The author tested the hypothesis that a history of drug-induced antagonism of alcohol impairment would enhance alcohol tolerance in humans. Groups of participants (N = 21) repeatedly performed a psychomotor task under different drug treatments: 0.65 g/kg alcohol, 4 mg/kg caffeine, or both drugs combined. Tolerance to a 0.65 g/kg alcohol dose challenge was then tested. Results showed that a history of combined alcohol and caffeine administrations increased alcohol tolerance compared with an exposure history to either drug alone. The findings contribute to the understanding of the complexities of polydrug use history and provide a useful model to examine how alcohol tolerance might be affected by a history of coadministration with other drugs (e.g., cocaine and nicotine).
Changing trends in heroin-related deaths in Sydney, Australia-1995 to 1999.
This 1997-1999 study replicates an earlier one (1995-1997) in which coronial cases were reviewed at the Department of Forensic Medicine in Australia. Ten percent of the 2945 cases were considered accidental illicit drug deaths, compared to 4% in the previous study. Heroin was associated with 90% of the deaths, but in only 17% of these cases as a single drug. Concomitant drug use, in particular alcohol, benzodiazepines, and antidepressants, has increased considerably. The combined effects of these substances might play a role in the disturbingly large increase in heroin (morphine) related deaths during this period.
The relationship of alcohol outlet density to heavy and frequent drinking and drinking-related problems among college students at eight universities.
- Weitzman ER, Folkman A, Kerry Lemieux Folkman MP, Wechsler H. Health Place 2003; 9(1): 1-6.
Correspondence: Elissa R. Weitzman, Department of Health & Social Behavior, Harvard School of Public Health, Landmark Center, 401 Park Drive, P.O. Box 15678, 02215, Boston, MA, USA; (email: eweitzma@hsph.harvard.edu).
To determine whether alcohol outlet density was correlated with heavy and frequent drinking and drinking-related problems, we compared ecological measures of outlet density with survey measures of drinking using a geographic information system and the Harvard School of Public Health College Alcohol Study (n=3,421, site n=8). We identified 966 outlets within 8 2-mile study areas. Densities/site ranged from 32 to 185. Density was correlated with heavy drinking (r=0.82, p=0.01), frequent drinking (r=0.73, p=0.04) and drinking-related problems (r=0.79, p=0.02). Women, underage students and students who picked up binge drinking in college were affected. Implications for prevention and research are discussed.
Considerations for more effective social norms based alcohol education on campus: an analysis of different theoretical conceptualizations in predicting drinking among fraternity men.
- Trockel M, Williams SS, Reis J. J Stud Alcohol 2003; 64(1): 50-59.
Correspondence: Mickey Trockel, Department of Community Health, University of Illinois at Urbana Champaign, 120 Huff Hall, 1206 South Fourth Street, Champaign, Illinois 61820, USA; (email: trockel@uiuc.edu).
OBJECTIVES: Recent alcohol education campaigns targeting college students have focused on correcting the erroneous perception students have of the amount of alcohol their peers consume. This strategy is based on assumptions that college students overestimate the amount of alcohol their peers consume and that correcting that misperception will lessen the pressure they feel to consume heavily. However, other theoretical constructs of normative influence may be as or more valuable in improving effectiveness of social norms based education for high-risk college students. This study evaluates the effects of three social normative influence factors on alcohol consumption among fraternity men.
METHODS: Participants were 379 members of randomly selected chapters from two large student fraternity organizations. We used hierarchical linear models to analyze the predictive value of normative influence variables in explaining alcohol consumption differences, both across individuals within chapters and across chapters.
FINDINGS: Perceived consumption norms and perceived subjective norms were significant predictors of alcohol consumption levels. Both normative influence variables are significant in predicting differences in consumption within chapters and across chapters of fraternity men. General approval of alcohol use did not account for significant variance within chapters in consumption or any unique variance in consumption between chapters.
DISCUSSION: Perceived subjective norms as defined by long-standing behavior theory may provide an alternative and potentially more promising intervention target for this high-risk student population than does the current focus on correcting students' errors in estimating the amount of alcohol their peers consume.
Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students.
- Hingson R, Heeren T, Zakocs R, Winter M, Wechsler H. J Stud Alcohol 2003; 64(1): 23-31.
Correspondence: Ralph Hingson, Social and Behavioral Sciences Department, Boston University School of Public Health, 715 Albany Street, T2W, Boston, Massachusetts 02118, USA; (email: rhingson@bu.edu).
OBJECTIVES: This study explored whether college students who were first intoxicated by alcohol at ages younger than 19 are more likely to become alcohol dependent and frequent heavy drinkers, drive after drinking, ride with intoxicated drivers and be injured after drinking. It also investigated whether these results occur because these students believe they can drink more and still drive legally and safely.
METHODS: In 1999, 14,138 of 23,751 full-time 4-year students from a random sample of 119 college and universities nationwide completed self-administered questionnaires (response rate: 60%). This analysis focused on 12,550 who were aged 19 or older. Respondents were asked the age at which they first got drunk, as well as questions about recent alcohol-related behaviors and consequences.
FINDINGS: Compared with respondents first drunk at age 19 or older, those first drunk prior to age 19 were significantly more likely to be alcohol dependent and frequent heavy drinkers, to report driving after any drinking, driving after five or more drinks, riding with a driver who was high or drunk and, after drinking, sustaining injuries that required medical attention. Respondents first intoxicated at younger ages believed they could consume more drinks and still drive safely and legally; this contributed to their greater likelihood of driving after drinking and riding with high or drunk drivers.
DISCUSSION: Educational, clinical, environmental and legal interventions are needed to delay age of first intoxication and to correct misperceptions among adolescents first drunk at an early age about how much they can drink and still drive safely and legally.
- Prince F, Corriveau H, Hebert R and Winter WA. Gait and Posture 1997; 7(2): 128-135.
Correspondence: Francois Prince, Gait and Posture Laboratory, Sherbrooke Geriatric University Institute, University of Sherbrooke Sherbrooke, QC J1H 4C4, CANADA; (email: unavailable).
Walking is one of the most common of all human movements. It exists to transport the body safely and efficiently across ground level, uphill or downhill. Walking is learned during the first year of life and reaches maturity around 7 until 60 years. Elderly walking performance then starts to decline and the elderly slow down gradually. Falls are a major cause of morbidity in the elderly and in almost all incidences of falls, some aspects of locomotion have been implicated. With the increased life expectancy of the elderly and their more active lifestyle there is now an emphasis on determining any changes that occur in their gait patterns in order to reduce the frequency of falls, to identify diagnostic measures that are reliable predictors of fall-prone elderly and finally to develop programs for preventing such falls. This review addresses the gait related changes in the elderly in order to pinpoint the effect of normal aging for comparison with different gait deviations related to some pathologies. Spatio-temporal, kinematics, kinetics and EMG data will be reviewed as well as the physiological changes associated with gait and aging. Finally, the selection criteria will be reviewed and recommendation on the urgent need of a valid healthy elderly database will be addressed.
Integrating safety into the design process: elements and concepts relative to the working situation
- Ra�d Hasan, Alain Bernarda, Joseph Ciccotellib and Patrick Martinc Safety Science 2003; 41(2-3): 155-179.
Correspondence: Ra�d Hasan, Research Centre for Automatic Control, University of Nancy I, Faculte des Sciences, BP 239, F54 506, Vandoeuvre les Nancy Cedex, FRANCE; (email: hasan@cran.uhp-nancy.fr).
