The present analysis deals with the presumed improved driving skill of car drivers with low blood alcohol concentrations (BACs) compared to the driving skill of sober drivers. Several roadside surveys indicate such a controversial possibility, which is illustrated graphically in "The Grand Rapid Study" (1964) as a relative accident risk curve for driving while intoxicated (DWI). A curve which shows a "DIP" below a baseline accident risk of one for sober drivers in the interval between BACs of 0.01 and 0.04g/l. Since then, various attempts have been made to show this "DIP" in the otherwise "exponentially" raising curve to be an artificial distortion based on disproportionate demographic subgroups. It is, however, our thesis that the observations of "The Grand Rapid Study" and other roadside surveys are valid, because the presumed mono-causal traffic accident curve hides "tiredness" as an additional human risk factor. This makes the first part of the night-time relative accident risk curve for impaired drivers artificially augmented by "tired" drivers with insignificant amounts of alcohol in the blood and therefore incorrectly accused of accidents due to DWI. The accident risk curve for higher BACs raises similarly abrupt due to drivers impaired by a combined effect of alcohol and "tiredness". Moreover, to imply an accident risk of one for all sober drivers independent of the time of the day is debatable as an increased accident risk is present in the late night-time hours due to "tired" drivers. This increase in "tired" sober accident drivers suppresses the accident risk curve for DWI with BACs of 0.01-0.04g/l below the fixed baseline of one for the background population.
OBJECTIVES: To ascertain whether the weather affects the attendance rate of children with injuries at a pediatric accident and emergency department.
METHODS: The maximum daily temperature and weather conditions (rain/cloud/sun) were noted over a three month period in spring/summer 2002, together with the number of children attending with new injuries or trauma.
FINDINGS: There was a direct association between trauma attendance and clement weather with higher attendances on dry and sunny days. There was a less obvious association between maximum daily temperature and attendance.
DISCUSSION: These findings confirm the anecdotal belief that warm sunny weather results in a higher attendance of pediatric injuries.
Epidemiology and prevention of domestic injuries among children in the Verona area (north-east Italy).
- Majori S, Bonizzato G, Signorelli D, Lacquaniti S, Andreetta L, Baldo V. Ann Ig 2002; 14(6): 495-502.
Correspondence: Silvia Majori, Department of Medicine and Public Health, Institute of Hygiene and Environmental and Occupational Preventive Medicine, University of Verona, ITALY; (email: silvia.majori@univr.it).
In the developed world, domestic injuries (DI) are an important cause of morbidity, temporary or permanent disability, and death in early life, the social and economic costs of which are often underestimated. To assess the epidemiology of this phenomenon in an area of north-eastern Italy, a retrospective investigation was performed with an anonymous questionnaire administered to the parents of approximately 3000 children aged between 3 and 15 years. More than 45% of the sample had suffered at least one DI in their lifetime. The most common involved falling, wounding and scalding, and particularly affected children above 4 years old. The various types of injury were analyzed and correlated with the parents' personal parameters, the circumstances and the location of the accident. The type of aid required (medical advice was sought in more than 70% of cases) and the outcome of the DI (26% cases of temporary disability and 2% of permanent disability) were also assessed. The majority of DI could be prevented by a capillary campaign on the prevention of domestic hazards in childhood, preferably as part of a holistic approach to the problem that also considers their living conditions in architectural and interior design terms.
Children's response to a commercial back-up warning device.
- Sapien RE, Widman Roux J, Fullerton-Gleason L. Inj Prev 2003; 9(1): 87-88.
Correspondence: Robert E Sapien, Department of Emergency Medicine, University of New Mexico Health Science Center, ACC 4th Floor West, Albuquerque, New Mexico 87131, USA; (email: rsapien@salud.unm.edu).
OBJECTIVE: To determine preschool children's response to a commercial back-up warning alarm in a mock setting of an automobile backing up.
SETTING: Preschool parking lot in Albuquerque, New Mexico, USA.
