Correspondence: Ronald V. Maier, Department of Surgery, University of Washington and Harborview Medical Center, Seattle, Washington; USA; (email: unavailable).
BACKGROUND: Alcohol intoxication has long been associated with an increased risk of injury from a number of mechanisms and with trauma recidivism. It is less certain whether alcohol abuse is associated with worse outcomes for a given degree of injury.
METHODS: Review of the pertinent English-language literature.
FINDINGS: The vasodilator effects of alcohol may hamper fluid resuscitation, especially in head-injured patients. Acute and chronic alcohol intoxication both have substantial effects on the cellular and molecular responses necessary to fight infection. High alcohol concentrations exert an immunosuppressive effect on production of proinflammatory cytokines such as tumor necrosis factor and interleukin-1. However, the clinical effects of the immunosuppression are variable and difficult to discern in heterogeneous trauma patient populations with variable degrees of intoxication.
DISCUSSION: Alcohol has a profound impact on the epidemiology of injury, but the physiology and biochemical effects in an individual patient may be difficult to predict. Identification of intoxicated persons is essential, despite economic disincentives to do so, because even brief targeted intervention programs can decrease substantially the patient's risk of subsequent injury.
Effectiveness of a multifaceted intervention on falls in nursing home residents.
- Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, Nikolaus T. J Am Geriatr Soc 2003; 51(3):306-313.
Correspondence: Clemens Becker, Bethesda Geriatric Clinic, Academic Center at the University of Ulm, Ulm, Germany; and Department of Biometry and Medical Documentation, Universitat Ulm, Ulm, GERMANY; (email: unavailable).
OBJECTIVES: To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers. DESIGN: Prospective, cluster-randomized,controlled 12-month trial.
SETTING: Six community nursing homes in Germany.
PARTICIPANTS: Long-stay residents (n = 981) aged 60 and older; mean age 85; 79% female.
INTERVENTIONS: Staff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training, and hip protectors.
MEASUREMENTS: Falls, fallers, and fractures.
FINDINGS: The incidence density rate of falls per 1,000 resident years (RY) was 2,558 for the control group (CG) and 1,399 for the intervention group (IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) = 0.41-0.73). Two hundred forty-seven (52.3%) fallers were detected in the CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57-0.98). The incidence density rate of frequent fallers (>2/year) was 115 (24.4%) for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35-0.89). The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG (RR = 1.11, 95% CI = 0.49-2.51). Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57-1.07).
DISCUSSION: The incidence density rate of falls and fallers differed considerably between the control and intervention groups. The study was underpowered to demonstrate a significant difference of hip or nonhip fractures. Because of a low fracture rate in both groups, the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention.
Preventing Falls in Community-Dwelling Frail Older People Using a Home Intervention Team (HIT): Results From the Randomized Falls-HIT Trial.
Correspondence: Thorsten Nikolaus, Department of Geriatric Medicine, University of Ulm and Bethesda Geriatric Clinic, Ulm, Germany; and Geriatric Department, Katharina Kasper Kliniken, Frankfurt, GERMANY; (email: unavailable).
OBJECTIVES: To evaluate the effect of an intervention by a multidisciplinary team to reduce falls in older people's homes.
DESIGN: Randomized, controlled trial with follow-up of subjects for 1 year.
SETTING: University-affiliated geriatric hospital and older patients' homes.
PARTICIPANTS: Three hundred sixty subjects (mean age +/- standard deviation = 81.5 +/- 6.4) admitted from home to a geriatric hospital and showing functional decline, especially in mobility.
INTERVENTION: The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a diagnostic home visit and home intervention or a comprehensive geriatric assessment with recommendations and usual care at home. The home intervention included a diagnostic home visit, assessing the home for environmental hazards, advice about possible changes, offer of facilities for any necessary home modifications, and training in the use of technical and mobility aids. An additional home visit was made after 3 months to reinforce the recommendations. After 12 months of follow-up, a home visit was made to all study participants.
MEASUREMENTS: Number of falls, type of recommended home modifications, and compliance with recommendations.