The fact that the design of equipment and machines can no longer be separated from the concept of human safety has led to criteria linked to exploitation being taken into account during their design. This paper firstly looks at the problem of integrating safety into the design as early as possible, and goes on to review the state of the art and examine the work known to have been carried out in this respect. The area of application of our research is then presented. The production system analyzed is an offset printing line. We present the results of an analysis of the design process employed in the design and integration company and of how safety is integrated into the design process. The ultimate aim is to provide designers the means of integrating the potential work context at the start of the design process. We propose a system model by defining the working situation and the elements characterizing this situation as well as the concepts relative to these elements. Entity-relationship formalism is used to present the model, which is an extension of the generic model proposed by Harani (Harani, Y., 1997. Une approche Multi-Mod�les pour la capitalisation des connaissances dans le domaine de la conception. PhD Report, Institut National Polytechnique de Grenoble, Laboratoire de G�nie Industriel et de Production M�canique, Grenoble, France).
Ageing effects on the attention demands of walking.
- Sparrow WA, Bradshaw EJ, Lamoureux E, Tirosh O. Hum Mov Sci 2002; 21(5-6): 961-72.
Correspondence: W. A. Sparrow, School of Health Sciences, Deakin University, 221 Burwood Hwy, Burwood 3125, Vic., AUSTRALIA; (email: sparrow@deakin.edu.au).
Attention demands of walking were determined in six male and six female young adults (mean 26.3 yrs) and 12 gender-matched healthy, active older adults (mean 71.1 yrs) using a dual task procedure with a reaction time (RT) secondary task. In three conditions an auditory stimulus, a visual stimulus and both stimuli (auditory/visual) were presented. Relative to no-walking baselines, increased RT was found in all conditions revealing an attentional cost of normal walking. When participants traversed the laboratory walkway and also positioned one of their feet within a target area on the ground, attention demands were greater than in unconstrained walking. In the targeting task, RTs to the visual stimulus were longer than for the auditory stimulus due to the interference associated with viewing both the stimulus monitor and the foot-target. Older participants' RTs in the visual and auditory/visual conditions, but not in the auditory condition, were significantly longer than for the young group in both walking tasks but RTs for young and older adults were not different in no-walking baseline trials. Inspection of mean RT functions at time intervals following gait initiation (0-3000 ms from the first step) suggested a fluctuating attentional cost of walking with increased demands associated with contingencies requiring step length regulation. The findings have applied significance in demonstrating the possibility of increased falls and pedestrian accident risk in older individuals in dual task situations such as road crossing.
Evaluation of safety balls and face guards for prevention of injuries in youth baseball.
- Marshall SW, Mueller FO, Kirby DP, Yang J. JAMA 2003; 289(5): 568-74.
Correspondence: Stephen W. Marshall, CB#7435 McGavran-Greenberg Hall, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 (e-mail: smarshall@unc.edu).
BACKGROUND: Safety balls and face guards are widely used in youth baseball, but their effectiveness in reducing injury is unknown.
OBJECTIVE: To evaluate the association of the use of face guards and safety balls and injuries in youth baseball.
DESIGN, SETTING, AND PARTICIPANTS: Ecological study using a national database of compensated insurance claims maintained by Little League Baseball Incorporated, combined with data on the number of participants in Little League and data from a census of protective equipment usage for youth aged 5 to 18 years participating in Little League Baseball in the United States during 1997-1999.
MAIN OUTCOME MEASURES: Rate of injury and injury rate ratio comparing users with nonusers of protective equipment.
FINDINGS: A total of 6 744 240 player-seasons of follow-up and 4233 compensated injury claims were available for analysis. The absolute incidence of compensated injury per 100 000 player-seasons was 28.02 (95% confidence interval [CI], 26.76-29.29) for ball-related injury and 2.71 (95% CI, 2.32-3.11) for facial injury. Overall, use of safety balls was associated with a reduced risk of ball-related injury (adjusted rate ratio, 0.77; 95% CI, 0.64-0.93). This reduction was essentially due to 1 type of safety ball, known as the reduced-impact ball (adjusted rate ratio, 0.72; 95% CI, 0.57-0.91). Use of face guards reduced the risk of facial injury (adjusted rate ratio, 0.65; 95% CI, 0.43-0.98). Metal and plastic guards appeared to be equally effective. Safety balls appeared to be more effective in the minor division (ages 7-12 years) than in the regular division (ages 9-12 years).
DISCUSSION: Reduced-impact balls and face guards were associated with a reduced risk of injury in youth baseball. These findings support increased usage of these items; however, it should be noted that the absolute incidence of injury in youth baseball is low and that these equipment items do not prevent all injuries.
Parachuting: a sport of chance and expense.
- Baiju DS, James LA. Injury 2003; 34(3): 215-217.
Correspondence: Dean Bajiu, C/O L.A. James, Department of Orthopaedic and Trauma, Horton General Hospital, 47 Gospel Farm Road, Acocks Green, B27 7JN, Birmingham, UK; (email: deanbaiju@hotmail.com).
This paper seeks to determine the cost to the NHS associated with treating parachute-related injuries. More specifically, it compares the training received by civilians to that received by military personnel together with the types of parachutes used or the type of jump. It also reviews the information given to civilian jumpers prior to their first jump. Fifty-three jumpers suffered injuries in the period under review. Of these, 32 cases with 41 injuries were transferred to Accident and Emergency Department for treatment. Injuries involved most of the musculoskeletal system. Twenty-six (n=32) patients were admitted for treatment, with an average length of hospital stay of 6.8 days. Post-discharge, the length of time lost from work was 42.8 days. The cost to the NHS was calculated at pound 4026.50 per patient treated. This did not include time lost from work, subsequent follow up or any other secondary procedures. Civilian parachute jumpers were trained for 6.5h compared to 31.5h for military personnel. Twenty-seven patients used rectangular rather than circular parachutes. Thirty of the 41 injuries occurred during static line jumps, with 7 occurring during tandem jumps and only 5 during free-fall jumps. Twenty-three of the 32 jumpers sustained the injury during their first jump. First-time civilian jumpers were given a minimum of information regarding risks and injuries prior to their jump and were inadequately insured against potential injuries. The cost of caring for these patients is substantial when compared to the money that is raised for charity during some of the jumps. Private insurance, with the NHS legally able to claim expenses would help to offset these medical costs. It is also possible that by increasing civilian training, there may be a reduction in the number of injuries sustained by first-time civilian jumpers from 1.1 to 1.2% (11% in charity jumps) to the military figures of 0.22-0.89%.
All-terrain vehicles-unstable, unsafe and unregulated. A prospective study of ATV-related trauma in rural Ireland.
- Moroney P, Doyle M, Mealy K. Injury 2003; 34(3): 203-205.
Correspondence: P. Moroney, Department of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, IRELAND; (email: p_moroney@hotmail.com).
