Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RO-114, Boston, MA 02215; (email: kmukamal@caregroup.harvard.edu).
(Copyright 2003, American Medical Association)
BACKGROUND: Alcohol consumption has been associated with complex changes in cerebral vasculature and structure in older adults. How alcohol consumption affects the incidence of dementia is less clear.
OBJECTIVE: To determine the prospective relationship of alcohol consumption and risk of dementia among older adults.
DESIGN, SETTING, AND PARTICIPANTS: Nested case-control study of 373 cases with incident dementia and 373 controls who were among 5888 adults aged 65 years and older who participated in the Cardiovascular Health Study, a prospective, population-based cohort study in 4 US communities. The controls were frequency-matched on age, death before 1999, and their attendance of a 1998-1999 clinic. Participants in this study underwent magnetic resonance imaging (MRI) of the brain and cognitive testing between 1992 and 1994 and were followed up until 1999.
MAIN OUTCOME MEASURES: Odds of incident dementia, ascertained by detailed neurological and neuropsychological examinations according to average alcohol consumption, assessed by self-reported intake of beer, wine, and liquor at 2 visits prior to the date of the MRI.
FINDINGS: Compared with abstention, the adjusted odds for dementia among those whose weekly alcohol consumption was less than 1 drink were 0.65 (95% confidence interval [CI], 0.41-1.02); 1 to 6 drinks, 0.46 (95% CI, 0.27-0.77); 7 to 13 drinks, 0.69 (95% CI, 0.37-1.31); and 14 or more drinks, 1.22 (95% CI, 0.60-2.49; P for quadratic term =.001). A trend toward greater odds of dementia associated with heavier alcohol consumption was most apparent among men and participants with an apolipoprotein E epsilon4 allele. We found generally similar relationships of alcohol use with Alzheimer disease and vascular dementia.
DISCUSSION: Compared with abstention, consumption of 1 to 6 drinks weekly is associated with a lower risk of incident dementia among older adults.
Correspondence: D. Kevin Horton, Agency for Toxic Substances and Disease Registry, Division of Health Studies/Epidemiology and Surveillance Branch, 1600 Clifton Road NE, Mailstop E-31, 30333, Atlanta, GA, USA; (email:dhorton@cdc.gov).
(Article is in public domain. Published by Elsevier Science)
Massive quantities of hazardous substances are transported each day throughout the United States. While most arrive safely at their destination, uncontrolled releases of substances in transit do occur and have the potential of causing acute public health consequences for those individuals at or near the release. Data from 16 state health departments participating in the Agency for Toxic Substances and Disease Registry's (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine the public health consequences that occurred from actual releases in transit. Of the 9392 transportation events analyzed, 9.1% resulted in 2008 victims, including 115 deaths. The population groups injured most often were employees and the general public. The most common injury sustained was respiratory irritation. Evacuations were ordered in 5.5% of events effecting at least 63,686 people. Human error and equipment failure were the most common factors leading to events. These findings underscore the importance of job safety training, community planning, and effective emergency response to prevent adverse public health consequences from occurring or lessen their effect on the public.
Correspondence: Amanda J. Woods, Division of General Practice, University of Nottingham, Tower Building,Floor 13, University Park, Nottingham, NG7 2RD, UK; (email: amanda.woods@nottingham.ac.uk).
OBJECTIVE: to determine community midwives' knowledge, attitudes and practice with regard to baby walkers.
DESIGN: survey, using questionnaires.
SETTING: primary care, East Midlands, UK.
PARTICIPANTS: Sixty-five community midwives participating in a cluster randomized controlled trial to reduce baby walker use.
FINDINGS: there was a 94% response. Seventy per cent of the midwives, felt that it was part of their role to discuss baby walkers, and 62% felt that giving advice about walkers before birth acceptable. The midwives had a limited knowledge of baby walker injury risk and only one midwife had any baby walker-related health education material. Three attitude scales were computed and indicated that the midwives held a negative view of baby walkers and were positive about baby walker health education, believing that parents hold a positive attitude to baby walkers. Those midwives who had used a walker with their own children were more positive about baby walkers and less positive about baby walker health education.
DISCUSSION: midwives are willing to be involved in baby walker health education during pregnancy. However, they require evidence-based knowledge and materials rather than relying on personal experience.
Aspiration of fruit gel snacks.
- Qureshi S, Mink R. Pediatrics 2003; 111(3): 687-689.
Correspondence: Sonea Qureshi, Division of Pediatric Critical Care, Department of Pediatrics, Harbor-UCLA Medical Center, 100 W. Carson Street, Box 491, Torrance, CA 90509, USA; (email: soneaq@worldnet.att.net).
Aspiration of a foreign body is common in children and can cause upper airway obstruction, leading to significant morbidity or mortality. We report 3 cases of aspiration of a popular fruit-flavored gel snack that led to cardiopulmonary arrest and death in 1 case and respiratory failure in 2 other cases. There is increasing concern about the safety of this gel snack and its risk of aspiration, even in older children. Pediatricians should advise parents and children about the dangers of eating this candy during their health maintenance visits.
Ambulance crash-related injuries among Emergency Medical Services workers--United States, 1991-2002.
- Proudfoot SL, Romano NT, Bobick TG, Moore PH. MMWR 2003; 52(8): 154-156.
Full article with case reports, editorial comments, and data tables is available online: Download Document.
Ambulance crashes are one of many hazards faced by Emergency Medical Services (EMS) personnel. Although no complete national count of ground ambulance crashes exists, the total number of fatal crashes involving ambulances can be ascertained by using the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS). To characterize risk factors for EMS workers involved in ambulance crashes, CDC's National Institute for Occupational Safety and Health (NIOSH) and NHTSA investigated three case reports of ambulance crashes. This report summarizes these investigations, presents surveillance data, and discusses recommendations for prevention measures. NIOSH is identifying and testing alternative measures to reduce injury risk for EMS workers.
Research suggests that violence has entered the medical setting to a remarkable degree,causing medical professionals to be at the highest risk for becoming the victims of assaults and violent acts. This article reviews general theories of aggression and research on these theories, and uses them to assess risk factors in patients with chronic pain. There are data to suggest that pain may increase the risk of aggressiveness in some patients. However, it may decrease the risk in others paradoxically. The research available underscores the need for evaluating patients with pain for the risk of violent or aggressive behavior; specific recommendations are made in this regard.
