to date evidence in relation to the role of exercise in the reduction of risk factors and the prevention of falls and injuries. Falls and injury may lead to a spiral of inactivity and
decline that take older people close to or below the critical "thresholds" of performance necessary for everyday activities. Yet, low strength and power, poor balance, poor gait and functional ability, and fear of falling are all risk
factors for falls modifiable with tailored exercise. Although the evidence on types, amounts and specificity of exercise to prevent falls is not complete, recommendations have been published that have been effective, either as an exercise stand-alone intervention or with exercise as part of a multifactorial intervention. It is clear that the target population must be at risk or already fallers, they must be "not too fit" and "not too frail." Supervised home-based exercise programs may be effective in those aged over 80 because they fall more frequently, injure more easily, and recover more slowly. In younger, community-dwelling, fallers multifactorial group interventions including targeting of balance, strength, power, gait, endurance, flexibility, co-ordination and reaction may be more effective. There are, however, research questions that still need answering - whether there are certain types of exercise harmful in certain subgroups of older people, what is the ideal
intensity, frequency and duration of exercise for different subgroups of older people (primary and secondary prevention) and the relative value of the different components of fitness to prevention of falls and injuries. This review highlights the necessity of tailored, specific balance and strength exercise in the multidisciplinary prevention of falls and injuries.
Correspondence: B. E. Bledsoe, Department of Emergency Medicine, University of North Texas Health Sciences Center, Fort Worth, Texas, USA; (email: bbledsoe@earthlink.net).
OBJECTIVE: To determine the number of air medical helicopter accidents in the United States during a five-year period beginning January 1, 1997, and ending December 31, 2001.
METHODS: The National Transportation Safety Board's (NTSB's) Accident Synopses database was accessed to determine the number of accidents involving air medical helicopters during the five-year study period. The NTSB reports for each accident were downloaded.
FINDINGS: The NTSB records revealed 47 accident files pertaining to air medical helicopters during the five-year study period. These were analyzed for: date of accident, time of accident, air ambulance operator, location of accident, type of aircraft, number of persons, number of fatalities, number of injuries, cause of accident, and other factors the NTSB investigators deemed appropriate. Of the 47 accidents, there were 40 fatalities and 36 injuries. Overall, there were 13 helicopter types involved. The majority of accidents (70%) were attributed to pilot error. The number of accidents increased from a low of 4 in 1997 to a maximum of 12 in both 2000 and 2001.
DISCUSSION: This study has examined 47 U.S. air medical helicopter accidents for a five-year period (1997-2001). There was an increase in the number of accidents during the study period. However, this study is limited by
the fact that it presents only raw data and does not reflect the actual incidence of accidents per hours flown. Various factors related to these accidents have been described. These factors should be considered when strategies to improve air medical helicopter safety are developed.
An examination is made of a meta-analysis by Attewell, Glase and McFadden which concludes that bicycle helmets prevent serious injury, to the brain in particular, and that there is mounting scientific evidence of this. The Australian Transport Safety Bureau (ATSB) initiated and directed the meta-analysis of 16 observational studies dated 1987-1998. This examination concentrates on injury to the brain and shows that the meta-analysis and its included studies take no account of scientific knowledge of its mechanisms. Consequently, the choice of studies for the meta-analysis and the collection, treatment and interpretation of their data lack the guidance needed to distinguish injuries caused through fracture of the skull and by angular acceleration. It is shown that the design of helmets reflects a discredited theory of brain injury. The conclusions are that the meta-analysis does not provide scientific evidence that such helmets reduce serious injury to the brain, and the Australian policy of compulsory wearing lacks a basis of verified efficacy against brain injury.
BACKGROUND: Penetrance values estimate the utilization of poison centers services. For a variety of reasons, penetrance values may vary greatly among geographic areas of population. We examined the relationship between ethnicity and penetrance in our population.
METHODS: We conducted a retrospective review of data from January 1, 2000 through December 31, 2000 from our poison center's database. Home calls to the center were evaluated by zip code, age, gender, substance, route of exposure, and outcome. These data were compared with U.S. Census 2000 geographic and community demographic data for San Diego by zip code. From this information, we identified zip code regions with substantial Latino populations (>50%), and substantial Caucasian populations (>70%). Study groups were limited to those zip codes with median household incomes of $20,000-$50,000. Aggregate total and pediatric penetrance values were calculated for each group and compared.