FINDINGS: After 1 year, there were 163 falls in the intervention group and 204 falls in the control group. The intervention group had 31% fewer falls than the control group (incidence rate ratio (IRR) = 0.69, 95% confidence interval (CI) = 0.51-0.97). The intervention was most effective in a subgroup of participants who reported having had two or more falls during the year before recruitment into the study. In this subgroup, the proportion of frequent fallers and the rate of falls was significantly reduced for the intervention group compared with the control group (21 vs 36 subjects with recurrent falls, P =.009; IRR = 0.63, 95% CI = 0.43-0.94). The compliance rate varied with the type of change recommended from 83% to 33% after 12 months of follow-up.
DISCUSSION: Home intervention based on home visits to assess the home for environmental hazards, providing information about possible changes, facilitating any necessary modifications, and training in the use of technical and mobility aids was effective in a selected group of frail older subjects with a history of recurrent falling.
BACKGROUND: Industries and occupations vary with respect to the incidence of fatal injuries and their causes.
METHODS: Fatalities from the National Traumatic Occupational Fatality database (years 1983-1994) serve as the basis for examining external cause of death code specific rates. Industries and occupations are compared with respect to rate and frequency of fatal injuries. In addition, external causes of injury (E-codes) are examined across all industries and occupations as well as within industries and occupations to evaluate which events would be identified by frequency ordered comparisons versus injury rate ordered comparisons.
FINDINGS: Machinery,electric current, homicide, falls, and transportation-related events are identified by high frequency and rate of occurrence.
DISCUSSION: The external cause categories of homicide, machinery-related, motor-vehicle-related, electric current, and falls, account for over one-half of all occupational fatal injuries. Targeted interventions in homicide may be especially warranted in sales and service occupations and in the retail trade and services industries. In addition, younger workers might be targeted for special interventions designed to identify hazardous practices, procedures,and solutions to reduce fatalities associated with electrocution or falls from buildings.
External cause-specific summaries of occupational fatal injuries. Part II: An analysis of years of potential life lost.
- Bailer AJ, Bena JF, Stayner LT, Halperin WE, Park RM. Am J Ind Med 2003; 43(3):251-261.
Correspondence: A. John Bailer, Miami University, Department of Mathematics and Statistics, Oxford, Ohio, USA; (email: baileraj@muohio.edu).
BACKGROUND: Fatal injury surveillance data provide an opportunity to assess the impact of occupational injuries and may indicate which industries or occupations are appreciably more hazardous than others, and thus should be given priority in public health intervention.
METHODS: Fatalities from the National Traumatic Occupational Fatality surveillance system served as the basis for examining external cause (E-code) specific impact summaries. Years of potential life lost (YPLL) were calculated for fatal injuries in the years 1983-1994. Industries and occupations were compared with respect to frequency of fatal injuries. In addition, injuries in categories of external causes are examined across all industries and occupations.
FINDINGS: Machinery, electric current, homicide, falls, and transportation-related are the external cause groups highlighted by high frequency/rate of occurrence. Electric current event groups are also characterized by high average YPLL. Poisoning, conflagration, and lightning were also identified in several occupations as having high associated average YPLL.
DISCUSSION: The external-cause-specific analysis of average YPLL identified industries and occupations where, on average, younger workers were dying in fatal injuries. Noteworthy in this assessment were homicides and falls. The YPLL measure coupled with more commonly employed indices (e.g., rates) may provide a fuller description of the impact of occupational fatal injuries.
OBJECTIVE: To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America.
METHODS: We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America.
FINDINGS: In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45%) were in 1-year-old children, 69 (27%) were in 2-year-old children, and 26 (10%) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20,000 children below 13 years of age, for a rate of 1.3 per 1,000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing.
DISCUSSION: There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step.
- Stevenson MR, Rimajova M, Edgecombe D, Vickery K. Pediatrics 2003; 111(2): E115-119.
Correspondence: Mark R. Stevenson, Injury Research Centre, School of Population Health, University of Western Australia, Crawley, WA 6009; AUSTRALIA; (email: marks@dph.uwa.edu.au).