The use of contact lenses by U.S. civilian pilots.
Correspondence: B. Van Nakagawara, Federal Aviation Administration, Civil Aerospace Medical Institute, Vision Research Team, Oklahoma City, Oklahoma 73125, USA; (email: van.nakagawara@faa.gov).
(Article is in public domain. Optometry journal is not available online)
BACKGROUND: Since 1976, the use of contact lenses by civilian pilots has been permitted to correct distant vision for obtaining a Federal Aviation Administration (FAA) aeromedical certificate. This study examined the civil airman population's experience with contact lens use for a 30-year period (1967 to 1997).
METHODS: Population totals for airmen who carried pathology codes 161 (contact lens) and 158 (orthokeratology) from January 1, 1967 through December 31, 1997 were used to calculate prevalence rates by class of medical certificate and age. The National Transportation Safety Board and FAA databases were queried to determine if contact lens use had contributed to aviation mishaps.
FINDINGS: The prevalence of contact lens use grew faster for first-class medical certificate holders and airmen > or = 40 years of age during the period. The frequency of airmen with orthokeratology increased by 23 times in a 10-year period. Reports from five aviation accidents and one incident suggested that contact lens use was a contributing factor in these mishaps.
DISCUSSION: Professional pilots and older airmen were found to be more inclined to use contact lenses. The increasing use of contact lenses and the rapid changes in contact lens technology warrant continued monitoring to ensure aviation safety.
- Langham M, Moberly N. Ergonomics 2003; 46(4): 345-363.
Correspondence: Martin P. Langham, School of Cognitive and Computing Sciences, University of Sussex, Falmer, Brighton BN1 9QH, UK; (email: martinl@cogs.susx.ac.uk).
This review sets out to evaluate the ways in which pedestrian conspicuity has been defined and measured and to consider the various scenarios in which studies of pedestrian conspicuity have been conducted. Research from the psychological and human factors literature is reviewed, in addition to relevant studies on conspicuity that fall outside the scope of applied psychology. Methodological differences between these studies are compared and their ecological validity in terms of the real-world context of pedestrians at risk from vehicles is discussed. The authors argue that there have been many methodological differences in pedestrian conspicuity studies, but that this may not necessarily be problematic when investigating a phenomenon with multiple causal factors. However, suggestions are made for improving ecological validity and establishing a more unified framework for future research in this area.
Effects of label format on knowledge acquisition and perceived readability by younger and older adults.
- Wogalter M, Vigilante Jr W. Ergonomics 2003; 46(4): 327-344.
Correspondence: Michael S. Wogalter, Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7801, Raleigh, NC, 27695-7801, USA; (email: wogalter@ncsu.edu).
This research examines consumers' information acquisition and preference for labels of a simulated over-the-counter (OTC) medication. Twelve otherwise identical OTC drug bottles were compared with different back labels varying in (a) print size, (b) amount of white space between text, and (c) label design (standard vs extended/pull-out). A no back label condition served as a control. Older (mean age=77.7 years) and younger (mean age=21 years) adults were given one of the 12 bottles and asked to perform one of two information acquisition tasks: (a) they examined the bottle for 3 minutes and then completed a questionnaire with the bottle absent, or (b) they answered the same questionnaire while the bottle was present. Afterwards, participants were given all of the bottles and asked to rank them according to perceived readability. The younger adults' information acquisition performance was significantly better than the older adults' for all label conditions except the control condition where both groups' low performance did not differ. Specifically, the older adults' performance was significantly better in the medium and large print conditions than in the small print conditions - with the latter conditions not differing from the control condition. Younger adults showed no performance differences among the different print-size conditions. No substantial effects on knowledge acquisition performance from the white space manipulations were found. However, the perceived readability ranks showed that both groups preferred larger print size and white space. The white space effect was smaller than for print size, particularly for older adults. The extended/pull-out label design was facilitative for older adults in that it allowed the use of larger print. The results suggest that older consumers may be unable to acquire information in the 'fine' print frequently found in various kinds of product literature.
See also item 1 under Pedestrian and Bicycle Issues
Millions of children ingest household products and medications yearly. The continuous proliferation of new products and pharmaceutic agents makes it difficult for physicians to maintain a current command of toxicologic information. Multiple sources, including poison control centers, can provide information; however, EPs must be familiar with several agents that are either significant for their frequency or for their disproportionate potential for morbidity and mortality in pediatric patients. With this select group of intoxicants, physicians must anticipate cardiovascular and pulmonary instability and rapid changes in central nervous system functioning. Appropriate supportive care requires monitoring of the following: vital signs, level of consciousness, airway control, ventilation and circulatory support, body temperature, urine output, and acid base balance. Once these concerns are addressed, prevention of further absorption, enhancing a product's elimination, and treatment with specific antidotes may enhance supportive care. Care is also likely to be enhanced if the EP recognizes the inherent differences (medically and socially) between adults and children of various ages. Definitive emergency care is completed only after the provision of a developmentally oriented preventive strategy.
See also item 1 under Perception and Response Issues
Child disobediance and noncompliance is viewed by practitioners and researchers as a key element of child and adolescent problem behavior. Child disobedience and noncompliance is a recurring problem frequently brought to the attention of pediatricians and others working with children and their parents. This article reviews empirical studies concerning childhood noncompliance. Definitions of noncompliance (also called disobedience) are presented, and observational studies that have measured noncompliance in the laboratory and at home are reviewed. Studies show considerable variability in the prevalence of noncompliance, but demonstrate that it is a frequent problem for parents. Longitudinal data from the Pittsburgh Youth Study are presented to more closely examine the onset and stability of noncompliance in childhood and adolescence. Evidence suggests that extreme childhood noncompliance is relatively stable over time, peaking slightly during early adolescence and decreasing during late adolescence. Studies indicate that for some children noncompliance predicts aggression and externalizing problems. Antecedents of noncompliance including parental discipline techniques and child characteristics are reviewed. Parent training programs designed to reduce noncompliance are described, and the effectiveness of such programs is examined.
Consensus Recommendations for Using Hospital Discharge Data for Injury Surveillance.
- Injury Surveillance Workgroup. Consensus Recommendations for Using Hospital Discharge Data for
Injury Surveillance. Marietta (GA): State and Territorial Injury Prevention Directors Association; 2003.