All-terrain vehicles (ATVs) are fast, powerful machines that pose a significant threat to public safety. In the USA, ATVs are responsible for 273 deaths and over 68,000 injuries each year. As the incidence of ATV-related accidents in Britain and Ireland is unknown we carried out a prospective audit of all patients presenting to our Accident and Emergency Departments with ATV-related trauma over a 1-year period. Of 32 patients with ATV-associated injuries, 10 were under 16 years of age and 23 had no previous experience of operating an ATV. We documented 24 fractures (2 open) and 1 tension pneumothorax. Helmet usage was high and head injuries were few and not of a serious nature. Two-thirds of injuries occurred on commercial adventure sports courses. Since ATVs are off-road vehicles, they are exempt from safety regulations that apply to other forms of transport. As care-providers to trauma victims, we must make prevention of these injuries a priority and campaign for both voluntary and legislative controls to make ATV use a safer leisure pursuit.
Sports injury or trauma? Injuries of the competition off-road motorcyclist.
Correspondence: N. T. Colburn, Division of Orthopaedics, University of Alabama Medical Center, and the Baptist Health Systems, 3317 Teakwood Road, Birmingham, AL 35226, USA; (email: colburncycle1@aol.com).
A prospective analysis of the injuries of off-road competition motorcyclist at four International Six Day Enduro (ISDE) events was performed utilizing the injury severity score (ISS) and the abbreviated injury scale (AIS). Of the 1787 participants, approximately 10% received injuries that required attention from a medical response unit. The majority (85%) sustained a mild injury (mean ISS 3.9). Loss of control while jumping and striking immovable objects were important risk determinants for serious injury. Although seasoned in off-road experiences, mean 15.3 years, 54% of those injured were first year rookies to the ISDE event. Speeds were below 50 km/h in the majority of accidents (80%), and were not statistically correlated with severity. The most frequently injured anatomical regions were the extremities (57%). The most common types of injury were ligamentous (50%). Seventy-seven percent of all fractures were AIS grades 1 and 2. The most common fractures were those of the foot and ankle (36%). Multiple fractures involving different anatomical regions, or a combination of serious injuries was seen with only one rider. When compared to the injuries of the street motorcyclist, competition riders had lower AIS grades of head and limb trauma. Off-road motorcycle competition is a relatively safe sport with injury rates comparably less than those of contact sports such as American football and hockey.
Recovery from mild concussion in high school athletes.
- Lovell MR, Collins MW, Iverson GL, Field M, Maroon JC, Cantu R, Podell K, Powell JW, Belza M, Fu FH. J Neurosurg 2003; 98(2): 296-301.
Correspondence: Mark Lovell, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; (email: lovellmr@msx.upmc.edu).
OBJECTIVES: A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion.
METHODS: Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury.
FINDINGS: High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a non-injured control group. Statistically significant differences between preseason and post-injury memory test results were still evident in the concussion group at 4 and 7 days post-injury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and post-traumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days post-injury and was also related to slower resolution of self-reported symptoms.
DISCUSSION: The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting post-concussion symptoms and memory decline.
Use of an electronic medical record improves the quality of urban pediatric primary care.
- Adams WG, Mann AM, Bauchner H. Pediatrics 2003; 111(3): 626-632.
Correspondence: William G. Adams, Division of General Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; (email: unavailable).
OBJECTIVE: To evaluate the quality of pediatric primary care, including preventive services, before and after the introduction of an electronic medical record (EMR) developed for use in an urban pediatric primary care center.
METHODS: A pre-post-intervention analysis was used in the study. The intervention was a pediatric EMR. Routine health care maintenance visits for children <5 years old were reviewed, and documentation during pre-intervention (paper-based, 1998) and post-intervention visits (computer-based, 2000) was compared.
FINDINGS: A total of 235 paper-based visits and 986 computer-based visits met study criteria. Twelve clinicians (all attendings or nurse practitioners) contributed an average of 19.4 paper-based visits (range: 5-39) and 7 of these clinicians contributed an average of 141 computer-based visits each (range: 61-213). Computer-based clinicians were significantly more likely to address a variety of routine health care maintenance topics including: diet (relative risk [RR]: 1.09), sleep (RR: 1.46), at least 1 psychosocial issue (RR: 1.42), smoking in the home (RR: 15.68), lead risk assessment (RR: 106.54), exposure to domestic or community violence (RR: 35.19), guns in the home (RR: 58.11), behavioral or social developmental milestones (RR: 2.49), infant sleep position (RR: 9.29), breastfeeding (RR: 1.99), poison control (RR: 3.82), and child safety (RR: 1.29). Trends toward improved lead exposure, vision, and hearing screening were seen; however,differences were not significant. Users of the system reported that its use had improved the overall quality of care delivered, was well-accepted by families, and improved guidance quality; however, 5 of 7 users reported that eye-to-eye contact with patients was reduced, and 4 of 7 reported that use of the system increased the duration of visits (mean: 9.3 minutes longer). All users recommended continued use of the system.
DISCUSSION: Use of the EMR in this study was associated with improved quality of care. This experience suggests that EMRs can be successfully used in busy urban pediatric primary care centers and, as recommended by the Institute of Medicine, must play a central role in the redesign of the US health care system.
Implementing a hospital-based violence-related injury surveillance system--a background to the Jamaican experience.
- Ward E, Durant T, Thompson M, Gordon G, Mitchell W, Ashley D; Violence-Related Injury Surveillance System. Inj Control Saf Promot 2002; 9(4): 241-247.
Correspondence: Elizabeth Ward, Division of Health Promotion and Protection, Ministry of Health, 2-4 King Street, Kingston, JAMAICA; (email: warde@moh.gov.jm).
Violence, a leading cause of injuries and death, is recognized as a major public health problem. In 1996, injuries were the second leading cause of hospitalizations in Jamaica. The estimated annual cost of in-patient care for injuries was 11.6 million US dollars. To develop strategies to reduce the impact of violence-related injuries on Jamaican health care resources, the Ministry of Health, Division of Health Promotion and Protection (MOH/DHPP) in collaboration with the Centers for Disease Control and Prevention and the Tropical Metabolic Research Institute, University of the West Indies Mona, designed and implemented a violence-related injury surveillance system (VRISS) at Kingston Public Hospital (KPH). In 1998, the VRISS, based on the International Classification of External Cause of Injury (ICECI), was implemented in the accident and emergency (A&E) department of Jamaica's tertiary care hospital, KPH. VRISS collects demographic, method and circumstance of injury, victim-perpetrator relationship and patient's discharge status data. From 8/1/98 to 7/31/99, data on 6,107 injuries were collected. Injuries occurred primarily among males aged 25-44 years. Most injuries (54%; 3171) were caused by use of a sharp object. Nearly half (49%; 2992) were perpetrated by acquaintances. The majority, 70% (4,252), were the result of a fight or argument and 17% were admitted to the hospital. The VRISS utilized A&E department data to characterize violence-related injuries in Jamaica, a resource-limited environment. These data will be used to guide intervention development to reduce violence-related injuries in Jamaica.
Comparative evaluation of different modes of a national accident and emergency department-based injury surveillance system: Jamaican experience.
- Arscott-Mills S, Holder Y, Gordon G; Jamaican Injury Surveillance System. Inj Control Saf Promot 2002; 9(4): 235-239.
Correspondence: Sharon Arscott-Mills, Health Promotion and Protection Division, Ministry of Health, 2-4 King St., Kingston, JAMAICA; (email: millss@moh.gov.jm).