OBJECTIVE: To investigate the causes of child drowning and determine the need for changes in the legislation as well as improvements to the inspection and enforcement of current legislation related to barriers surrounding private swimming pools.
METHODS: There were 3 stages to the study: a retrospective review of coroner's data, an audit of swimming pool inspections, and in-depth interviews with swimming pool inspectors in Western Australia. The incidence of childhood drowning (per population) and compliance rates of swimming pools (per 1000 swimming pools) to the legislation were measured.
FINDINGS: During the 12-year observational period (1988-2000) 50 children younger than 5 years drowned in private swimming pools in Western Australia with an overall incidence of drowning of 4.4 per 100 000 children per year. Sixty-eight percent of drownings occurred in pools that did not have 4-sided fencing with an almost 2-fold increased risk (incidence rate ratio: 1.78; 95% confidence interval: 1.40-1.79) of a child's drowning in a swimming pool with 3-sided versus 4-sided fencing. The compliance rate of swimming pools (compliance to the current legislation) at first inspection was approximately 400 per 1000 swimming pools.
DISCUSSION: Almost two thirds of the swimming pools in which children drowned had only 3-sided fencing. With a combination of a change in legislation, enhanced inspection processes, and public education, the incidence of drowning in private swimming pools in Western Australia could be reduced in the coming years.
Effects of the characteristics of neighbourhoods and the characteristics of people on cause specific mortality: a register based follow up study of 252,000 men.
Correspondence: P Martikainen, Population Research Unit, Department of Sociology, University of Helsinki, Finland International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, UK; (email: pekka.martikainen@helsinki.fi).
OBJECTIVE: To assess the strength of the associations between neighbourhood characteristics and mortality, after adjusting for individual characteristics.
DESIGN AND SETTING: 1990 census records of over 25 year old men in the Helsinki Metropolitan area linked to death records in 1991-1995; almost 1.22 million person years and 15,000 deaths. Individual characteristics were education, occupation based social class, housing tenure, housing density, and living arrangements. Proportion of manual workers,proportion of over 60 year olds, and social cohesion were measured for 55 small areas, and SAS Glimmix was used to fit multilevel models.
FINDINGS: Men in areas with high proportion of manual workers and low social cohesion have high mortality, particularly among 25-64 year olds. About 70% of this excess mortality is explained by compositional differences of people living in these areas. Accidents and violence, circulatory diseases, and alcohol related causes contribute most to these area effects. Area characteristics do not consistently modify or mediate the effects of individual socioeconomic characteristics on mortality.
DISCUSSION: As compared with individual characteristics neighbourhood characteristics have modest independent effects on male mortality. Furthermore, individual socioeconomic characteristics are associated with mortality independently of area characteristics. Rather than the characteristics of areas, other social contexts, such as peer groups and family settings may be more fruitful targets for further research and policy on contextual effects on mortality.
Work injuries among Finnish farmers: A National Register Linkage study 1996-1997.
- Virtanen SV, Notkola V, Luukkonen R, Eskola E, Kurppa K. Am J Ind Med 2003; 43(3): 314-325.
Correspondence: Simo V. Virtanen, Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki, FINLAND; (email: Simo.Virtanen@ttl.fi).
BACKGROUND: Farming is one of the most injury-prone occupations in Finland as it is in other countries. Our goals were to describe work injuries of Finnish farmers and to compare occupational injury rates between various subgroups.
METHODS: A national cohort of 69,629 full-time farmers and their 11,657 compensated injuries were identified from an insurance company database. Cohort data were merged with a population census and farm register. Relative incidence rates were calculated using Poisson regression.
FINDINGS: Men had higher injury rates than women, except with regard to injuries caused by animals. Dairy and hog farming were the riskiest activities, and injury rates increased with the number of dairy cows.
DISCUSSION: One-half of insured farmers in Finland are full-time farmers, which may have lead to underestimation of risk in Finnish injury statistics. Dairy farming is of particular concern because it is both common and has a high injury rate.
Correspondence: Michael Bohnert, Institute of Forensic Medicine, University of Freiburg,Albertstrasse 9, D-79104, Freiburg, GERMANY; (email: bohnert@ukl.uni-freiburg.de).