Full report available online: Download Document (Requires Adobe Acrobat).
State health agencies rely on injury surveillance to assess specific needs for injury prevention programs and policies
and to monitor their effectiveness. Injury surveillance is the ongoing process of tracking and monitoring incidence
rates, causes, circumstances and resulting in fatal and non-fatal injuries and disseminating this data in order to
prevent these injuries from occurring. Death certificates and other sources are useful for surveillance of fatal injuries.
To monitor nonfatal injuries, however, other sources of data are required. One common and important source for
monitoring nonfatal injuries is hospital discharge data.
Over 40 states collect data on hospital discharges. State hospital discharge data systems collect data on injuries
considered serious enough to warrant hospitalization and are, therefore, priority targets for prevention. Another
advantage is that hospital discharge data, unlike some national surveillance data sets, may be stratified at state,
county, city, and even community levels of analysis, making these data useful for monitoring the effects of injury
interventions, where the interventions are implemented.
However, hospital discharge data also have limitations for injury surveillance. State hospital discharge data systems
were originally established for hospital administration and management purposes and are based on a uniform
hospital discharge billing form. Therefore, hospital discharge data elements are not always specified or classified in
such a way as to be informative for purposes of injury surveillance. Moreover, hospital discharge data are not
collected uniformly for all states, or even within states from year to year. Standardization of data analysis and reporting
methods may facilitate comparison of hospital discharge rates, but differences in rates should be interpreted with
caution, due to the inherent dissimilarities of state hospital discharge data systems. In addition, they are incomplete
as they include federal facilities (e.g., Indian health, military).
To assess the strengths and limitations of hospital discharge data for injury surveillance and to recommend standard
methods for analyzing and reporting such data, an Injury Surveillance Workgroup was convened by STIPDA in
2001, with representatives from the State and Territorial Injury Prevention Directors Association (STIPDA); the
Council of State and Territorial Epidemiologists; the National Center for Injury Prevention and Control and the
National Center for Health Statistics, Centers for Disease Control and Prevention; and the National Association of
Injury Control Research Centers. The Workgroup recommended standard processes for analyzing and reporting
hospital discharge data by state injury prevention programs and others to facilitate comparisons of state hospital
discharge rates for injury surveillance.
The ultimate goal of these recommendations is to improve state injury surveillance to support injury prevention
programs and policies. By helping to standardize injury surveillance at the state level, the Workgroup also hopes to
enable further collaboration between state injury prevention programs as well as integration of injury prevention
within traditional public health activities. To that end, this report recommends a minimum set of state surveillance
standards for hospital discharge data. However, these recommendations are not intended to limit individual states in
setting and achieving their own specific objectives for injury surveillance.
Surveillance of interpersonal violence in Kingston, Jamaica: an evaluation.
Correspondence: L.M. Hasbrouck, Epidemic Intelligence Service (EIS) Program, Epidemiology Program Office, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; (email: lmh0@cdc.gov).
Injuries are among the leading causes of death in Jamaica. Homicide rates have been sharply increasing since 1991. In 1997, the rate of homicide (45/100,000) in Jamaica was over five times the US rate in 1997 (7.9/100,000). In response to this problem and the alarming increase in non-fatal assaultive injuries, the Jamaican Ministry of Health together with the CDC established a Violence-Related Injury Surveillance System (VRISS) using patient registration data from Kingston Public Hospital. The VRISS was evaluated for usefulness, and for system attributes: system acceptability, simplicity, flexibility, sensitivity, and predictive value positive (PVP). System-identified cases were compared with clinical records and data from direct patient interviews. The surveillance system was flexible, acceptable to clinical staff and Ministry officials, and moderately sensitive, detecting 62% to 69% of violent injuries identified from clinical records and a patient survey. The system's predictive value positive was high, with 86% of potential cases confirmed as actual cases. Although adequate, system sensitivity was reduced by incomplete or no registration of patients during periods of staff shortage. In conclusion, despite some logistic shortcomings, the system appeared promising for collecting limited information on non-fatal interpersonal violent injuries. With modification and expansion, the system may be capable of collecting unintentional-injury data also.
Post-traumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South Australia.
- Chan AO, Medicine M, Air TM, McFarlane AC. J Clin Psychiatry 2003; 64(2): 175-181.
Correspondence: Angelina O Chan, Department of Psychological Medicine, Changi General Hospital, SINGAPORE; (email: unavailable), Tracy M. Air and Alexander C. McFarlane, Department of Psychiatry, Queen Elizabeth Hospital, University of Adelaide, Adelaide, AUSTRALIA; (email: tracy.air@adelaide.edu.au) & alexander.mcfarlane@adelaide.edu.au).
BACKGROUND: Motor vehicle accident studies thus far have focused primarily on psychiatric consequences and outcomes and medicolegal and treatment aspects, particularly of post-traumatic stress disorder (PTSD). This study aimed to determine the impact of motor vehicle accident-related psychiatric disorders on health and economic costs in quantitative terms.
METHOD: Of the 3088 victims of motor vehicle accidents who made a claim through the State Insurance Commission, South Australia, between November 27, 1996, and March 23, 1999, 391 responded to the study and were assessed using the 28-item General Health Questionnaire, the PTSD Checklist-Civilian Version, and the Dissociative Experiences Scale. At the end of the study period, computerized cost records and accounting data on the health and economic costs incurred were obtained for each of the subjects.
FINDINGS: The total health and economic cost in Australian dollars for the 391 motor vehicle accident victims was A$6,369,519.52. At about 9 months after the accident, of the 391 subjects who replied to the questionnaires, 31% were identified as depressed and 62% as anxious, while 29% met criteria for PTSD. PTSD cases incurred significantly higher health care costs compared with non-PTSD cases (p <.001). Untreated PTSD cases incurred significantly higher economic losses compared with treated PTSD and non-PTSD cases (p <.05).
DISCUSSION: The health and economic costs associated with motor vehicle accidents are enormous. Psychiatric morbidity among victims was high, and motor vehicle accident-related PTSD significantly contributed to increased overall health care and economic costs.
Do hospital E-codes consistently capture suicidal behavior?
- Rhodes AE, Links PS, Streiner DL, Dawe I, Cass D, Janes S. Chronic Dis Can 2002; 23(4): 139-145.