FINDINGS: Our study group consisted of 6 zip codes with significant numbers of Latino residents, and 11 zip codes with significant numbers of Caucasian residents. Aggregate call volume for the county was 6.5 calls per 1000 population, while that for children less than age 5 was 43. Penetrance values for the study zip codes with large Latino populations were significantly lower with a mean value of 22.4 for children, and 5.0 for all ages. These values were statistically significant when compared to county data and that from the control zip codes with largely Caucasian residents (61 aggregate and 49.6 pediatric).
DISCUSSION: Penetrance values were significantly lower in zip codes with large numbers of Latino residents. Reasons for this variation are being investigated.
Jellyfish envenoming syndromes: unknown toxic mechanisms and unproven therapies.
- Bailey PM, Little M, Jelinek GA, Wilce JA. Med J Aust 2003; 178(1): 34-37.
Department of Biochemistry, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, AUSTRALIA; (email: pbailey@iinet.net.au)
Interest in envenoming syndromes caused by Australian jellyfish has been intense since the deaths in early 2002 of two tourists in Queensland, attributed to the Irukandji syndrome. We review current knowledge of these envenoming syndromes, mechanisms of venom action and therapy, focusing on the deadly box jellyfish, Chironex fleckeri, and the array of jellyfish thought to cause the Irukandji syndrome. Current understanding of jellyfish venom activity is very limited, and many treatments are unproven and based on anecdote.
Bupropion poisoning: a case series.
- Balit CR, Lynch CN, Isbister GK. Med J Aust 2003; 178(2): 61-63.
NSW Poisons Information Centre, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, AUSTRALIA; (email: corrinebalit@aol.com)
BACKGROUND: Bupropion hydrochloride (Zyban; Glaxo Wellcome Australia, Boronia, Vic.) was marketed in Australia in November 2000 in a sustained-release (SR) formulation as a short term aid in abstaining from smoking. It has previously been marketed as an antidepressant in other countries. Bupropion is structurally similar to stimulants such as the amphetamines, and selectively inhibits the neuronal reuptake of dopamine and noradrenalin. Previous reports of bupropion overdose almost all involve the immediate-release (IR) formulation. There are reports of the SR formulation in overdose, but there is limited information on its spectrum of toxicity in overdose. Information on pediatric safety of either formulation is also limited.
OBJECTIVE: To investigate the toxicity of bupropion hydrochloride in deliberate self-poisoning in adults and accidental ingestion by children.
METHODS: Design and setting: Prospective study of cases identified from calls to the New South Wales Poisons Information Centre (NSW PIC), with follow-up through hospital medical records. Participants: Patients with bupropion poisoning managed in hospital, about whom the NSW PIC was contacted for advice, from 1 November 2000 to 31 July 2001 (59 adults and 10 children). Main outcome measures: Clinical effects, adverse outcomes (including seizures and death) and treatment.
FINDINGS: 45 of the 59 adults were followed up (76%), 19 of whom had taken bupropion alone. Major clinical effects of bupropion included sinus tachycardia (83%), hypertension (56%), seizures (37%), gastrointestinal symptoms (37%) and agitation (32%). Seizures were dose-dependent, with those having seizures ingesting a significantly higher median dose (P = 0.02). All seizures were brief and self-limiting. 29 patients received decontamination therapy. 10 patients required pharmacologic sedation, 10 were admitted to intensive care and six were intubated. None died. Eight of 10 accidental ingestions by children were followed up (80%); one child had symptoms (vomiting and hallucinations).
DISCUSSION: Bupropion overdose caused significant clinical effects in adults, but few in children.
BACKGROUND: We have reported an increased frequency of burns in children associated with campfires. More than 70% of these were caused by hot embers rather than flames, most occurring the morning after the campfire had been considered to be extinguished. These injuries result in significant post-burn scarring, which requires recurrent expensive treatment as the child grows. We were unable to find any evidence-based guidelines on the best method of extinguishing campfires.
OBJECTIVE: To measure the degree of heat retained in a standard campfire after extinguishing with either sand or water, or allowing the fire to burn out, to determine the optimal method of extinguishing a campfire.
METHODS: On each of three days, three identical fires were built on a sand base, using equal quantities of ironbark logs and pine planks, to create a typical campfire. One fire on each occasion was the control. After burning for three hours, one of the test fires was extinguished with enough water to completely extinguish it (ie, no embers were visible) and the other was extinguished with enough sand to cover the fire (again no embers were visible). Maximum temperatures of all three fires were recorded (through a small hole in the sand for the fire extinguished with sand) using the Fluke 65 infrared thermometer (Carlton-Bates, Little Rock, Arkansas, USA), and a Raynger 3I thermal device (Raytec Corporation, Santa Cruz, California, USA) (maximum temperature, 500 degrees C ± degrees C and 1200 ± 0.5%, respectively). Temperatures were recorded before extinguishing the fire, at 10 minutes, and at 1, 4, 8, and 12 hours.