Among the few cases of suicidal self-incineration primary or secondary complex suicides are a rarity. Accordingly the number of reports on this subject in the forensic literature is small. In a retrospective analysis of the Freiburg and Berlin autopsy material, four cases were found within an observation period of 11 years. These are described together with seven other cases reported in the literature. Altogether most of these suicides are primary combinations, especially with falls from a height. Other combinations include hanging or the infliction of stabs, cuts or gunshot injuries. The sex and age distribution is similar to that found for suicide by self-incineration alone.
Public hazards or private tragedies? An exploratory study of the effect of coroners' procedures on those bereaved by suicide.
Correspondence: Lucy Biddle, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, BS8 2PR, Bristol, UK; (email: lucy.biddle@bristol.ac.uk).
This study in the UK examined how the suicide inquest can affect bereaved relatives and impact upon their grief. In-depth qualitative interviews were conducted with a sample of 16 individuals bereaved by suicide in order to explore their experiences of the inquest. Thematic analysis was used to identify recurrent problems and their effects. Several interviewees had been significantly traumatised by the inquest process. They were particularly disturbed by the judicial atmosphere, media activity, the invasion of privacy, and giving evidence. Exposure to graphic evidence, delayed inquests, confiscated suicide notes and the inquest's failure to provide explanation and deal with blame also presented problems. Difficulties were compounded by a widespread lack of preparation and communication prior to the event. The inquest adversely affected resolution of grief in two main ways: by exacerbating common grief reactions associated with bereavement by suicide, such as, shame, guilt and anger; and, by interfering with necessary grief work, most notably, the task of arriving at a meaningful and acceptable account of the death. Other interviewees described more positive experiences, one of whom regarded the inquest as helpful to their resolution of grief. Whereas these results may not typify all inquest experiences, the findings do suggest that a number of reforms are necessary to avoid the possibility of the inquest distressing this vulnerable group. Ideally, there should be a clear protocol for dealing with bereaved relatives. This is currently lacking in the coroners' system.
BACKGROUND: Previous suicide assessment research has led to standard predictors of risk. Despite this, there are approximately 30,000 suicides per year in the United States, 5% to 6% of which occur in hospitals. The primary purpose of this study is to improve our ability to assess risk and intervene successfully.
METHOD: Charts from 76 patients who committed suicide while in the hospital, or immediately after discharge, were reviewed. The week before suicide was rated for both standard risk predictors and, using items from the Schedule for Affective Disorders and Schizophrenia (SADS), for presence and severity of symptoms found to be correlated with acute risk in recent studies.
FINDINGS: Regarding standard predictors, only 49% (N = 37) had any prior suicide attempt and 25% (N = 19) were admitted for this reason. Thirty-nine percent (30/76) were admitted for suicidal ideation, but 78% denied suicidal ideation at their last communication about this; 46% (N = 35) showed no evidence of psychosis; of those on precautions (N = 45), 51% (N = 23) were on q 15 minute suicide checks or 1:1 observation; and 28% (N = 21) had a no-suicide contract in effect. On SADS ratings, 79% (N = 60) met criteria for severe or extreme anxiety and/or agitation.
DISCUSSION: Standard risk assessments and standard precautions used were of limited value in protecting this group from suicide. Adding severity of anxiety and agitation to our current assessments may help identify patients at acute risk and suggest effective treatment interventions. The importance of a matched comparison group to ascertain if this sample can be blindly discriminated from inpatients who do not commit suicide is clear.
An ecological study of the relations between the recent high suicide rates and economic and demographic factors in Japan.