The objective was to conduct a comparative evaluation of two injury surveillance systems in operation in the Accident and Emergency departments of public hospitals in Jamaica. The evaluation was conducted at 12 hospitals across Jamaica offering varying levels of service delivery. It was designed in three phases: (1) a retrospective review of surveillance system data; (2) prospective process evaluation; (3) system environment evaluation. These data were analyzed to determine the sensitivity and specificity of the manual Accident & Emergency Statistical Report (A&ESR) versus the computer-based Patient administration system/Jamaica injury surveillance system (PAS/JISS), and to determine an injury registration rate. Results showed a variation from 8% to 27% in injury registration rates at the hospitals reviewed. The sensitivity of the computer-based PAS ranged from 29.7% to 97.1% while the sensitivity of the manual system ranged from 22.1% to 100%. The computer-based system generally detected a greater percentage of injuries. Problems were identified with missing data fields in the computer-based system, while problems of recording and transcription were identified in the manually-based system. Recommendations were made to improve data quality in both data collection systems. Although shortcomings were identified with the A&ESR, the system is performing the function for which it was designed, that of tracking A&E workload. The PAS/JISS is more user-friendly and a truer reflection of the injury situation.
The establishment of a Jamaican all-injury surveillance system.
- Ward E, Arscott-Mills S, Gordon G, Ashley D, McCartney T; Jamaican Injury Surveillance System. Inj Control Saf Promot 2002; 9(4): 219-225.
Correspondence: Elizabeth Ward, 4th Floor, Ministry of Health, 2-4 King Street, Kingston, JAMAICA; (email: warde@moh.gov.jm).
The impact of injuries on the Jamaican health care system is a growing problem. Based on the successful implementation of a Violence-Related Injury Surveillance System (VRISS) in the Accident and Emergency (A&E) department of the Kingston Public Hospital (KPH), Ministry of Health (MOH) officials decided to expand the system to the Jamaica Injury Surveillance System (JISS), allowing for the surveillance of both intentional and unintentional injuries. A working group designed the expanded injury surveillance system based on the International Classification of External Causes of Injury. The expanded system allowed for the collection of data on all injuries seen in the A&E departments by adding four injury projects to the computerized A&E registration process. These were (1) unintentional injury, (2) violence-related injury, (3) suicide attempt (also known as intentional self-harm) and (4) motor vehicle-related injuries. The expanded JISS was implemented at the KPH and four additional hospitals across the island. The geographic distribution of these hospitals provided a reflection of rural and urban, highland and coastal communities and their distinctive injury profiles. Data collected at registration were printed on trauma sheets and reviewed by medical staff before being incorporated into the patient's record. Monthly reports detailing demographics and summary statistics were generated and made available at the local and national level. By monitoring the national injury profile, the JISS provides data to support needed policy changes to minimize the impact of injuries on the health services and on the health of the population.
Seasonal variation in the incidence of wrist and forearm fractures, and its consequences.
- Wareham K, Johansen A, Stone MD, Saunders J, Jones S, Lyons RA. Injury 2003; 34(3): 219-22.
Correspondence: Antony Johansen, Bone Research Unit, Academic Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, UK; (email: fiant@ukonline.co.uk).
We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of wrist and forearm fractures. We examined seasonal variation in the incidence of these injuries, and looked at resulting pressures on outpatient and inpatient trauma services. AWISS collected data from eight Accident and Emergency (A&E) departments which between them serve a total of 1.2 million people in South Wales. During a single year, we identified all 5013 people who presented with a wrist or forearm fracture. Seasonal variation in wrist/forearm fracture incidence was apparent, but showed a different pattern in different age groups. Overall incidence figures were dominated by an increase in children's fractures in spring and summer. Children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year).In contrast, older people showed a higher incidence in the winter. During the winter months people aged over 75 sustained a total of 160 wrist/forearm fractures; an incidence of 8.2/1000 per year, significantly higher than the incidence observed in other months (5.8/1000 per year). Seasonality of incidence was not apparent in other age groups. Children presenting during the spring and summer months were significantly more likely to need admission to hospital; 22.8% were admitted compared with just 10.3% of those presenting during the winter months (P<0.001, chi(2)-test). Other age groups showed no significant seasonal variation in the likelihood of hospital admission.
Incidence and characteristics of falls leading to hospital treatment: a one-year population surveillance study of the Danish population aged 45 years and over.
- Hoidrup S, Sorensen TI, Gronbaek M, Schroll M. Scand J Public Health 2003; 31(1): 24-30.
Correspondence: Susanne Høidrup, Danish Epidemiology Science Centre at the Institute of Preventive Medicine, Copenhagen University Hospital, DENMARK; (email: sh@ipm.hosp.dk).
OBJECTIVES: The aim was to quantify and characterize the incidence of fall injury events among middle-aged and older adults who require acute medical attention at Danish hospitals.
METHODS: A one-year population surveillance study was carried out, based on the Danish National Hospital Register (DNHR), which covers all somatic hospital discharges and accident and emergency (A&E) services at hospitals in Denmark.
FINDINGS: During 1996 a total of 81,121 fall injury events were treated at A&E departments or resulted in admission to a somatic hospital department among Danes aged 45 years and over. Up to age 50 years the incidence rates of injurious fall events requiring medical attention were similar in men and women. At age 50 years, the incidence rates in women exceeded the rates in men and remained 1.2-1.8 times higher thereafter. After age 70 years, the rates increased exponentially in both sexes: from 27.4 and 49.3 per 1,000 person-years in men and women, respectively, to peaks of 112.8 and 170.8 per 1,000 person-years, respectively, at age 85 years and over. The proportion of falls occurring indoors and in institutional settings increased with advancing age. Compared with men, women had higher rates of fall-related contusions, distortions and fractures at all ages.
DISCUSSION: Fall-prevention programs should be directed towards the population aged 70 years and over, in particular towards women and hazards in residential environments. Our finding of an increasing incidence of injurious fall events among women around the time of the menopause raises the hypothesis that loss of estrogen production plays a role in the etiology of falls in women.
Seasonal variation of proximal femoral fractures in the United Kingdom.
- Crawford JR, Parker MJ. Injury 2003; 34(3): 223-225.
Correspondence: John R. Crawford, 33 Kingfisher Way, Cottenham, Cambridge CB4 8XN, , UK; (email: jrcrawford@orthopaedics.com).
A prospective study including 3034 consecutive hip fracture patients admitted to a single unit in the United Kingdom over a 12-year period was performed. The daily incidence of hip fractures was compared between all four seasons throughout the year. Information was recorded for each patient including level of mobility, mental test score, type of residence, fracture type and total length of stay. Mortality rates at 30, 120 and 365 days were also calculated.
More hip fractures occurred during the winter compared to summer (P=0.002). There was an increase in the number of extracapsular fractures (P=0.006) and tendency to a higher mortality for those patients admitted in the winter months. There was no significant difference in patient characteristics between the winter and summer seasons. Funding and resources within the health service may need to be adjusted to accommodate this variation in patient load.
A profile of injuries in Jamaica.
- Arscott-Mills S, Gordon G, McDonald A, Holder Y, Ward E. Inj Control Saf Promot 2002; 9(4): 227-234.
Correspondence: Sharon Arscott-Mills, Division of Health Promotion and Protection, Ministry of Health, 2-4 King St., Kingston, JAMAICA; (email: millss@moh.gov.jm).