FINDINGS: Each of the fires burned at greater than 510 degrees C. Extinguishing with water resulted in a rapid drop in temperature, so that by 10 minutes the mean temperature of the fire was 47° C (range, 46°- 50° C). This smouldering fire was easily recognizable as a recent fire. In contrast, in the fire extinguished with sand, after 10 minutes no smouldering was audible and no smoke was visible, but the mean temperature was 267° C (range, 226° - 350° C). After 8 hours, the mean temperature was 91° C (range, 77°- 118° C), sufficient to cause a full-thickness burn with contact of one second's duration. The temperature of the control fire remained at over 100° C after 12 hours. The differences in fire temperature after extinguishing with sand or water were statistically significant at the time intervals between 10 minutes and 8 hours inclusive (P < 0.05; Student's t-test).
DISCUSSION: The temperature required to cause a full-thickness burn in one second is 70° C. Hence, even after 8 hours, fires "extinguished" with sand retain sufficient heat to cause a full-thickness burn. Campers spend one million nights a year in Queensland national parks alone, and campfires are an integral part of the camping lifestyle. Fires, incompletely extinguished with sand, create an invisible hazard, particularly for children. The only safe way to extinguish a campfire is with water.
Deaths among drivers of off-road vehicles after collisions with trail gates - New Hampshire, 1997-2002.
- Acerno T, Andrew T, Twitchell N, Pelletier A, Ramsey L, Gray P, Gamache C, Shults R, Magri J. MMWR 2003; 52(3): 45-46.
The full report with figures and editorial note is available: ( Download Document ).
During April--July 2002, three deaths occurred on New Hampshire trails when adolescents driving off-highway recreational vehicles (OHRVs) collided with trail gates. Because of these three incidents, the New Hampshire Department of Health and Human Services conducted a study to determine the extent of the problem and characteristics of the fatal events. This report describes trail gate fatalities in New Hampshire during 1997--2002. To prevent trail gate collisions, efforts should focus on increased enforcement of OHRV operating rules, driver education, enhanced gate visibility, and improved signage.
Fixed Theme Park Rides and Neurological Injuries: Expert Panel Consensus Report.
- American Association of Neurological Surgeons. Rolling Meadows, Illinois: American Association of Neurological Surgeons (2002).
This 27-page report was produced by the American Association of Neurological Surgeons, Outcome Sciences, Inc., and Neuro-Knowledge under contract for Six-Flags Theme Parks, Inc.
Investigation of amusement park and roller coaster injury likelihood and severity.
Exponent Failure Analysis Associates was retained on behalf of Six Flags to investigate the type, frequency and severity of injuries that occur at fixed amusement parks and assess the likelihood of injuries to patrons on rides.
This project was separated into six tasks: 1)Review of the scientific literature; 2) Analysis of roller coaster accelerations including their magnitude and duration; 3) Analysis of occupant head acceleration data from a sample of Six Flags roller coasters; 4) Measurement of head accelerations for common daily or recreational activities; 5) Examination of first-aide station data from a sample of Six Flags parks; 6) Review of U.S. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) data.
Exponent has come to the following conclusions within a reasonable degree of engineering and scientific certainty based on the information available at the time of this report. Each conclusion is discussed fully in the body of the report.
Roller Coaster Acceleration Levels:
1. Over the last forty years, there has been no increase in the accelerations produced in roller coasters as determined from data supplied by Six Flags. Maximum speed data for 167 roller coasters and acceleration data for 110 roller coasters were compared with the year of initial installation. While top speeds have increased, maximum accelerations have remained essentially unchanged.
2. Computer analysis indicated that none of the 34 Six Flags rides with the highest levels of +Gz accelerations evaluated had accelerations with high enough magnitudes and long enough durations to cause loss of consciousness, even to a rider who was very susceptible to G-induced loss of consciousness (GLOC).
3. Common activities like sneezing, falling down, swinging on a swing, or being hit in the head with a pillow caused accelerations of the head that far exceeded the magnitude or duration of accelerations experienced by riders of roller coasters (as determined from rider acceleration data supplied by Six Flags). Being hit on the back of the head with a pillow was found to cause head accelerations as high as 11 G's in the y direction (side to side) and 14 G's in the +z direction (head to toe). Being spun on a tire swing generated a peak of negative 2.3 G's in the z direction (toe to head) sustained for a duration of more than 25 seconds. A simple sneeze generated nearly 4 G's in the x direction (front to back).