METHODS: With subjects acting as their own controls, 33 preschoolers were asked to walk behind a stationary vehicle twice. The first time, the control, no warning sound was emitted from the vehicle. The second time, the vehicle was placed in reverse gear triggering an alarm. Children's responses were recorded by a hidden video camera. Avoidance behavior by the child was considered a positive response. Location and distance to where the response occurred was measured.
FINDINGS: Thirty three children, 38-61 months, were studied. None responded to the alarm with avoidance behavior but 18 looked toward the vehicle or hesitated in their gait.
DISCUSSION: Although over half of the children acknowledged the warning alarm, the device did not elicit avoidance behavior. Mere acknowledgment of the warning device would not prevent injury.
Correspondence: Andrea Gielen, Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, 624 N Broadway, Baltimore, MD 21205, USA; (email: agielen@jhsph.edu).
OBJECTIVES: To examine the validity of self reported data on parents' home safety practices of using smoke alarms and stair gates, and having syrup of ipecac.
SETTING: Families from a pediatric continuity clinic in a large, urban teaching hospital with infants from birth to 6 months were enrolled in the study.
METHODS: As part of a randomized controlled trial to promote home safety, parents' responses to personal interviews were compared to observations made in the respondents' homes two to four weeks after the interview. Positive and negative predictive values, sensitivity, and specificity were computed and compared between the intervention and control group families.
FINDINGS: Sensitivities were high among the four safety practices. Specificities were much lower and fell into a much wider range than sensitivities. The positive predictive values were low and the negative predictive values were high. No differences in these indicators of validity were found between intervention and control group families.
DISCUSSION: If the main interest in an evaluation is on the relative difference between study groups, rather than the absolute value of the outcome measure, our results suggest that self reported data may be of acceptable validity. However, when assessing a patient's risk, clinicians need to recognize the problem of over-reporting of safety practices.
Correspondence: Anthony Surada, Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah, USA; (email: unavailable).
There is little published information concerning the epidemiology of fatal injuries involving respiratory protection. We compiled a case series from U.S. Occupational Safety and Health Administration investigation reports from 1984 through 1995. For the 12-year period there were 41 incidents resulting in 45 deaths due to asphyxiation or chemical poisoning while wearing a respirator. There were 23 deaths related to airline respirators, 17 deaths involving use of negative pressure (air purifying) respirators, and 5 deaths involving self-contained breathing apparatus. Among the 23 deaths involving airline respirators, 15 were associated with compatible connection couplings for breathable air and inert gases. Three workers with beards died who wore tight-fitting respirators in an atmosphere that was immediately dangerous to life and health. Most of the fatalities involved regulatory and procedural violations, and would have been prevented by proper training and compliance with existing regulations. The information concerning the victims was limited but it did not appear that medical screening would have prevented any of the deaths.
Designing the accident and emergency system: lessons from manufacturing.
OBJECTIVES: To review the literature on manufacturing process design and demonstrate applicability in health care.
METHODS: Literature review and application of theory using two years activity data from two healthcare communities and extensive observation of activities over a six week period by seven researchers.
FINDINGS: It was possible to identify patient flows that could be used to design treatment processes around the needs of the patient. Some queues are built into existing treatment processes and can be removed by better process design. Capacity imbalance, not capacity shortage, causes some unnecessary waiting in accident and emergency departments.
DISCUSSION: Clinicians would find that modern manufacturing theories produce more acceptable designs of systems. In particular, good quality is seen as a necessary pre-requisite of fast, efficient services.
Nail gun injuries in residential carpentry: lessons from active injury surveillance.
- Lipscomb HJ, Dement JM, Nolan J, Patterson D, Li L. Inj Prev 2003; 9(1): 20-24.
Correspondence: Hester J Lipscomb, Division of Occupational and Environmental Medicine,Department of Community and Family Medicine, Box 3834, Duke University Medical Center, Durham, NC 27710, USA; (email: hester.lipscomb@duke.edu).