This study analyses 6 months of data from three hospitals participating in the computerized emergency room-based Jamaica Injury Surveillance System (JISS) since 1999. The categories of injuries tracked were unintentional, violence-related and motor vehicle-related. The resultant data showed that injuries comprised 17% (12,179) of all Accident and Emergency (A&E) department registrations for the period. The highest percentage of injuries were violence-related (51%, 6,380), followed by unintentional injuries (33%, 4,030) and motor vehicle-related (15%, 1,769). Injury profiles varied by institution with the majority of Cornwall Regional Hospital's and Kingston Public Hospital's injuries being intentional while that of May Pen Hospital was unintentional. The data also demonstrate that young males are at highest risk for all types of injuries as well as for the more severe injuries requiring hospital admission. The risk factor data provided through the JISS will inform and guide private and public sector efforts to address the problem of injuries in Jamaica.
Patterns of alcohol use among Australian secondary students: results of a 1999 prevalence study and comparisons with earlier years.
- White VM, Hill DJ, Effendi Y. J Stud Alcohol 2003; 64(1): 15-22.
Correspondence: Vicki M. White, Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, Victoria 3053, AUSTRALIA; (email:. vicki.white@cancervic.org.au).
OBJECTIVE: This study was initiated to estimate the prevalence of alcohol use among Australian secondary students in 1999 and to examine changes in that prevalence over a 15-year period between 1984 and 1999.
METHOD: A randomly selected representative sample of approximately 400 secondary schools across Australia participated in the study. At each school, up to 80 randomly selected students completed a pencil-and-paper questionnaire anonymously. RESULTS: The use of alcohol by secondary students was widespread in 1999. By the age of 15, 44% of boys and 36% of girls had consumed alcohol in the week before the survey. Among 16 and 17 year olds, about 50% had consumed alcohol in this time period. Of 16 and 17 year olds who had consumed alcohol in the past week, around 35% had drunk at hazardous levels. Long-term trends in alcohol use showed declines during the late 1980s but increases through the 1990s. While the proportion of hazardous drinkers among 12-15 year olds had not changed throughout the 1990s, the proportion among 16 and 17 year olds had increased over the period of the survey. The proportion of current drinkers buying the last alcoholic drink consumed had decreased since 1987, although there was no change between 1996 and 1999 among 16 and 17 year olds. CONCLUSIONS: Alcohol is widely used by secondary students in Australia, and significant proportions of the student population drink at hazardous levels.
Association of comorbid post-traumatic stress disorder and major depression with greater risk for suicidal behavior.
- Oquendo MA, Friend JM, Halberstam B, Brodsky BS, Burke AK, Grunebaum MF, Malone KM, Mann JJ. Am J Psychiatry2003; 160(3): 580-582.
Correspondence: Maria A. Oquendo, Department of Psychiatry, College of Physicians and Surgeons at Columbia University, NY, USA; (email: mmao4@columbia.edu).
OBJECTIVE: Post-traumatic stress disorder (PTSD) increases the risk of suicidal behavior; a major depressive episode also increases the risk for suicidal behavior. The authors' goal was to examine the effect of comorbid PTSD and major depressive episode on suicidal behavior.
METHOD: Inpatients with a diagnosis of major depressive episode (N=156) were assessed for PTSD, suicidal behavior, and clinical risk factors for suicidal acts.
FINDINGS: Patients with comorbid major depressive episode and PTSD were more likely to have attempted suicide, and women with both disorders were more likely to have attempted suicide than men with both disorders. Cluster B personality disorder and PTSD were independently related to history of suicide attempts.
DISCUSSION: The greater rate of suicide attempts among patients with comorbid PTSD and major depressive episode was not due to differences in substance use, childhood abuse, or cluster B personality disorders.
Sexual orientation and self-harm in men and women.
- Skegg K, Nada-Raja S, Dickson N, Paul C, Williams S. Am J Psychiatry 2003; 160(3): 541-546.
Correspondence: Keren Skegg, University of Otago, 2nd floor Fraser Building, Cumberland Street, Health Sciences, Dunedin School of Medicine, NEW ZEALAND; (email: keren.skegg@stonebow.otago.ac.nz).
OBJECTIVE: Recent studies of homosexual people have found higher rates of nonfatal suicidal behavior than among heterosexuals. The purpose of this study was to determine associations between self-harm and sexual orientation for men and women separately, defining sexual orientation by sexual attraction rather than by behavior.
METHOD: In a birth cohort of 1,019 New Zealand young adults eligible to be interviewed at age 26 years, 946 participated in assessments of both sexual attraction and self-harm.
FINDINGS: Both women and men who had experienced same-sex attraction had higher risks of self-harm. The odds ratios for suicidal ideation in the past year were 3.1 for men and 2.9 for women. Odds ratios for ever having deliberately self-harmed were 5.5 for men and 1.9 for women. Men with same-sex attraction were also significantly more likely to report having attempted suicide. In both sexes, a greater degree of same-sex attraction predicted increasing likelihood of self-harm, with over one-third of men and women with persistent major same-sex attraction reporting this. Men with even a minor degree of same-sex attraction had high rates of self-harm and resulting physical injury. One-quarter of deliberate self-harm among men and one-sixth among women was potentially attributable to same-sex attraction.
DISCUSSION: This study provides evidence of a link between increasing degrees of same-sex attraction and self-harm in both men and women, with the possibility of some difference between the sexes that needs to be explored further.
Suicide prevention: a study of patients' views.
- Eagles JM, Carson DP, Begg A, Naji SA. Br J Psychiatry 2003; 182(3): 261-265.
Correspondence: John M Eagles, Royal Cornhill Hospital, Cornhill Road, Aberdeen AB25 2ZH, UK; (email: unavailable).
Background Suicide prevention strategies are usually formulated without seeking the views of people with psychiatric illnesses. Aims To establish what helped patients with severe psychiatric illness when they felt suicidal. Method A semi-structured interview was constructed following transcribed interviews with 12 patients. This was administered to 59 out-patients with serious and enduring mental illness, focusing on factors they found helpful or unhelpful when at their most despairing. Results Three-quarters of patients were in contact with psychiatric services when feeling at their lowest, and this contact was generally deemed to be helpful. Social networks were considered just as helpful as psychiatric services by the half of patients who discussed their feelings with friends or relatives. Religious beliefs and affiliations were helpful. Negative influences included the media and the stigma of psychiatric illness. Conclusions Efforts at suicide prevention might usefully focus on enhancing patients' social networks, increasing the likelihood of early contact with psychiatric services and decreasing the stigma attached to psychiatric illness. Larger studies of patients exposed to different service models would be informative.
Psychiatric Emergency Services and the System of Care
OBJECTIVE: Admissions to psychiatric emergency services have frequently been cited as a gauge of how well a mental health system manages behavioral disorders. However, few measurements of the longitudinal association between psychiatric emergencies and characteristics of a mental health system have been described. The purpose of this study was to assess whether weekly admissions to psychiatric emergency services would increase when outpatient services were reduced, whether weekly admissions would increase when greater effort was made to identify and treat persons with acute mental illness, and whether weekly admissions would decrease when emergency services were enhanced to include postrelease case management.
METHODS: Time-series methods were applied to approximately 29,010 admissions to three psychiatric emergency services of the San Francisco Department of Public Health over a 180-week period.
FINDINGS: Reduced outpatient services, efforts to identify acutely ill persons, and changes in emergency services themselves were found to affect admissions to emergency services. However, community events such as extreme weather, holidays, job loss, and the scheduling of receipt of income also affected the workload of the emergency service.