Head Injuries:
4. After reviewing occupant head acceleration data supplied by Six Flags for 71 of their most dynamic roller coasters, Exponent has determined that it is highly improbable that a normal rider would suffer a serious head injury. Occupant head accelerations supplied by Six Flags for riders on 71 roller coasters were compared to head accelerations experienced during common activities using an index based on the Federally accepted Head Injury Criterion (HIC). The calculated HIC scores for the rides ranged from 0.2 to 9.4. Exponent's in-house testing found that getting hit on the head with a pillow generated a HIC score of 20.8 and a sneeze generated a HIC of 0.5.
5. The annual rate of spontaneous, non-traumatic, non-impact cerebrovascular injuries (e.g., vertebral artery dissections, carotid artery dissection, sub-arachnoid hemorrhages) that have occurred at amusement parks is far below the rates that one would expect at fixed theme parks based on attendance and average rates for the general population. The scientific literature reports that the rate of spontaneous, non-traumatic, non-impact cerebrovascular injuries for the population of the United States is approximately 25,000 injuries per year.
CPSC Injury Data:
6. The use of a single product code that includes amusement attractions of all types, the mis-match between the geographic distribution of amusement parks and NEISS hospitals, changes in the sample of hospitals beginning in 1997, and the redaction of ride and park specific identifiers reduces the usefulness of NEISS data for estimating amusement park ride injuries and assessing trends.
7. Additions of hospitals close to several major theme parks in 1997 are likely to have caused the reported increase in CPSC estimated injuries in 1997. Six of the newly added hospitals are within 20 miles of parks that had an estimated attendance of 35 million patrons in 1997. This represents a net increase of approximately 29 million fixed park attendees within 20 miles of a sample hospital. All analysis should be conducted with post 1997 data in order to remove this sample bias.
8. The CPSC data from 2001 include a total of 5,335 injuries of all types associated with fixed site amusement park rides in the year 2001. This number is lower than the number of injuries in the CPSC data associated with children's wagons (6,934) and beach chairs or folding lawn chairs (7,103) from 2000 NEISS data.
9. The majority of all injuries associated with fixed amusement park rides were found to be minor in nature and did not require hospitalization. The majority of the injuries were contusions, abrasions, strains and sprains, and lacerations. The CPSC has reported that since 1993 the rate of hospitalized injuries for fixed amusement park attendees was one out of 2.7 million attendees or 0.00004%. Less than 2% of all the injuries recorded by the CPSC NEISS related to fixed amusement park rides required hospitalization. This percentage is two points lower than the 4% of injuries requiring hospitalization for all products that the CPSC monitors. Data from 2001 showed a similar rate.
10. There was a 19% drop in total fixed site amusement park associated injuries for patrons from 2000 to 2001 in the CPSC NEISS data.
11. Exponent analysis of CPSC NEISS data from 1997-2001 showed no statistical increase in the national estimate of the number of injuries associated with fixed site amusement park attractions over that time period while attendance has increased.
12. Exponent analysis of CPSC NEISS data from 1997-2001 indicate that risk of injury associated with fixed site amusement parks has not exhibited a statistically significant trend during that time. Risk of injury associated with fixed site amusement park attractions has dropped in each of the last two years.
Six Flags Injury Data:
13. Analysis of first-aide station data from five Six Flags parks, representing approximately 25% of all attendance of Six Flags parks for the years 1999 to 2001 showed that only 6% of all patrons complaining of injuries at the parks requested or required transport to a medical facility outside the park. Analysis of nine years of data from one park showed that only 5.8% of those transported from the park required hospitalization.
14. The injury rate for Six Flags patrons requiring or requesting transport to a medical facility outside the park was found to be seven injuries per million park attendees (0.0007%), with an estimated one serious injury (requiring overnight hospital stay) per 2.6 million park attendees (0.00004%).
15. The injury rate for Six Flags roller coaster patrons requiring or requesting transport to a medical facility outside the park was found to be one injury per million rides (.0001%). Serious injuries requiring an overnight stay at the hospital would be even lower.