Correspondence: Anne E. Rhodes, The Suicide Studies Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, CANADA; (email:rhodesa@smh.toronto.on.ca).
Hospital separation data are used to study suicidal behavior; however, there is little information about the appropriateness of these data for research and planning activities. The study purpose is to examine how consistently hospital separation E-code data reflect suicidal behaviors. Expert clinicians reviewed medical records of individuals who had a separation for self-poisoning to determine whether the self-poisoning was deliberate. Agreement among clinicians was evaluated and latent class analysis performed to derive a summary estimate of the prevalence of deliberate self-poisoning. This estimate was then compared to the prevalence of deliberate self-poisoning based on the external cause of injury (E-codes). Clinicians estimated the prevalence to be 63% higher than the E-code based prevalence. Much larger discrepancies were apparent among older age groups, those whose care was primarily medical in nature and those with a longer length of hospital stay. In acute care settings, self-poisoning among the elderly may not receive adequate attention and/or documentation. Estimating the prevalence of admissions for suicidal behavior using hospital separation data is of questionable validity, particularly among older age groups.
Development of a novel method to predict disability after head trauma in children.
- Cassidy LD, Potoka DA, Adelson PD, Ford HR. J Pediatr Surg 2003; 38(3): 482-485.
Correspondence: Laura D. Cassidy, Departments of Surgery and Neurosurgery, University of Pittsburgh and Children's Hospital of Pittsburgh, and the Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA; (email: lcs3@pitt.edu).
Background: Although analysis of functional independence measures (FIM) at discharge are useful for assessing extent of disability in head-injured children, there is no reliable method to predict the severity of disability at the time of admission. The authors developed a novel method to predict severe disability after head trauma on admission.
METHODS: Head-injured patients, 2 to 16 years old, with FIM recorded at discharge (n = 3,491) were identified in our state trauma database for the period from 1993 through 1996. Patients categorized as completely dependent by one or more of the FIM (Feeding, Locomotion, Expression, Transfer Mobility, Social Interaction) were classified as disabled. Probability of disability (P(D)) was estimated based on regression weights for Glasgow Coma Scale (GCS), Injury Severity Score (ISS), age, and number of anatomic regions injured. Observed to expected disability rates were compared using a test data set of 2,553 patients entered in the database between 1997 through 1999.
FINDINGS: There was no statistically significant difference between observed and expected disability across all P(D) intervals, which suggests that the P(D) accurately predicted disability.
DISCUSSION: P(D) offers a novel and reliable method for early prediction of likelihood of disability in children who sustain head trauma. Routine use of the P(D) may lead to earlier intervention to improve long-term results in head-injured children.
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.
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.
Correspondence: Jill M. Baren, MD, Division of Emergency Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA; (email: baren@e-mail.chop.edu).
OBJECTIVE: To determine the prevalence of traumatic injuries in children involved in drowning and near-drowning accidents.
DESIGN/METHODS: Ten-year retrospective medical chart review of patients at an urban tertiary care pediatric facility. Included patients had International Classification of Diseases, Ninth Revision, Clinical Modification codes for fatal/nonfatal drowning or E codes for fall into water, accidental drowning, and submersion. We recorded demographics, event characteristics, diagnostics, and outcome data. We used the chi(2) or the Fisher exact test to compare patients with and without injuries.
FINDINGS: One hundred forty-three patients met inclusion criteria. Of these, 95 (66.4%) were male. Median age was 3.8 years, and 30 (23.4%) of 128 had preexisting conditions. Site of drowning was the pool (70.6%), the bathtub (19.0%), or natural water (10.4%). The prevalence of traumatic injury was 4.9% (95% confidence interval, 0%-28%). The predominant mechanism of injury was diving, and all injuries were to the cervical spine. Patients with injury were more likely to be older (mean age, 13.5 vs 5.1 years; P<.001) and to have a history of diving (85.7% vs 2.2%; P<.001). The presence of injury was not associated with sex, preexisting condition, or site of drowning (P>.05).
DISCUSSION: The prevalence of traumatic injury in drowning and near drowning is low. We identified only cervical spine injuries, and all but 1 patient had a clear history of diving. Use of specialized trauma evaluations may not be warranted for patients in drowning and near-drowning accidents without a clear history of traumatic mechanism.
Elderly trauma patients with rib fractures are at greater risk of death and pneumonia.
- Bergeron E, Lavoie A, Clas D, Moore L, Ratte S, Tetreault S, Lemaire J,Martin M. J Trauma 2003; 54(3): 478-485.
Correspondence: Eric Bergeron, Choc-trauma Mont�r�gie, H�pital-Charles-LeMoyne, 3120, boul. Taschereau, Greenfield Park, Quebec J4V 2H1, CANADA; (email: eric.bergeron@traumaquebec.org).
BACKGROUND The purpose of this study was to show that elderly patients admitted with rib fractures after blunt trauma have increased mortality.
METHODS Demographic, injury severity, and outcome data on a cohort of consecutive adult trauma admissions with rib fractures to a tertiary care trauma center from April 1, 1993, to March 31, 2000, were extracted from our trauma registry.
FINDINGS Among 4,325 blunt trauma admissions, there were 405 (9.4%) patients with rib fractures; 113 were aged >/= 65. Injuries were severe, with Injury Severity Score (ISS) >/= 16 in 54.8% of cases, a mean hospital stay of 26.8 +/- 43.7 days, and 28.6% of patients requiring mechanical ventilation. Mortality (19.5% vs. 9.3%; < 0.05), presence of comorbidity (61.1% vs. 8.6%; < 0.0001), and falls (14.6% vs. 0.7%; < 0.0001) were significantly higher in patients aged >/= 65 despite significantly lower ISS ( = 0.031), higher Glasgow Coma Scale score ( = 0.0003), and higher Revised Trauma Score ( < 0.0001). After adjusting for severity (i.e., ISS and Revised Trauma Score), comorbidity, and multiple rib fractures,patients aged >/= 65 had five times the odds of dying when compared with those <65 years old.
DISCUSSION Despite lower indices of injury severity, even after taking account of co-morbidities, mortality was significantly increased in elderly patients admitted to a trauma center with rib fractures.
Long-term outcomes after injury in the elderly.
- Inaba K, Goecke M, Sharkey P, Brenneman F. J Trauma 2003; 54(3): 486-491.