DISCUSSION: The causes and course of mental illness inextricably tie a psychiatric emergency service to the overall mental health system and to events in the community it serves. These connections make it possible for managers to anticipate the use of emergency services and to detect disruptions in the remainder of the mental health services systems.
Factors Related to Psychiatric Hospital Readmission Among Children and Adolescents in State Custody
- Romansky JB, Lyons JS, Lehner RK, West CM. Psychiatr Serv 2003; 54: 356-362.
OBJECTIVE: This study examined factors related to psychiatric hospital readmission among children and adolescents who were wards of the Illinois Department of Children and Family Services.
METHODS: The authors analyzed service reports and clinical ratings on the Childhood Severity of Psychiatric Illness (CSPI) for 500 randomly selected children and adolescents who underwent psychiatric hospitalization. Children who were readmitted to the hospital within three months of discharge from the index hospitalization were compared with those who were not readmitted in terms of preadmission factors, clinical characteristics at the index hospitalization, services in the hospital, and posthospital services.
FINDINGS: The children who were readmitted were rated as more learning disabled or developmentally delayed and had received fewer posthospital service hours than the children who were not readmitted. The highest rates of readmission were found among children who lived in congregate care settings before the index hospitalization and those who lived in a rural region.
DISCUSSION: The findings of this study highlight the significance of enabling factors, notably living arrangement, geographic region, and posthospital services, for children and adolescents in the child welfare system. Prevention of readmission among these children must focus on community-based services.
Clinical Utility and Policy Implications of a Statewide Mental Health Screening Process for Juvenile Offenders
- Stewart DG, Trupin EW. Psychiatr Serv 2003; 54: 377-382.
OBJECTIVES: This study examined the utility of screening adjudicated juvenile offenders for mental health symptoms at intake to the State of Washington Juvenile Rehabilitation Administration. The authors assessed the ability of a screening measure, the Massachusetts Youth Screening Inventory, second edition (MAYSI-2), to identify youths with mental health problems and co-occurring substance use problems. This study also examined the relationship of these symptoms to treatment utilization both before and after intake to the juvenile justice system. Ethnic and gender differences in the screening results were studied.
METHODS: The MAYSI-2 was administered to 1,840 youths consecutively admitted to state custody. Cluster analysis was used to group the youths by mental health symptom status, and the relationship between symptoms and treatment utilization was tested in the groups identified in the cluster analysis.
FINDINGS: Youths who reported a high level of mental health symptoms, with or without co-occurring substance use problems, were more likely to have received previous mental health treatment than youths with a low level of mental health symptoms. Youths with a high level of mental health symptoms were more likely to receive extraordinary sentences and were thus less likely to be eligible for community transition programs than youths with a low level of mental health symptoms. Significant gender and ethnic differences in mental health symptom reporting on the screening inventory were found. Female offenders were significantly more likely than male offenders to report a high level of symptoms, and Hispanic youths were significantly less likely than youths in other ethnic groups to report a high level of symptoms.
DISCUSSION: The MAYSI-2 has utility in identifying youths in the juvenile justice system who have mental health problems, and MAYSI-2 results are related to use of treatment services both before and after intake to the juvenile justice system. Ethnic and gender differences in MAYSI-2 reporting must be considered in interpreting mental health screening data.
Correspondence: Richard Mayou, Department of Psychiatry, Warneford Hospital, Oxford University, OX37JX, Oxford, UK; (email: richard.mayou@psych.ox.ac.uk).
The study aimed to describe the immediate and later physical, social and psychological consequences of a road traffic accident for vehicle occupants, motorcyclists, cyclists and pedestrians amongst consecutive hospital attenders at an Accident and Emergency Department. Physical and accident details were collated from hospital records. Subjects completed questionnaires at hospital attendance, 3 months, 1 and 3 years. There were 1148 respondents from 1441 consecutive attenders over a 1-year period. The main outcome measures were self-report physical status, standard measures of post-traumatic stress disorder, mood, travel anxiety and health status at 3 months, 1 and 3 years. There were marked differences in injury pattern and immediate reaction between road user groups. Pedestrians and motorcyclists suffer the most severe injuries and report more continuing medical problems and greater resource use, especially in the first 3 months. There were few differences in psychological or social outcomes at any stage of follow-up. Despite differences between the road user groups in their injuries, immediate reactions and treatment, there were few longer-term differences. A third of all groups described chronic adverse consequences which were principally psychological, social and legal.
Drinking, cannabis use and driving among Ontario students.
- Adlaf EM, Mann RE, Paglia A. CMAJ 2003 Mar 4;168(5): 565-566.
Correspondence: Edward M. Adlaf, Population and Life Course Studies, Centre for Addiction and Mental Health, 33 Russell St., Toronto ON M5S 2S1, CANADA; (email: edward_adlaf@camh.net).
Little is known about the risks of injury among adolescents who drive after the use of alcohol or cannabis or ride in cars driven by drunk drivers. We examined data from self-administered interviews with 1846 students in grades 7 to 13 who participated in the 2001 Ontario Student Drug Use Survey about their experiences related to alcohol, cannabis and driving during the 12 months preceding the survey. In all, 31.9% of the students reported being a passenger in a car driven by a drunk driver; of the students in grades 10 to 13 who had a driver's licence, 15.1% reported driving within an hour after consuming 2 or more drinks, and 19.7% reported driving within an hour after using cannabis. Our study shows that a sizeable proportion of adolescents are exposed to alcohol- and drug-related driving risks.
The effects of alcohol on driving-related sensorimotor performance across four times of day.
Correspondence: John Dalrymple-Alford, Christchurch Movement Disorders and Brain Research Group, Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch 8004, NEW ZEALAND, (email: psyc338@psyc.canterbury.ac.nz).
OBJECTIVES: The effect of alcohol on driving-related tracking tasks at four times of day was examined to address concerns that the legal driving alcohol threshold in New Zealand (80 mg/dl blood) may have greater effects during the early afternoon and early morning than during the evening and midmorning. METHODS: A volunteer group of 16 male army personnel provided a homogenous sample with respect to time-of-day characteristics. After a formal practice session, members of the sample performed lateral (one-dimensional) tracking tasks in eight counterbalanced sessions, either with or without alcohol (0.836 g/kg), at 0900, 1300, 1800 and 0100 hours. The tasks varied in terms of smooth and ballistic motor pursuit, unpredictability and availability of target preview.
FINDINGS: Alcohol markedly impaired tracking accuracy (error from target), especially in nonpreview conditions. The only evidence for an overall time-of-day effect was on a ballistic pursuit nonpreview task, but there was no indication of any alcohol by time-of-day interactions.
DISCUSSION: When tested 30 minutes after consumption of alcohol, sensorimotor tracking skills are markedly impaired at alcohol levels approaching the New Zealand threshold for legal driving, but these effects are not subject to circadian variations.
Comparative and joint prediction of DUI recidivism from alcohol ignition interlock and driver records.
Correspondence: Paul Marques, Pacific Institute for Research and Evaluation, 11710 Beltsville Drive, Suite 300, Calverton, Maryland 20705, USA; (email: marques@pire.org).
OBJECTIVES: This work was conducted to find practical predictors that anticipate which driving under the influence (DUI) offenders will continue to drink and drive after a period of alcohol ignition interlock-controlled driving ends. The interlock prevents impaired driving by requiring a low blood alcohol concentration (BAC) breath sample before allowing an engine to start. Each breath test is recorded. The study evaluated the interlock record as a predictor of future DUI offenses relative to driver records and self-report items.