The male suicide mortality in Japan reached the highest in 1998, since statistics were first recorded in 1899. We investigated whether the recent high suicide rates were associated with economic and demographic factors, using the Pearson's correlation and multivariate regression analyses. The annual numbers of suicide deaths, economic variables, and the proportion of elderly people between 1995 and 2000 were obtained for all the 47 prefectures in Japan. The correlation analyses showed that the male SMR of suicide was mostly associated with the economic variables and the proportion of the elderly men. The female SMR of suicide was associated with the job application rate, and the proportion of elderly women in several years. The multivariate regression analyses showed that the male SMR of suicide was mostly associated positively with the job application rate and the proportion of elderly men and negatively with the amount of household savings and public assistance rate. The largest proportion of the variance of the male SMR of suicide was explained by the set of independent variables in 1998. The goodness-of-fit of the model concerning the female SMR of suicide was poor.
Correspondence: Johannes G. Ramaekers, Experimental Psychopharmacology Unit, Brain & Behavior Institute, Maastricht University, Maastricht, THE NETHERLANDS; (email: unavailable).
BACKGROUND AND METHOD: The current review summarizes the major results from all published studies from 1983 to 2000 (9 double-blind, crossover, placebo-controlled studies in healthy volunteers and 1 double-blind, baseline-controlled study in patients) that have determined the effects of antidepressants on actual driving performance using a standard test. That test measures driving impairment from vehicular "weaving" (i.e., standard deviation of lateral position [SDLP]) during 1 hour of on-the-road driving in normal traffic.
FINDINGS: Changes in SDLP after acute doses of sedating antidepressants (i.e., amitriptyline, imipramine, doxepin, and mianserin) were comparable to those seen in drivers conducting the same test with a blood alcohol concentration of 0.8 mg/mL or more. Driving performance of subjects returned to placebo levels after 1 week of treatment, except after treatment with mianserin, for which the impairing effect lasted unabated over treatment. Nocturnal doses of sedating antidepressants (i.e., dothiepin, mianserin, and mirtazapine), however, did not produce residual driving impairment when measured the next day. Nonsedating antidepressants (i.e., moclobemide, fluoxetine, paroxetine, venlafaxine, and nefazodone) generally did not affect SDLP. However, SDLP rose to unacceptable levels after administration of combinations of nonsedating antidepressants and benzodiazepines with incompatible pharmacokinetic profiles. Correlational analyses demonstrated that conventional tests of psychomotor performance or self-ratings of side effects did not strongly predict antidepressant effects on SDLP. Regression analysis revealed a strong linear relation between antidepressant effects in the standard driving test and the number of patients reporting somnolence in clinical trials with the same antidepressants.
DISCUSSION: Application of actual driving tests remains essential to conclusively defining the potential hazard of drugs for driving.
Rupture of the aorta following road traffic accidents in the United Kingdom 1992-1999. The results of the co-operative crash injury study.
- Richens D, Kotidis K, Neale M, Oakley C, Fails A. Eur J Cardiothorac Surg 2003; 23(2): 143-148.
Department Cardiothoracic Surgery, Nottingham City Hospital, Hucknall Road, Nottingham NG 5 1PB, UK; (email: drichens@ncht.trent.nhs.uk).
OBJECTIVE: The true incidence and survivability of blunt traumatic aortic rupture following road traffic accidents in the UK is unclear. The objective of this study was to determine the extent of blunt traumatic aortic rupture in the UK after road traffic accidents and the conditions under which it occurs.
METHODS: Data for the study was obtained from the Co-operative Crash Injury Study database. Road traffic accidents that happened between 1992 and 1999 and included in the Co-operative Crash Injury Study database were retrospectively investigated.
FINDINGS: A total of 8285 vehicles carrying 14435 occupants were involved in 7067 accidents. There were 132 cases of blunt traumatic aortic rupture, of which the scene survival was 9% and the overall mortality was 98%. Twenty-one percent of all fatalities had blunt traumatic aortic rupture (130/613). Twenty-nine percent were due to frontal impacts and 44% were due to side impacts. Twelve percent of the blunt traumatic aortic rupture cases in frontal vehicle impacts were wearing seat belts and had airbag protection and 19% had no restraint mechanism. The Equivalent Test Speed of the accident vehicles, (where equivalent test speed provides an estimate of the vehicle impact severity and not an estimate of the vehicle speed at the time of the accident), ranged from 30 to 110 km/h in frontal impacts and from 15 to 82 km/h in side impacts.