Correspondence: Frederick D. Brenneman, Trauma Program, Sunnybrook and Women's College Health Sciences Centre, C-135, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, CANADA; (email: fred.brenneman@swchsc.on.ca).
BACKGROUND: The lasting impact of injury on lifestyle in the elderly remains poorly defined. The purpose of this study was to determine the long-term quality-of-life outcomes in elderly trauma patients.
METHODS: The trauma registry at a regional trauma center was used to identify hospital survivors of injury >/= 65 years old discharged from April 1996 to March 1999. The 36-Item Short Form (SF-36) Health Survey was administered to this group by telephone interview and the scores compared with age-adjusted Canadian norms. Comparisons with test were made for continuous data.
FINDINGS: Complete data collection was achieved in 128 of 171 (75%) study patients. The mean Injury Severity Score was 21, the mean initial Glasgow Coma Scale score was 13, and the mean age was 74. Most (97%) were victims of blunt trauma. Compared with Canadian age-adjusted norms, there was a significant ( < 0.05) decrease in seven of eight SF-36 domains: Physical Functioning, Role-Physical and Role-Emotional (limitations secondary to physical and emotional health), Social Functioning, Mental Health, Vitality, and General Health. Before injury, most (98%) were living independently at home. However, at long-term follow-up (mean, 2.8 years; range, 1.5-4.5 years), only 63% were living independently and 20% still required home care.
DISCUSSION: Although the majority of elderly injury survivors achieve independent living, long-term follow-up indicates significant residual disability in quality of life as measured by the SF-36.
The Association between Gender and Mortality among Trauma Patients as Modified by Age.
- George RL, McGwin G Jr, Metzger J, Chaudry IH, Rue LW. J Trauma 2003; 54(3): 464-471.
Correspondence: Gerald McGwin, Center for Injury Sciences, 120 Kracke Building, 1922 7th Avenue South, University of Alabama at Birmingham, Birmingham, AL, USA; (email: gerald.mcgwin@ccc.uab.edu).
BACKGROUND: Several studies have reported a null association between gender and mortality after traumatic injury, whereas others found an age-specific association between male gender and increased mortality. Relatively small sample sizes may have contributed to the heterogeneity among existing studies; therefore, a large-sample-size study was undertaken.
METHODS: The National Trauma Data Bank was queried, yielding data for over 150,000 patients involved in blunt or penetrating trauma. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the association between gender and mortality, both overall and according to mechanism of injury and age categories.
FINDINGS: Among those who sustained blunt trauma, male patients had a significant increase in the risk of death compared with female patients (OR, 1.49; 95% CI, 1.39-1.59) that was most apparent for those >/= 50 years of age (OR, 1.97; 95% CI, 1.84-2.11). For penetrating trauma patients, essentially no significant association, either overall (OR, 1.03; 95% CI, 0.91-1.17) or by age category, was apparent.
DISCUSSION: This study found an association between gender and mortality among blunt trauma patients, particularly those aged >/= 50 years. Animal studies demonstrate that the sex hormones influence the inflammatory response to injury. These results may highlight the importance of sex hormones in traumatic injury outcomes.
Death after injury in rural Norway: high rate of mortality and prehospital death.
BACKGROUND: Finnmark is a rural and remote area in Norway with a sparse population and long distances. Trauma-related mortality has been consistently above the Norwegian national average for the last 20 years. Although the causes of death are well established, very little is known about the time and place of death. This information has implications for the organization of emergency services in rural areas. We examined all trauma deaths over a five-year period in order to inform the debate on how best to reduce our above-average mortality rate.
METHODS: A retrospective study of all deaths after trauma (ICD-9 E800-E999) during the years 1991-95 using data obtained from the National Registry of Death.
FINDINGS: Of the 183 cases found, 130 deaths were due to trauma using definitions comparable to similar studies. The mortality rate was 77 per 100 000 inhabitants per year. Death occurred in the prehospital phase in 85% of cases. Seventy-two per cent of all deaths (regardless of location) occurred within the first h after injury, eight per cent from 1 to 4 h and the remaining 20% occurred after 4 h.
DISCUSSION: When planning interventions to reduce the mortality rate from trauma in rural areas, a high proportion of prehospital deaths should be expected. The high number of patients who are found dead (which can only be reduced by injury prevention) must be taken into account. Measures to reduce 'preventable' causes of death by bystanders should be evaluated. Further knowledge of exact mechanisms of death in the prehospital phase is required.
Correspondence: Cheryl M. Kodjo, Division of Adolescent Medicine, Children's Hospital at Srong, University of Rochester Medical Center, Box 690, 601 Elmwood Ave, Rochester, NY 14642, USA; (email: cheryl_kodjo@urmc.rochester.edu).
BACKGROUND: Recent incidents of school violence have heightened the need to identify societal, interpersonal, and adolescent characteristics that contribute to weapon carrying.
OBJECTIVES: To assess the prevalence of weapon carrying at school and to determine associated risk factors for adolescent males and females.
DESIGN: A cross-sectional study using the 1994-1995 National Longitudinal Study of Adolescent Health data.
PARTICIPANTS: A nationally representative sample of 6504 adolescents and their parents.
MAIN OUTCOME MEASURE: Whether adolescents have ever carried a weapon at school.
STATISTICS: chi(2) Analyses and hierarchical regressions were done using SPSS (SPSS Inc, Chicago, Ill) and SUDAAN (Research Triangle Park, NC) software. Regression models included demographic, intrinsic, and extrinsic factors.
FINDINGS: Of the overall sample, 9.3% (n = 595) reported having carried a weapon at school. Of these, 77% were male (male vs female adjusted odds ratio [AOR], 3.1; 95% confidence interval [CI], 2.3-4.1). Substance use, school problems, perpetration of violence, and witnessing violence were significantly associated with weapon carrying for both males and females. However, for males, extrinsic factors were more important in mediating the effects of substance use and perpetration of physical violence on school weapon carrying, while intrinsic factors mediate these variables for females.
DISCUSSION: These findings suggest that interventions for violence prevention for males and females need to be targeted toward different areas.
Correspondence: Shelley A. Johnson, The Pennsylvania State University, School of Nursing, College of Health and Human Development, Hershey, PA, (email: kmf103@psu.edu).
OBJECTIVE: To discover what teachers perceive to be contributing factors to violence in schools.