OBJECTIVES: To examine all accident and emergency (A & E) department attendances
by children under the age of 1 year over a period of 12 months. Also to try to
identify the prevalence and severity of accident types in small children and to
suggest ways to reduce such accidents. METHODS: The A & E department of the Royal
Aberdeen Children's Hospital (RACH) serves a population of over half a million.
All children under 1 year of age attending this department in the year 2000 had
their case notes reviewed by the author and the cause, type, and severity of the
illness or injury noted.
FINDINGS: During the 12 month audit period 1416 new
cases under the age of 1 year presented to RACH, 790 of which presented directly
to A & E. Six hundred and eighteen (78%) were self referred and 116 children
attended A & E on more than one occasion during the year. Four hundred and thirty
four (55%) of the A & E attendances were classed as "accidents", the remainder
were mainly for medical conditions such as respiratory distress. Two hundred and
sixty four (61%) were caused by falls and 38% were admitted for inpatient
management. Two hundred and twenty nine (29%) required radiographs, which
revealed 30 fractures. Thirty seven children sustained scalds/burns and there
were 33 accidental ingestions. Six cases were judged to be non-accidental.
DISCUSSION: There is a surprisingly high rate of "accidental" injury in this
age group, bringing into question the effectiveness of current accident
prevention strategies. Perhaps specific prevention advice should be targeted at
parents and carers of young children. There should always be a high index of
suspicion for non-accidental injury.
Mortality, severe morbidity, and injury in children living with single parents in Sweden: a population-based study.
- Weitoft GR, Hjern A, Haglund B, Rosen M. Lancet 2003; 361(9354): 289-295.
Correspondence: Gunilla Ringbäck Weitoft, Centre for Epidemiology, Swedish National Board of Health and Welfare, 106 30 Stockholm, SWEDEN; (email: gunilla.ringback@sos.se).
BACKGROUND: Growing up with one parent has become increasingly common, and seems to entail disadvantages in terms of socioeconomic circumstances and health. We aimed to investigate differences in mortality, severe morbidity, and injury between children living in households with one adult and those living in households with two adults.
METHODS: In this population-based study, we assessed overall and cause-specific mortality between 1991 and 1998 and risk of admission between 1991 and 1999 for 65 085 children with single parents and 921 257 children with two parents. We estimated relative risks by Poisson regression, adjusted for factors that might be presumed to select people into single parenthood, and for other factors, mainly resulting from single parenthood, that might have affected the relation between type of parenting and risk.
FINDINGS: Children with single parents showed increased risks of psychiatric disease, suicide or suicide attempt, injury, and addiction. After adjustment for confounding factors, such as socioeconomic status and parents' addiction or mental disease, children in single-parent households had increased risks compared with those in two-parent households for psychiatric disease in childhood (relative risk for girls 2.1 [95% CI 1.9-2.3] and boys 2.5 [2.3-2.8]), suicide attempt (girls 2.0 [1.9-2.2], boys 2.3 [2.1-2.6]), alcohol-related disease (girls 2.4 [2.2-2.7], boys 2.2 [2.0-2.4]), and narcotics-related disease (girls 3.2 [2.7-3.7], boys 4.0 [3.5-4.5]). Boys in single-parent families were more likely to develop psychiatric disease and narcotics-related disease than were girls, and they also had a raised risk of all-cause mortality.
DISCUSSION: Growing up in a single-parent family has disadvantages to the health of the child. Lack of household resources plays a major part in increased risks. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, children of single parents still have increased risks of mortality, severe morbidity, and injury.
Correspondence: Karol L. Kumpfer, Department of Health Promotion and Education, University of Utah, Salt Lake City 84112, USA; (email: karol.kumpfer@health.utah.edu).
This research tested the effectiveness of a multicomponent prevention program, Project SAFE (Strengthening America's Families and Environment), with 655 1st graders from 12 rural schools. This sample was randomly assigned to receive the I Can Problem Solve (ICPS) program (M. B. Shure & G. Spivack, 1979), alone or combined with the Strengthening Families (SF) program (K. L. Kumpfer, J. P. DeMarsh, & W. Child, 1989), or SF parent training only. Nine-month change scores revealed significantly larger improvements and effect sizes (0.35 to 1.26) on all outcome variables (school bonding, parenting skills, family relationships, social competency, and behavioral self-regulation) for the combined ICPS and SF program compared with ICPS-only or no-treatment controls. Adding parenting-only improved social competency and self-regulations more but negatively impacted family relationships, whereas adding SF improved family relationships, parenting, and school bonding more.