DISCUSSION: Blunt traumatic aortic rupture carries a high mortality and occurred in 21% of car occupant deaths in this sample of road traffic accidents. Impact scenarios varied but were most common from the side. The use of an airbag or seat belt does not eliminate risk. The injury can occur at low severity impacts particularly in side impact.
BACKGROUND: Health hazards specific to women workers have not been adequately documented. This study assessed military environmental factors associated with rape occurring during military service, while controlling for pre-military trauma experiences.
METHODS: A national cross-sectional survey of 558 women veterans serving in Vietnam or in subsequent eras was obtained through structured telephone interviews.
FINDINGS: Rape was reported by 28% (n = 151) of participants, with consistent rates found across eras. Military environmental factors were associated with increased likelihood of rape, including: sexual harassment allowed by officers (P < 0.0001), unwanted sexual advances on-duty (P < 0.0001) and in sleeping quarters (P < 0.0001).
DISCUSSION: Violence towards military women has identifiable risk factors. Work and living environments where unwanted sexual behaviors occurred were associated with increased odds of rape. Officer leadership played an important role in the military environment and safety of women. Assailant alcohol and/or drug abuse at time of rape was notable. Interventions and policies based on modifiable environmental risk factors are needed to increase protection for women in the workplace.
"They're too smart for that": predicting what children would do in the presence of guns.
Correspondence: Susan M. Conner, Department of Pediatrics, Rainbow Pediatric Trauma Center, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106-6039, USA; (email: susan.connor@uhhs.com).
(Copyright 2003, American Academy of Pediatrics)
OBJECTIVES: We examined parents' beliefs about how children would react to finding guns, with particular emphasis on how parents reasoned about children's actions.
METHODS: Based on a randomized telephone survey of Northeast Ohio residents, we focused on the 317 urban and 311 rural respondents who had children 5 to 15 years old in their homes. Respondents were asked about gun ownership and their expectations of how children would react to finding guns. Analysis examined responses in relation to various demographic and socioeconomic variables.
FINDINGS: All respondents--regardless of gun ownership, geography, race, gender, education level, income, or child age--were equally likely (appro"too smart" or "knew better." Only 40% based their predictions on specific instructions they had given their children. Only 12% (15/122) of owners stored guns locked and unloaded. Only 3 of 13 variables tested were positively associated with safe storage: having a child 5 to 9 years old, having at least a 4-year college education, and having an income >or=65,000 dollars per year.
DISCUSSION: Results indicate that parental beliefs may effectively relieve adults of responsibility and place the burden on children to protect themselves. The implication for injury prevention is that caregivers' unrealistic expectations of children's developmental levels and impulse control may influence storage decisions or the inclination to address gun safety issues with children or other adults with whom children spend time (relatives, playmates' parents).
Violent Women, Blame Attribution, Crime, and Personality.
- Weizmann-Henelius G, Sailas E, Viemero V V, Eronen M. Psychopathology 2002; 35(6): 355-361.
BACKGROUND: The attribution of blame for criminal act has an impact, both on the way the offender must come to terms with the offence and on the risk of recidivism. Blame attribution has been found to be related to the type of crime and personality.
OBJECTIVES: This study examined the relationship of blame attribution and feelings of guilt in violent female offenders, according to factors related to crime, background and personality.
METHODS: The Gudjonsson Blame Attribution Inventory (BAI) and the Defense Style Questionnaire (DSQ) were administered to 58 violent female offenders. The Hare Psychopathy Checklist-Revised (PCL-R), Structured Clinical Interview II for DSM-IV (SCID II) and clinical interviews were used for assessment.
FINDINGS: Lower scores of guilt feelings were found in women than has been reported for men. The feelings of guilt were higher in homicide than in other violent crimes, but lower in the cases where women had committed prior violent crimes. No differences were found between psychiatric patients and prisoners. The duration of hospitalisation and incarceration did not result in differences in blame attribution and guilt, but when the victims survived, guilt feelings seemed to increase with the passing of the time. External attribution was related to motives of crime, but traumatic experiences did not have a crucial impact upon blame attribution. The attribution of blame and the amount of guilt feelings were found to be related to personality. Women scoring high on psychopathy reported less guilt than women with low scores. The corresponding result was not obtained in the group of women with antisocial personality disorder, who, however, showed an unexpectedly low use of external attribution.