METHODS: Open-ended questions were asked of a convenience sample of teachers ( = 396) during an in-service education program on school violence. The teachers were in a semi-rural school district in a Mid-Atlantic state. Answers were analyzed using content analysis; all responses were reviewed and important themes were extracted. Identified themes were then placed into suitable categories and studied to determine relationships.
FINDINGS: Of the surveys analyzed ( = 239), 13 themes were identified. The three categories which then identified probable causes of school violence were (1) lack of knowledge, (2) lack of support, and (3) inadequate safety measures.
DISCUSSION: Nurses can use the results of this study in multiple ways. One is to help parents understand their role in preventing school violence. Because violence in the home and violence in the media seem to foster violent acting-out behavior, nurses can teach parents about these correlations and seek solutions such as the elimination of family violence, and monitoring television viewing and video games. Nursing assessments of school-aged children and their families can include these elements. School nurses in particular can use these study results as an opportunity to develop interventions for students, teachers, and families that stress knowledge building about impulse control, anger management, appropriate parenting, and early intervention for at-risk children.
Spirituality and attempted suicide among American Indians.
- Garroutte EM, Goldberg J, Beals J, Herrell R, Manson SM. Soc Sci Med 2003; 56(7): 1571-1579.
Correspondence: Eva Marie Garroutte, Department of Sociology, Boston College, 140 Commonwealth Avenue, 02467, Chestnut Hill, MA, USA; (email: va.garroutte@bc.edu).
American Indians exhibit suicide-related behaviors at rates much higher than the general population. This study examines the relation of spirituality to the lifetime prevalence of attempted suicide in a probability sample of American Indians. Data were derived from a cross-sectional sample of 1456 American Indian tribal members (age range 15-57 yrs) who were living on or near their Northern Plains reservations between 1997 and 1999. Data were collected by personal interviews. Commitment to Christianity was assessed using a measure of beliefs. Commitment to tribal cultural spirituality (or forms of spirituality deriving from traditions that predate European contact) was assessed using separate measures for beliefs and spiritual orientations. Results indicated that neither commitment to Christianity nor to cultural spirituality, as measured by beliefs, was significantly associated with suicide attempts (p(trend) for Christianity=0.22 and p(trend) for cultural spirituality=0.85). Conversely, commitment to cultural spirituality, as measured by an index of spiritual orientations, was significantly associated with a reduction in attempted suicide (p(trend)=0.01). Those with a high level of cultural spiritual orientation had a reduced prevalence of suicide compared with those with low level of cultural spiritual orientation. (OR=0.5, 95% CI=0.3, 0.9). This result persisted after simultaneous adjustment for age, gender, education, heavy alcohol use, substance abuse and psychological distress. These results are consistent with anecdotal reports suggesting the effectiveness of American Indian suicide-prevention programs emphasizing orientations related to cultural spirituality.
Influence of lack of full-time employment on attempted suicide in Manitoba, Canada.
OBJECTIVES: Unemployment has been repeatedly associated with suicide; however, whether the association is causal remains unclear. Little is known about the relationship between part-time work and either attempted or completed suicide. The objective of this study was to compare the relationships of unemployment, part-time work, nonlaborforce participation, and full-time work with attempted suicide.
METHODS: This study utilized a database consisting of 27,446 potential labor force participants that combines information on health care utilization in Manitoba, Canada, with detailed information from the 1986 census. Persons who attempted suicide after the census (N=144) were identified using established definitions based on hospital claims to identify serious attempts only.
FINDINGS: Step-wise multiple logistic regression, which controlled for multiple confounding variables, revealed that unemployment [odds ratio (OR) 3.68, 95% confidence interval (95% CI) 1.76-7.71, part-time work (OR 1.99, 95% CI 1.07-3.71) and being out of the labor force (OR 2.11, 95% CI 1.12-3.97)] were all associated with attempted suicide. A dose-response relationship was observed between weeks worked in 1985 and suicide attempts after the census.
DISCUSSION: All three groups of those who were not working full-time had an elevated likelihood of attempted suicide after adjustment for potential confounding factors. This finding suggests that working full-time is protective against suicide attempts. Suicide attempts related to lack of full-time work may be more preventable than other causes of attempted suicide and may be decreased by social policies that limit "under" and unemployment.
Elevated Suicide Risk among Patients with Multiple Sclerosis in Sweden.
- Fredrikson S, Cheng Q, Jiang GX, Wasserman D. Neuroepidemiology 2003; 22(2): 146-152.
Correspondence: Sten Fredriskson, Division of Neurology, NEUROTEC, Karolinska Institutet, Huddinge University Hospital, Stockholm, SWEDEN; (email:sten.fredrikson@neurotec.ki.se).
Results from previous studies of suicide risk among patients with multiple sclerosis (MS) are inconsistent. This may be explained partly by differences in methodology and study populations. The purpose of our study was to investigate suicide risk among hospital patients with MS in Sweden. During the period 1969-1996, 12,834 cases were recorded in the Swedish Hospital Inpatient Register, with 77,377 hospital admissions, in which MS was a primary or secondary diagnosis at discharge. The mean follow-up time for the whole cohort was 9.9 (SD 7.3) years. When the data for these MS patients were linked to the Swedish Causes of Death Register for the same period, 5,052 (39.4%) were found to have died. Among the 5,052 deaths, suicide was an underlying cause of death in 90 cases (1.8%). The mean period between the initial admission date with an MS diagnosis at discharge and the date of death for the 90 MS suicide cases was 5.8 (SD 5.1) years. This was significantly shorter (p = 0.002) than the mean of 7.9 (SD 6.4) years for MS cases who died due to other causes. Suicide risk, calculated as the standardized mortality ratio (SMR), was significantly elevated (SMR = 2.3) among both male and female MS cases compared with the general population. Suicide risk was particularly high in the first year after initial admission with an MS diagnosis, and among younger male MS cases. The mean age at the time of suicide was 44.5 (SD 12.4) years, and 58% of the suicides were committed within 5 years after the first admission with an MS diagnosis. The crude suicide rate among MS patients during the study period was 71 per 100,000 person-years. The rate was significantly higher (p < 0.001) in males (114) than in females (47), with an odds ratio of 2.4 (95% CI: 1.6-3.8). These findings have implications for suicide preventive measures in neurological practice.