Correspondence: E D Shenassa, Centers for Behavioral and Preventive Medicine, One Hoppin Street, Suite 500, Providence, RI 02903, USA; (email: Edmond_Shenassa@Brown.edu).
OBJECTIVES: (1) To quantify lethality of firearms relative to other suicide
methods, (2) to quantify the extent to which suicide mortality may be reduced by
limiting access to firearms.
METHODS: Data on suicides and hospitalized
para-suicides that occurred in the state of Illinois from 1990 to 1997 were
combined. Total number of episodes for each suicide method was estimated as the
sum of the number of suicides and the number of para-suicides for that method.
Gender and suicide method were used as proxies for intention to die, and
estimated lethality of suicide methods within method-gender groups (for example,
male firearm users). Logistic regression was used to quantify the lethality of
firearms relative to other suicide methods. Excess mortality associated with the
use of firearms was estimated by conservatively assuming that in the absence of
firearms the next most lethal suicide method would be used.
FINDINGS: From
January 1990 to December 1997, among individuals 10 years or older in the state
of Illinois, there were 37 352 hospital admissions for para-suicide and 10 287
completed suicides. Firearms are the most lethal suicide method. Episodes
involving firearms are 2.6 times (95% CI 2.1 to 3.1) more lethal than those
involving suffocation-the second most lethal suicide method. Preventing access
to firearms can reduce the proportion of fatal firearms related suicides by 32%
among minors, and 6.5% among adults.
DISCUSSION: Limiting access to firearms is
a potentially effective means of reducing suicide mortality.
Treatment of pediatric and adolescent mental health emergencies in the United
States: current practices, models, barriers, and potential solutions.
Correspondence: John D. Hoyle, Michigan State University College of Human Medicine, MERC/Spectrum Emergency Medicine Residency, Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, Michigan, 49503 USA; (email: jdhoyle@hotmail.com).
Mental illness significantly impairs the lives of 10% of all children and
adolescents in the United States (National Institute of Mental Health. Brief
Notes on the Mental Health of Children and Adolescents. Bethesda, MD: National
Institute of Mental Health, 1999). Of the myriad mental health problems
afflicting children, an alarming number are known to have grim outcomes. Some
illnesses continue into adulthood, while others may culminate in death during
adolescence. Despite the serious consequences of children's mental health
problems, early treatment can improve or control these conditions. Even with
this knowledge, seemingly little effort is geared toward removing barriers to
treatment for these diseases that plague our children. As a part of its
five-year plan, Emergency Medical Services for Children (EMSC) has collaborated
with the National Association of EMS Physicians (NAEMSP) to examine childhood
and adolescent mental health emergencies--particularly their presentation and
management within the emergency medical services system. This document presents
a critical review of current practices and models for treatment of children and
adolescents that includes identification of barriers to mental health treatment
and recommendations for their resolution.
Pediatric mental health emergencies: summary of a multidisciplinary panel.
Correspondence: John D. Hoyle, Michigan State University College of Human Medicine, MERC/Spectrum Emergency Medicine Residency, Department of Emergency Medicine, Butterworth Hospital, Grand Rapids, Michigan, 49503 USA; (email: jdhoyle@hotmail.com).
The World Health Organization has estimated that by the year 2020, neuropsychiatric disorders will become one of the five most common causes of morbidity, mortality, and disability among children (U.S. Department of Health and Human Services. HHS Fact Sheet on Mental Health Issues. www.hhs.gov. 2001). This is a distressing statistic, particularly when many of the mental health disorders are preventable and/or treatable with good prognosis. Children's mental health services and access to them are inconsistent within the United States. The National Institute of Mental Health reports that although 10% of our nation's children currently suffer from mental illness, only one-fifth of these children receive necessary treatment. (National Institute of Mental Health. Brief notes on the mental health of children and adolescents. Bethesda, MD: National Institute of Mental Health, 1999). The purpose of this article is to present summary information from a national consensus conference regarding the current state of emergency mental health resources for children and adolescents. The intended audience includes community health care providers, emergency care workers, and researchers. Major issues explored in this paper include the questions: Are emergency mental health services for children and adolescents readily available in communities? Is access to care possible for all children? Are resources and services in place to ensure that the mental health needs of this vulnerable population are not neglected? The authors would like to see the development of local, regional, and national systems that facilitates coordination between emergency medical services (EMS), emergency medicine, and mental health communities to ensure appropriate local resources are in place and to allow the emergent identification and treatment of mental health needs in the pediatric and adolescent population.