DISCUSSION: The results suggest that it might be difficult for women to cope with the violent offence and that the characteristics of psychopathy seems to have a crucial impact on the guilt feelings and consequently on coping with the crime in female offenders.
BACKGROUND AND PURPOSE: The physiology behind sudden violent death is considered in the light of information from a wide variety of clinical, experimental, forensic and veterinary sources. Physiological causes can be classified under the headings of blood loss; asphyxia; electrocution; tissue loss; destruction of brain; disconnection of brain; and poisoning. Death, although sudden, is not necessarily instantaneous; asphyxia and electrocution take some time to kill the subjects.
DISCUSSION: The chemistry of dying, death and changes post mortem, needs more research in order to design further rational resuscitation procedures.
By the time they reach age 18, American children will have seen 16,000 simulated murders and 200,000 acts of violence (American Psychiatric Association, 1998). Media violence can be hazardous to children's health, and studies point overwhelmingly to a causal connection between media violence and aggressive attitudes, values and behaviors in some children (Congressional Public Health Summit, 2000). Through education in clinics, schools, and primary care offices, pediatric nurses can minimize the impact of media violence. They can obtain comprehensive media histories on children and families. They can teach children and parents about the effects of media violence and advise them how to avoid exposure. Nurses can also encourage the entertainment industry to exercise more responsibility in the ways they entertain children.
Domestic abuse in pregnancy: results from a phone survey in northern Israel.
- Fisher M, Yassour-Borochowitz D, Neter E. Isr Med Assoc J 2003; 5(1):35-39.
Correspondence: M. Fisher, Israel Society of Obstetrics and Gynecology in the Community, Emek Yezreel College, ISRAEL; (email: unavailable).
BACKGROUND: Domestic violence is considered a major risk factor in pregnancy.
OBJECTIVES: To assess the prevalence of different kinds of abuse (physical, psychological, sexual) of pregnant as compared to non-pregnant women, and to identify demographic risk factors for physical abuse that characterize the woman and her partner.
METHODS: A cross-sectional survey was conducted in 270 women seeking gynecologic care at women health centers in northern Israel. Information was collected by means of a standardized questionnaire administered via phone, and addressing demographic data, interaction with the partner, and reporting of physical abuse. All information was obtained from the respondents (including information about her partner).
FINDINGS: Four abuse scores were computed: severe physical attack, minor physical attack, psychological abuse, and sexual coercion. Psychological abuse was found to be the most prevalent (24%), followed by minor and severe physical attack (17% and 8.1%, respectively), and sexual coercion (5.6%). Physical attacks related to pregnancy (directed at the abdomen) occurred in 5.4% of the pregnant women. There was no significant difference in the prevalence of the different types of abuse between pregnant and non-pregnant women. Physical attack was associated with socioeconomic status, work status, and degree of religiosity.
DISCUSSION: Pregnant women were at a similar risk for abuse as non-pregnant women in all abuse categories. Predictors for abuse--socioeconomic status and religiosity--were reviewed primarily in a cultural context.
Neighborhood disorder, individual protective factors, and the risk of adolescent delinquency.
Traditionally, violent and delinquent behaviors have been addressed by the criminal justice system, with the focus being secondary and tertiary interventions. During the last decade, the focus on violence as a public health issue has increased. The purpose of this research was to examine how individual protective factors for adolescent delinquency varied according to neighborhood quality. The researcher conducted a secondary data analysis, using data from the National Youth Survey A total of 1,621 adolescents comprised the sample. The majority of the respondents participated in some type of delinquent behavior, with more Blacks reporting participation in violent behaviors. There was a positive relationship between academic history and no participation in delinquent behavior. The regression model for violent delinquency accounted for 10% of the variance in the disordered neighborhoods. Primary prevention efforts, commonly used by public health nurses, should be aimed at eliminating risk factors such as those found in disordered neighborhoods.