Correspondence: E.K. Ung, Division of Child and Adolescent Psychiatry, Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road, SINGAPORE; (email: unavailable).
BACKGROUND: Suicide and parasuicide rates are important markers of the health of a nation. Suicide is a common cause of mortality in youth and parasuicide has its peak prevalence in adolescence and early adulthood. Both pose a tremendous burden to individuals, families and society.
OBJECTIVES: Historical and current studies on suicide and parasuicide in Singapore are reviewed and discussed in the light of available worldwide research.
METHODS: Studies on suicide and parasuicide in Singapore were identified through a MEDLINE search (from 1979). Information from these studies were supplemented with relevant local monographs on suicide and parasuicide.
FINDINGS: Suicide is extremely rare in children under 10 years of age. Rates rise in the 10 to 14 years age group and increase markedly in the 15 to 19 years age group. The male to female ratio is about 2:1 for youths 10 to 14 years old and 1:1 for the 15 to 19 years age group. The historical preponderance of female suicide is much less clearly seen in recent years. Jumping from a height is the commonest method used, and mental illness and recent life stress are common causative factors. A peak in suicides in the young was found for June and October, and a trough for November and December. Parasuicide is extremely rare in children under 10 years of age. There was a peak in the months of October and November in the student population, corresponding to the examination months. Youths of Indian ethnicity were over-represented.
DISCUSSION: Preventing suicide and parasuicide is of paramount importance, given the severe burden of such acts on individuals, families and society. Current studies on youth suicide in Singapore and a national study on parasuicide are urgently needed to increase our understanding of these phenomena.
Correspondence: Michael Serby, Department of Psychiatry, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003, USA; (email: unavailable).
Depression in the elderly population is a major public health problem. It has a high prevalence, is frequently co-morbid with medical illnesses, impacts negatively on quality of life, increases the number of visits to different medical services, and carries a high risk of suicide, especially in men. Imaging studies have increased our understanding of the biological mechanisms of depression in the elderly. Depression is sometimes difficult to diagnose in the elderly. It should be differentiated from apathetic states ( negative syndrome), and its treatment requires knowledge of specific physiological changes that occur in this age group. Geriatric depression is more somatic and less ideational than depression in other age groups. Acute treatments with various antidepressant medications, augmentation strategies, electroconvulsive treatments, and psychotherapy must be coupled with maintenance strategies to prevent recurrences, which are common.
Correspondence: Beth E. Ebel, Department of Pediatrics, University of Washington, Harborview Injury Prevention and Research Center, 325 Ninth Ave, Box 359960, Seattle, WA 98104, USA; (email: bebel@u.washington.edu).
BACKGROUND: Once children have outgrown car seats, booster seats protect from injury better than lap and shoulder belts alone. However, the majority of children aged 4 to 8 years use only an adult seat belt.
OBJECTIVE: To evaluate the effectiveness of a multifaceted community booster seat campaign in increasing observed booster seat use among child passengers in motor vehicles.
DESIGN: Prospective, nonrandomized, controlled community intervention trial.
SETTING AND PARTICIPANTS: The campaign was initiated in 4 communities in the greater Seattle, Wash, area between January 2000 and March 2001. Eight communities in Portland, Ore, and Spokane, Wash, served as control sites. We observed 3609 booster-eligible children (those aged 4-8 years and weighing 18-36 kg [40-80 lbs]).
MAIN OUTCOME MEASURE: Observed booster seat use 15 months after the start of the campaign.
FINDINGS: Before the campaign began, 13.3% of eligible children in the intervention communities and 17.3% in the control communities were using booster seats, adjusting for child age, driver seat belt use, and sex of driver. Fifteen months after the start of the campaign, adjusted booster seat use had increased to 26.1% in the intervention communities and 20.2% in the control communities (P =.008 for the difference in time trends between intervention and control communities).
DISCUSSION: These data suggest that a multifaceted community education campaign can significantly increase the use of child booster seats.
Intensive care unit outcome of vehicle-related injury in elderly trauma patients.
- Hui T, Avital I, Soukiasian H, Margulies DR, Shabot MM. Am Surg 2002; 68(12): 1111-1114.
Correspondence: Thomas T. Hui, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA; (email: unavailable).
Vehicle-related trauma is a common mechanism of injury in elderly (age > or = 65 years) trauma patients. Several hospital-based studies have shown that patients with pedestrian injury have a higher mortality compared with those with motor vehicle collision (MVC) injury partially because of older patients found in the former group. In addition the injury patterns also differ significantly between these two mechanisms of vehicle-related trauma. The purpose of the present study is to compare the demographics, injury severity, injury patterns, and outcomes of elderly patients with pedestrian injury admitted to a surgical intensive care unit (SICU) of a Level I trauma center between January 1, 1994 and December 31, 2000 with those admitted with MVC injury. During the study period there were 187 elderly patients admitted to the surgical intensive care unit with vehicle-related injury. Fifty-one per cent of the patients had MVC injury. Patients were divided into two groups based on their mechanisms of injury (pedestrian vs MVC) for comparison. There was no difference in the mean age and gender between the two groups. Injury Severity Score, admission Simplified Acute Physiology Score, and mortality were significantly higher in the pedestrian group compared with the MVC group. Using logistic regression analysis three factors were found to be independently predictive of mortality: Simplified Acute Physiology Score, intracranial hemorrhage with mass effect on CT scan, and cardiac complications.
How readable are child safety seat installation instructions?
Correspondence: Deborah C. Girasek, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814, USA; (email: dgirasek@usuhs.mil).
OBJECTIVES: To measure the required reading level of a sample of child safety seat (CSS) installation instructions and to compare readability levels among different prices of CSSs to determine whether the lower cost seats to which low-income parents have greater access are written to a lower level of education.
METHODS: A CD-ROM containing CSS installation instructions was obtained from the National Highway Traffic Safety Administration. Pricing information was obtained for available models from an Internet-based company that provides comparative shopping information. Paper copies of the instruction sets were generated, and their readability levels were determined using the SMOG test. A second rater was used in addition to the primary investigator to assess inter-rater reliability of the SMOG as applied to the instruction sets.
FINDINGS: The readability of instruction sets ranged from the 7th- to 12th-grade levels, with an overall mean SMOG score of 10.34. No significant associations were found to exist between readability and seat prices; this was observed whether the data were treated as continuous or categorical.