The enactment of Kuwait's seat belt law in January 1994 provided an opportunity to examine the impact of seat belt use on road accident fatalities and injury types in this affluent Persian Gulf nation. Via a structured data form, the results of injurious/fatal road accidents for more than 1200 accident victims were gathered from the files of the six major government hospitals which treat most traffic accident victims. Statistical analysis of the data showed that seat belt use has had a positive effect in reducing both road traffic fatalities and multiple injuries in Kuwait. The use of seat belts has also affected the nature of the injuries resulting from road traffic accidents. Non-users of belts experienced higher frequencies of head, face, abdominal and limb injuries. Users of belts, on the other hand, suffered higher frequencies of neck and chest injuries. The interrelationship between the victim, his age, and the type of injuries resulting from road traffic accidents is also investigated.
Injuries sustained by bus passengers in the municipality of Odense 1996-1999.
BACKGROUND: Owing to several recent bus-related accidents in Denmark, we wished to investigate injuries sustained by passengers.
METHODS: From our ongoing registration of patients treated in the casualty department at Odense University Hospital, we identified all residents of Odense Municipality who had sustained injuries as bus passengers from 1996 to 1999. Market analysis and demographic information were used to calculate the incidence and risk.
FINDINGS: Over this four-year period, 327 consecutive injuries had been sustained by 246 bus passengers, 72 men and 174 women, mean ages 44 and 53 years. The incidence rate was 3.3 injured per 10,000 inhabitants per year, with no increasing tendency during the study period. The risk was 2.2 injured per 1,000,000 bus passengers per year, highest in women and increasing with age. Injuries most frequently occurred when the bus stopped (31%), as passengers were boarding or alighting (23%), or during collision with another vehicle (20%). Most commonly injured areas were the lower (30%) and upper (28%) extremities and the head or neck (27%). Contusions and sprains were the most common injuries (59%). The most common fractures were those of the humerus and hip region.
DISCUSSION: Bus passenger injuries are not a growing problem. The incidence increases with age.
Effect of the helmet act for motorcyclists in Thailand.
- Ichikawa M, Chadbunchachai W, Marui E. Accid Anal Prev 2003; 35(2): 183-189.
Correspondence: Masao Ichikawa, Department of Community Health, School of International Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, JAPAN; (email:masao@m.u-tokyo.ac.jp).
OBJECTIVES: This study investigated the effect of the helmet act for motorcyclists on increasing helmet use and reducing motorcycle-related deaths and severe injuries in Thailand.
METHODS: Data were derived from a trauma registry at the Khon Kaen Regional Hospital in the northeast Thailand. Helmet use and outcome in motorcycle crashes were compared 2 years before (1994-1995) and after (1996-1997) enforcement of the helmet act. During the study period, there were 12,002 injured motorcyclists including 129 death cases in the municipality of Khon Kaen Province who were brought to the regional hospital.
RESULTS: After enforcement of the helmet act, helmet-wearers increased five-fold while head injuries decreased by 41.4% and deaths by 20.8%. Those who had head or neck injuries or died were less likely wearing a helmet. Compliance of helmet use was lower at night. Fatality of injured motorcyclists did not significantly decrease in the post-act period and among helmet-wearers.
CONCLUSION: Enforcement of the helmet act increased helmet-wearers among motorcyclists but helmet use did not significantly reduce deaths among injured motorcyclists. Motorcyclists should be instructed to properly and consistently wear a helmet for their safety.
Graduated driver licensing and safer driving.
- McKnight AJ, Peck RC.J Safety Res 2003; 34(1): 85-89.
Correspondence: A. James McKnight, Transportation Research Associates, 78 Farragut Road, 21403, Annapolis, MD, USA; (email: jimmcknight@earthlink.net).
Graduated Driver Licensing (GDL) inserts between the leaner permit and full
licensure an intermediate or "provisional" license that allows novices to drive unsupervised but subject to provisions intended to reduce the risks that
accompany entry into highway traffic. Introduction of GDL has been followed by
lowered accident rates, resulting from both limiting exposure of novices to
unsafe situations and by helping them to deal with them more safely. Sources of
safer driving include extended learning, early intervention, contingent
advancement, and multistage instruction. To extend the learning process, most
GDL systems lengthen the duration of the learner phase and require a specified
level of adult-supervised driving. Results indicate that extended learning can
reduce accidents substantially if well structured and highly controlled. Early
intervention with novice traffic violators have shown both a general deterrent
effect upon novice violators facing suspension and a specific effect upon those
who have experienced it. Making advancement to full licensure contingent upon a
violation-free record when driving on the provisional license has also evidenced
a reduction in accidents and violations during that phase of licensure.