Psychosocial needs of young persons who are victims of interpersonal violence.
Correspondence: Leslie S. Zun, Department of Emergency Medicine, Mount Sinai Hospital, 15th and California, Chicago, IL 60608, USA; (e-mail: zunl@sinai.org).
OBJECTIVE Although most emergency departments (EDs) in the United States treat a large number of patients who are victims of interpersonal violence, few address their psychosocial needs. We conducted this study to determine the needs of victims of interpersonal violence using a psychosocial assessment tool administered in the ED.
METHODS We conducted a descriptive study of a prospective, consecutive random sample of young victims of violence in an inner city, level I adult and pediatric ED with 44,000 annual visits. Youths aged 10 to 24 years who were victims of life- or limb-threatening interpersonal violence in 1998 and 1999, excluding domestic violence, sexual assault, and child abuse, were interviewed using an assessment tool designed to determine the psychosocial needs of young persons. The youth assessment tool was composed of 13 constructs, including exposure to violence, legal issues, drug use and abuse, mental health problems, gang issues, gun accessibility, educational needs, employment, life skills, pregnancy and parenting issues, medical care, and recreational activities. The study was approved by our Institutional Review Board.
FINDINGS: We interviewed 112 victims of interpersonal violence with a mean age of 18.6 years; 83.9% were male, 67.9% were African American, and 30.4% were Hispanic. Of the youths interviewed, 72.1% had been shot, 15.3% had been stabbed, and 12.9% had been assaulted. In addition, 66.3% had been involved with the law, 73.7% used alcohol, and 65.3% used illegal drugs. Of the interviewees, 41.2% answered yes to at least one question in the CAGE ( put down on your drinking? annoyed by criticism of your drinking? guilty feeling about your drinking? eye-opener drinking?) assessment, 42.0% reported feeling sad or "down" prior to their injury, and half (54.1%) were involved in a gang. A total of 63.4% of the victims were not in school, did not finish school, or had not obtained a graduate equivalency diploma. The top psychosocial needs were determined to be educational issues (21.8%), occupational issues (ie, job; 16.8%), social issues (eg, gang involvement; 14.9%), and mental health problems (13.2%).
DISCUSSION: Young persons who are victims of interpersonal violence have a significant need for educational support, employment assistance, mental health services, and gang intervention services.
Adolescents exposed to physical violence in the community: a survey in Brazilian public schools.
- Zavaschi ML, Benetti S, Polanczyk GV, Soles N, Sanchotene ML. Rev Panam Salud Publica 2002; 12(5):327-332.
Correspondence: Federal University of Rio Grande do Sul, School of Medicine, Department of Psychiatry,Porto Alegre, Rio Grande do Sul, BRAZIL; (email: zavaschi@terra.com.br).
OBJECTIVE: To determine the proportion of adolescents who have been exposed to physical violence in the city of Porto Alegre, Brazil.
METHODS: Fifty-two Porto Alegre public schools that offer basic primary education (grades 1 to 8) were selected through a random sampling process stratified according to school size. In May-November 2000 a screening survey that identifies exposure to violence--experienced personally, witnessed, or knowing victims of violent acts--was administered to all students who were attending a randomly selected 8th grade class in each of the 52 schools.
FINDINGS: The total number of adolescents included in the analysis was 1,193, representing 10.3% of the students enrolled in 8th grade classes in the city's public school system. On average, each adolescent had been exposed to 19.8 incidents of violence (standard deviation (SD) = 8.5): 2.0 incidents personally experienced (SD = 2.1), 8.5 incidents witnessed (SD = 4.0), and 9.3 knowing a victim of an incident of violence (SD = 4.1). In our sample, the variables of being male (P < 0.0001), being in an older age group (P < 0.001), and not living with both parents (P < 0.001) were independently associated with exposure to more incidents of violence.
DISCUSSION: We found a high prevalence of incidents of violence among the adolescents in our sample in Porto Alegre. Considering the particular burden inflicted by violent acts on adolescents, health professionals must develop effective approaches to activity identifying, intervening in, and preventing community violence.