DISCUSSION: CSS instruction manuals are written at a reading level that exceeds the reading skills of most American consumers. These instruction sets should be rewritten at a lower reading level to encourage the proper installation of CSSs.
Non-fatal violence-related injuries in Kingston, Jamaica: a preventable drain on resources.
- Zohoori N, Ward E, Gordon G, Wilks R, Ashley D, Forrester T. Inj Control Saf Promot 2002; 9(4): 255-262.
Correspondence: N. Zohoori, Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 7, Jamaica, WEST INDIES; (email: NZohoori@UWIMona.edu.jm).
Using data for a one-year period from the Kingston Public Hospital (KPH) in Jamaica, we describe patterns of non-fatal violence-related injuries, and carry out simulation analysis to estimate rates of hospital admission under various injury reduction scenarios, and the potential savings that can be realized by reducing violent crimes. In this period there were 6107 registered violence-related visits to the KPH representing 11.5% of all recorded visits. Of these 16.6% (1001) were admitted. The most common methods of inflicting injury was by stabbing (52.1%), blunt injuries (37.9%) and gunshot wounds (7.3%). Multivariate analyses indicated that gunshot injuries, stab injuries, being male between the ages of 15 and 44 years, receiving the injury in November or December, and being injured by a stranger or unknown assailant, were significant correlates of a higher probability of admission. Simulation analysis with various injury reduction scenarios indicated decreases in the probability of admission ranging from 12% to 44%, with estimated savings of up to 31% of the annual supplies budget of KPH.
Gunshot injuries as seen at the Aga Khan Hospital, Nairobi, Kenya.
- Saidi HS, Nyakiamo J, Faya S. East Afr Med J 2002; 79(4): 188-192.
Correspondence: H.S. Saidi, Department of Human Anatomy, College of Health Sciences, University of Nairobi, P.O. Box 30197, Nairobi, KENYA; (email: unavailable).
OBJECTIVE: To determine the prevalence, injury patterns, offender-victim characteristics, treatment and outcome of firearm-related injuries at the Aga Khan Hospital, Nairobi.
DESIGN: Retrospective descriptive study.
SETTING: The Aga Khan Hospital, a major private hospital in Nairobi.
SUBJECTS: One hundred and seven patients who presented at the Aga Khan Hospital Accident and Emergency Department (January 1993-December 1998) with firearm injuries and were subsequently hospitalized. There were 97 males and 10 females aged four to 94 years. The mean age was 39 years.
FINDINGS: The peak incidence was in the 40-49 year age group. The male to female ratio was 10:1. The victim offender was a thug, thief or robber in 74.7% of cases. Law enforcement officers were responsible for 9.4% of the injuries. The Injury Severity Scores (ISS) ranged from one to 32 with mean score of 8.25. Injuries involving the extremities were the most prevalent. There were 31 major operations performed. The complication rate was 35.5%. Six (6.5%) of these patients died.
DISCUSSION: Gunshot injuries cause profound morbidity and significant mortality. A wider and larger study needs to be undertaken to elucidate the true nature of firearm injuries.
Examination of peer-group contextual effects on aggression during early adolescence.
Correspondence: Dorothy L. Espelage, Department of Educational Psychology, University of Illinois, Urbana-Champaign, College of Education, Champaign 61820-6990, USA; (email: espelage@uiu-c.edu).
Peer group contextual effects of aggressive behavior among middle school students (6th-8th graders) were examined using a short-term longitudinal design. More specifically, the homophily hypothesis that peer group membership influences individual-level bullying and fighting was evaluated with multilevel sex-specific models of individual- and peer-level aggression scores. Peer groups were identified via social network analysis. Intraclass correlation coefficients yielded through hierarchical linear modeling demonstrated substantial within-group similarity on self-reported bullying and fighting, suggesting that students affiliate with individuals who bully and fight at the same frequency. Peer group bullying and fighting was associated with individual-level behavior, even after controlling individual baseline levels for males and females. However, peer contextual effects explained more variance in individual bullying than individual fighting. This differential impact of peer group membership suggests that future studies consider peer relations across subtypes of aggression.
The prevalence of domestic violence in pregnant women.
- Johnson JK, Haider F, Ellis K, Hay DM, Lindow SW. BJOG 2003; 110(3): 272-275.
Correspondence: S. W. Lindow, Department of Obstetrics and Gynaecology, Hull Maternity Hospital, Hull HU9 5LX, UK; (email: unavailable).
OBJECTIVE: To determine the prevalence of domestic violence in a population of pregnant women. Questionnaire survey. Antenatal booking clinic in a north of England hospital. Five hundred consecutive women were included. Anonymous confidential questionnaire to women who were not accompanied by their partners. Disclosure of a past history of physical, emotional or sexual abuse. Four hundred and seventy-five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26-30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had forced sexual activity. The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.
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, Lindendreef 1, 2020 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.
Why elder abuse continues to elude the health care system.
- Kahan FS, Paris BE. Mt Sinai J Med 2003; 70(1): 62-68.
Correspondence: Fay S. Kahan, Department of Geriatrics, Box 1070, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029, USA; (email: unavailable).
Elderly men and women of all socioeconomic and ethnic backgrounds are vulnerable to mistreatment, and most often it goes undetected. For many elderly victims of abuse, the hospital is the only potential site for outside contact and support. An elder abuse program has been created at The Mount Sinai Hospital in New York City, and funding was granted to assist victims with compensation claims; provide counsel and advocacy for victims; and provide support via ongoing telephone contact and referrals to community agencies. Simultaneously, hospital-wide educational seminars and rounds have provided the staff and students with information concerning detection of abuse and neglect. Over a 2-year period, 182 cases were identified and assessed. More than 50% of these cases involved patients with a diagnosis of memory impairment. Five percent of the cases involved a long history of domestic violence. In most cases a family member was identified as the abuser, and in a majority of instances the victim either denied the suspected abuse or tried to rationalize the behavior of the abuser. Patients were afraid of reporting abuse or changing their situation, despite being informed of possible resources. To combat this escalating problem in our growing elderly population, interdisciplinary collaboration between physicians and social workers is often crucial. Communication via the medical record can be key to monitoring patients in the community. There also needs to be ongoing education of all hospital staff in an effort to continually heighten awareness of this problem.