METHODS: Subjects were 2,273 DUI offenders in Alberta, Canada, who used an interlock to gain full reinstatement of driving privileges; for 2,134, the installed periods ranged from 5 to 30 months. A median of 8.1 breath tests was logged for each installed day; 9.9 tests were taken on each day of vehicle use (4.3 starts plus 5.6 running retests). Predictors of postinterlock repeat DUI were compared by sensitivity and survival analyses.
FINDINGS: Although 69% of all interlock users had at least one BAC test > or = .04% (a "fail" test) within the first 5 months, only 9% were reconvicted up to 4 years after interlock removal. Failed interlock tests proportional to all BAC tests taken was the best predictor of driver recidivism risk during the years following interlock removal.
DISCUSSION: The interlock record provides new information, particularly about drivers with no prior DUI offenses. Prior moving violations and driving while suspended convictions, although better predictors than questionnaire data, were poorer than interlock records and prior DUI offenses. The alcohol interlock, already recognized as a useful control device, warrants attention for DUI prediction as well.
College attendance and risk-related driving behavior in a national sample of young adults.
Correspondence: Mallie J. Paschall, Prevention Research Center, 2150 Shattuck Avenue, Suite 900, Berkeley, California 94704, USA; (email: paschall@pire.org).
OBJECTIVES: This study examined and sought to explain the relationship between college attendance and indicators of risk-related driving (drinking and driving, seatbelt use) among young adults who participated in the 1999 National Household Survey on Drug Abuse (NHSDA).
METHODS: In-home interview data collected from 11,549 18-25 year olds were analyzed to examine the relationship between full- or part-time college status, drinking and driving and seatbelt use. Logistic regression analyses were conducted to determine whether full- or part-time college attendance would be associated with drinking and driving and seatbelt use when adjusting for demographics and age of onset of alcohol use, and whether these relationships would be explained by place of residence (e.g., dormitory), psychosocial factors (e.g., propensity for risk taking, disapproval of driving after drinking) and past-month heavy drinking.
FINDINGS: The prevalence of drinking and driving in the past year was highest for full-time college students (34.2%), followed by part-time students (32.8%) and other young adults (27.9%). Full-time students were also more likely to report always wearing a seatbelt as a driver (76.1%) or passenger (70.1%) than were part-time students (71.8%, 68.6%) and other young adults (62.7%, 56.7%). These relationships persisted when adjusting for demographic characteristics and age of onset of alcohol use. The higher level of drinking and driving among full-time students was partially explained by psychosocial factors and past-month heavy drinking, but the higher level of drinking and driving among part-time students was not explained by these variables. The higher levels of seatbelt use among full- and part-time college students were also not explained by place of residence, psychosocial factors or heavy drinking. DISCUSSION: College students are more likely than other young adults to drink and drive, but are also more likely to wear a seatbelt as a driver or passenger. This pattern of drinking and driving behavior may help to explain similar rates of fatal alcohol-related traffic crashes among college students and other young adults. Additional research is needed to better understand why college students are more likely to drink and drive and wear seatbelts than other young adults in the same age group.
Examining trajectories of adolescent risk factors as predictors of subsequent high-risk driving behavior.
- Shope JT, Raghunathan TE, Patil SM. J Adolesc Health 2003; 32(3): 214-224.
Correspondence: Jean T. Shope, Transportation Research Institute, University of Michigan, 2901 Baxter Road, Ann Arbor, MI 48109-2150, USA; (email: jshope@umich.edu).
To examine the effects on early high-risk driving behavior of changes over time (trajectories) in adolescent alcohol use, friends' support for drinking, susceptibility to peer pressure, and tolerance of deviance. Statewide driving data were obtained for 4813 subjects who had completed at least two previous school-based questionnaires. The self-administered questionnaire data provided predictor measures from 5th through 10th grades. Trajectory information on predictor measures was summarized using each measure's slope over time and level at the 10th grade data collection (last value). Regression models used serious offenses, alcohol-related offenses, serious crashes, and alcohol-related crashes as outcomes, trajectory measures as predictors, and produced parameter estimates adjusted for demographic measures. Probabilities of having a serious offense or serious crash for five sample trajectories on each measure were obtained from the estimated regression models. All four predictor measures were important, particularly in predicting serious offenses, alcohol-related offenses, and alcohol-related crashes. The highest probabilities for young adult high-risk driving were found among those with consistently high or increasingly high trajectories of friends' support for drinking, susceptibility to peer pressure, and tolerance of deviance. Programs to prevent adolescent risk behavior should take into account environmental and personality influences. Prevention efforts need to emphasize preserving low levels, preventing increases, and promoting decreases over time of adolescent risk factors for unhealthy behaviors, such as high-risk driving.
Violence exposure and substance use in adolescents: findings from three countries.
- Vermeiren R, Schwab-Stone M, Deboutte D, Leckman PE, Ruchkin V. Pediatrics 2003; 111(3): 535-540.
Correspondence: Robert Vermeiren, University Department of Child and Adolescent Psychiatry, Middelheimhospital, University of Antwerp, Antwerp, BELGIUM; (email:rvermeiren@europemail.com).
OBJECTIVE: To investigate relationships between exposure to community violence (witnessing and victimization) and reported substance use (cigarettes, alcohol, marijuana, and hard drugs) in a cross-national sample of adolescents, after controlling for the level of the adolescents' own violent behavior.
METHOD: A self-report survey was conducted in 3380 14- to 17-year-old adolescents in urban communities of 3 different countries: Antwerp, Belgium (N = 958); Arkangelsk, Russia (N = 1036); and New Haven, Connecticut (N = 1386).
FINDINGS: In all 3 countries,levels of reported smoking, alcohol use, marijuana use, and hard drug use showed increases with adolescent exposure to violence. Although positively related, substance use was increased less markedly in US adolescents who witnessed violence.
DISCUSSION: Current findings further emphasize the association between violence exposure and potential severe physical and psychosocial health problems in adolescents. In addition, the findings suggest that violence exposure and its consequences are a worldwide urban phenomenon. Cross-national differences were found, however, that warrant additional research, and prospective studies are needed to investigate the pathways from violence exposure to substance abuse.
Can the initial history predict whether a child with a head injury has been abused?
- Hettler J, Greenes DS. Pediatrics 2003; 111(3): 602-607.
Correspondence: Joeli Hettler, Division of Emergency Medicine, Children's Hospital, Boston, Harvard Medical School, Boston, MA, USA; (email: unavailable).
OBJECTIVE: Previous studies of child abuse have used the presenting history as part of the case definition of abuse. Thus, data from these studies cannot be used to determine the diagnostic utility of historical features for identifying cases of abuse. The objective of this study was to determine the diagnostic utility of certain historical features for identifying cases of abusive head trauma.
METHODS: We retrospectively studied all children, aged 0 to 3 years, who had acute traumatic intracranial injury and were admitted to a tertiary care pediatric hospital from 1993 to 2000. Cases were categorized as either "definite abuse" or "not definite abuse" on the basis of radiologic, ophthalmologic, and physical examination findings, without regard to the presenting history.