Multistage instruction attempts development of advanced skills only after
novices have had a chance to master more basic skills. Although this element of
GDL has yet to be evaluated, research indicates crash reduction is possible in
situations where it does not increase exposure to risk. While the various
elements of GDL have demonstrated potential benefit in enhancing the safety of
novice drivers, considerable improvement in the nature and enforcement of GDL
requirements is needed to realize that potential.
Stated preference in the valuation of interurban road safety.
- Rizzi LI, Ortuzar Jde D. Accid Anal Prev 2003; 35(1): 9-22.
Correspondence: Juan de Dios Ortúzar, Department of Transport Engineering, Pontificia Universidad Catolica de Chile, Casilla 306, Cod. 105, 22, Santiago, CHILE; (email: jos@ing.puc.cl) or Luis I. Rizzi lrizzi@mecon.gov.ar).
In Chile, as in most less-developed nations, if life savings are valued at all the human capital approach is used in a rather non-consistent fashion. As part of a 5-year research project on the value of transport externalities, a stated preference (SP) experiment was carried out in order to assess the value of a statistical life for Chilean interurban motorways. Interviewees had to choose among different routes for a hypothetical trip, based on the following attributes: travel time, toll charge and level of risk. The results of our experiment show that people were sensitive to the risk variable, thus "stating" a preference for safer routes. Several models were estimated with linear and non-linear utility specifications, and also incorporating the effects of socio-economic variables in a novel and interesting fashion. We were able to estimate subjective values of time consistent with previous values obtained in the country and reasonably looking values (in comparison to Chilean prices and foreign experience) of a statistical life. The paper discusses the experimental design, data collection and analysis, with emphasis on the role of lexicographic individuals that are a feature of SP studies that has not been carefully explored in the literature. We also present our modeling results and compare our derived values (of time and of a statistical life) with values found previously and/or elsewhere.
Although military deployment has been suggested as a possible cause of increases in domestic violence, little is known about it. The purpose of this study was to determine if deployment of 6 months to Bosnia predicted early postdeployment domestic violence. Active duty recently deployed (N = 313) and nondeployed (N = 712) male soldiers volunteered to take an anonymous questionnaire. Deployment was not a significant predictor of postdeployment domestic violence. However, younger soldiers, those with predeployment domestic violence, nonwhite race, and off-post residence also were more likely to report postdeployment domestic violence. The predicted probability of postdeployment domestic violence for a deployed 20-year-old, nonwhite soldier with a history of predeployment domestic violence and who lives on-post was 0.20 For the soldier without a history of predeployment domestic violence, it was 0.05. Prevention and intervention programs for postdeployment domestic violence shortly after return should target age and persons with a domestic violence history rather than deployment per se.
Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases.
- King WJ, MacKay M, Sirnick A. CMAJ 2003; 168(2): 155-159.
Correspondence: W. James King, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1, CANADA; (email: king@cheo.on.ca).
BACKGROUND: Shaken baby syndrome is an extremely serious form of abusive head trauma, the extent of which is unknown in Canada. Our objective was to describe, from a national perspective, the clinical characteristics and outcome of children admitted to hospital with shaken baby syndrome.
METHODS: We performed a retrospective chart review, for the years 1988-1998, of the cases of shaken baby syndrome that were reported to the child protection teams of 11 pediatric tertiary care hospitals in Canada. Shaken baby syndrome was defined as any case reported at each institution of intracranial, intraocular or cervical spine injury resulting from a substantiated or suspected shaking, with or without impact, in children aged less than 5 years.
FINDINGS: The median age of subjects was 4.6 months (range 7 days to 58 months), and 56% were boys. Presenting complaints for the 364 children identified as having shaken baby syndrome were nonspecific (seizure-like episode [45%], decreased level of consciousness [43%] and respiratory difficulty [34%]), though bruising was noted on examination in 46%. A history and/or clinical evidence of previous maltreatment was noted in 220 children (60%), and 80 families (22%) had had previous involvement with child welfare authorities. As a direct result of the shaking, 69 children died (19%) and, of those who survived, 162 (55%) had ongoing neurological injury and 192 (65%) had visual impairment. Only 65 (22%) of those who survived were considered to show no signs of health or developmental impairment at the time of discharge.
DISCUSSION: Shaken baby syndrome results in an extremely high degree of mortality and morbidity. Ongoing care of these children places a substantial burden on the medical system, caregivers and society.