FINDINGS: Forty-nine (30%) of 163 children met the criteria for definite abuse. Having no history of trauma had a high specificity (0.97) and positive predictive value (PPV; 0.92) for abuse. Among the subgroup of patients with persistent neurologic abnormality at hospital discharge (n = 34), having a history of no or low-impact trauma had a specificity of 1.0 and a PPV of 1.0 for definite abuse. Injuries were blamed on home resuscitative efforts in 12% of definite abuse cases and 0% of not definite abuse cases. The initial history of trauma was changed in 9% of definite abuse cases, as compared with 0% of not definite abuse cases.
DISCUSSION: Among young children with a head injury, certain historical features have high specificity and PPV for diagnosing child abuse.
Women's Accounts of Domestic Violence Versus Tactics-Based Outcome Categories
Correspondence: Edward W. Gondolf, Mid-Atlantic Addiction Training Institute, Sheetz Building, Oakland Avenue, IUP, Indiana, 15705 PA, USA; (email: egondolf@iup.edu).
This study compared battered women's accounts of violence with tactics-based outcomes to assess the measurement limitations in predicting recurring violence. Accounts of 536 incidents were collected from 299 women at batterer program intake and at 3-month intervals over a 15-month follow-up. Each incident was coded using a sequential, situational model of violence, and the incident codings were summarized for each woman. The components of violent incidents did not correspond to any particular tactics-based outcomes. The female partners of men who repeatedly reassaulted them were, however, less assertive than those of non-reassaulters. A small subgroup did commit unrelenting and excessive violence across the reassault categories.
Intimate Partner Violence in Spain: Findings From a National Survey
Correspondence: Juan Jose Medina-Ariza, University of Manchester, Criminology and Social Policy, 13 Oxford Road, Manchester, M13 9PL UNITED KINGDOM; (email: unavailable).
This article summarizes the findings from the first nationally representative survey on intimate partner violence conducted in Spain. Although feminist groups have been very active in the advocacy of solutions for this problem in Spain for the past two decades, it was not until 1997 that the problem received general attention from the public, after a particularly dramatic case of wife abuse shocked Spanish society. The article also raises questions about the measurement of violence against women and argues that it is crucial to incorporate questions about the subjective perception of the abuse. The findings show that sexual abuse in intimate relationships is as prevalent and serious as other forms of abuse. They also show that women suffering sexual abuse are less likely to define themselves as victims of abuse.
The Roles of Coping and Social Support in Battered Women's Mental Health
Victims of interpersonal violence try many different strategies to reduce or eliminate threats to their physical safety and emotional well-being. However, little is known about the relationship between women's coping strategies and their mental health. In what contexts do specific coping strategies improve mental health, and in what contexts are they harmful? This study investigated the role of social support -- a critical contextual factor -- as a moderator of the relationship between problem-focused coping, and post-traumatic stress disorder and depression among low-income, African American battered women. Problem-focused coping was associated with mental health symptoms only in women with lower levels of overall social support and in women whose closest supporters gave mixed advice or advice to stay with their partners, as opposed to clear advice to leave. The implications of these findings for research and practice are discussed.
The Impact of Family and Friends' Reactions on the Well-Being of Women With Abusive Partners
This study examined the degree to which battered women talked with family and friends about abuse they were experiencing and how family and friends responded. Participants were 137 women who had recently experienced domestic violence and were exiting a shelter. Most women confided in family and friends about the abuse. Family and friends' reactions depended on contextual factors, including the woman's relationship with her assailant, number of separations, number of children, and whether family and friends were threatened. Family and friends' negative reactions and offers of tangible support were significantly related to women's well-being, although positive emotional support was not.
Domestic Violence and Crime Victim Compensation: A Research Agenda
Correspondence: Fran S. Danis, University of Missouri-Columbia, 720 Clark Hall School of Social Work, Columbia, MO 65211-4470, USA; (email: DanisF@missouri.edu).
An analysis of state-by-state data available on the U.S. Department of Justice Web site revealed that more than 50% of clients served through federally funded crime victim assistance programs in 1999 were domestic violence victims. However, only 13.4% of all crime victim compensation claims were awarded to victims of domestic violence. This disparity provides the basis for a comprehensive research agenda to learn what barriers prevent domestic abuse victims from submitting eligible claims.
The Reliability and Validity of Measures of Domestic Violence Resources as Used in Intimate Partner Homicide Research
Recent studies have found that domestic violence shelter-based resources offer little or contradictory efficacy in reducing intimate partner homicides among women. These studies were limited, however, by their lack of measures on the quality of and access to services. This article describes a systematic examination of aggregate data sources that sought to develop reliable and valid measures for quality of domestic violence resources. The examination revealed problems with data sources but also uncovered limitations with measures used in recent research, suggesting that findings from such research should be viewed with caution. Recommendations are offered for assessing the impact of domestic violence resources, and an outline is provided for potentially more reliable and valid measures.
The Intimate Partner Violence Strategies Index: Development and Application.
Although research has documented the myriad ways that victims of IPV struggle to keep themselves safe, little research has gone the next step to investigate patterns in women's use of strategies, the factors that influence choice of strategies, or which strategies are most effective. One obstacle to conducting such research is the absence of an instrument to measure the nature and extent of battered women's strategic responses to violence across specific domains of strategies. This article describes the development of such an instrument, the Intimate Partner Violence Strategies Index, in the context of a longitudinal study of battered women's experience over time.
Dating Violence: Help-Seeking Behaviors of African American Middle Schoolers
This study examined the relationship of African American middle school youths' help-seeking intentions related to dating violence with their levels of violent victimization and perpetration. When faced with the possibility of dating violence, youth expressed a willingness to seek assistance from adults. Girls victimized by more violence reported a greater willingness to turn to friends for help, in addition to parents, than girls victimized by less violence. Boys who perpetrated more violence reported a greater willingness to turn to friends, in addition to parents, than those boys who perpetrated less violence. Implications for developing culturally sensitive prevention programming are discussed.
Help-Seeking Behavior Among Abused Immigrant Women: A Case of Vietnamese American Women
The present study examines help-seeking behavior among abused Vietnamese American women to understand factors associated with their decisions to seek help. Using a qualitative method and data obtained from in-depth interviews with 34 abused Vietnamese American women selected from four different Vietnamese communities in the United States (Orange County, CA; Houston, TX; Boston, MA; and Lansing, MI) and 11 Vietnamese Americans who had contacts with Vietnamese American victims of domestic violence through their jobs, the study found that abused Vietnamese American women have sought help from their personal networks, the criminal justice system, and various victim service agencies. Data analyses suggest that the decisions of Vietnamese American women to reach out are complex and diverse and are shaped by various structural, cultural, and organizational factors. Acculturation on the part of abused women as well as victim services can facilitate the women's efforts to seek help outside their personal networks.
The Physical and Psychosocial Health of Bedouin Arab Women of the Negev Area of Israel: The Impact of High Fertility and Pervasive Domestic Violence
This study examined the self-reported health status of Bedouin Arab women in relation to two salient features of current Bedouin Arab social mores: the emphasis on maintaining a high rate of fertility and the social acceptance of domestic violence. A quota sample of 202 Bedouin Arab women ranging in age from 22 to 75 were personally interviewed. Forty-eight percent of the women reported a lifetime exposure to physical violence, and 30% reported domestic violence that was associated with symptoms of poor mental health status and gynecological problems. Domestic violence was associated with a large number of children, and there is some indication that the level of domestic violence decreases during pregnancy.