OBJECTIVE: To describe circumstances surrounding injuries involving nail guns among carpenters, calculate injury rates, identify high risk groups and preventive measures.
METHODS: and setting: Active injury surveillance was used to identify causes of injury among a large cohort of union residential and drywall carpenters. Injured carpenters were interviewed by experienced journeymen; enumeration of workers and hourworked were provided by the union. The combined data allowed definition of a cohort of carpenters, their hours worked, detailed information on the circumstances surrounding injuries, and identification of preventive measures from the perspectives of the injured worker and an experienced investigator.
FINDINGS: Nail guns were involved in 14% of injuries investigated. Ninety percent of these injuries were the result of the carpenter being struck, most commonly by a nail puncturing a hand or fingers. The injury rate among apprentices was 3.7 per 200 000 hours worked (95% confidence interval (CI) 2.7 to 4.9) compared with a rate of 1.2 among journeymen (95% CI 0.80 to 1.7). While not always the sole contributing factor, a sequential trigger would have likely prevented 65% of the injuries from tools with contact trip triggers.
DISCUSSION: Training, engineering, and policy changes in the workplace and manufacturing arena are all appropriate targets for prevention of these injuries. Use of sequential triggers would likely decrease acute injury rates markedly. Over 70% of injuries among residential carpenters were associated with through nailing tasks (such as nailing studs or blocks, trusses or joists) or toe nailing (angled, corner nailing) as opposed to flat nailing used for sheathing activities; this provides some indication that contact trip tools could be used solely for flat nailing.
Causes of electrical deaths and injuries among construction workers.
- McCann M, Hunting KL, Murawski J, Chowdhury R, Welch L. Am J Ind Med 2003; 43(4): 398-406.
Correspondence: Michael McCann, The Center to Protect Workers' Rights, Silver Spring, MDCIH, 77 Seventh Avenue, #PHG, New York, NY 10011, USA; (email:michael.mccann@att.net).
BACKGROUND: Contact with electrical current is the fourth leading cause of deaths of construction workers. This study evaluates electrical deaths and injuries to construction workers.
METHODS: Two sources of data were analyzed in detail: (1) 1,019 electrical deaths identified by the Bureau of Labor Statistics, Census of Fatal Occupational Injuries (CFOI) for the years 1992-1998; and (2) 61 electrical injuries identified between November 1, 1990 and December 31, 1998 from a George Washington University Emergency Department injury surveillance database.
FINDINGS: Contact with "live" electrical wiring, equipment, and light fixtures was the main cause of electrical deaths and injuries among electrical workers, followed by contact with overhead power lines. Among non-electrical workers, contact with overhead power lines was the major cause of death. Other causes included contact with energized metal objects, machinery, power tools, and portable lights. Arc flash or blast caused 31% of electrical injuries among construction workers, but less than 2% of electrical deaths.
DISCUSSION: Adoption of a lockout/tagout standard for construction, and training for non-electrical workers in basic electrical safety would reduce the risk of electrical deaths and injuries in construction. Further research is needed on ways to prevent electrical deaths and injuries while working "live".
Bicycle injuries are the most common cause of serious head injury in children, and most of these injuries are preventable. The protective effect of bicycle helmets is well documented, but many child bicyclists do not wear them. This article summarizes the current state of research on bicycle injuries and helmet use and examines the effectiveness of legislation and injury-prevention strategies. Current studies indicate that children who wear helmets experience fewer head injuries and decreased severity of injury. Community-wide helmet-promotion campaigns combined with legislation are most successful in increasing helmet use and decreasing injury. Nurses can participate both at the institutional level and in community advocacy groups to promote bicycle safety for children.
Family characteristics and pedestrian injury risk in Mexican children.
- Celis A, Gomez Z, Martinez-Sotomayor A, Arcila L, Villasenor M. Inj Prev 2003; 9(1): 58-61.
BACKGROUND: Family characteristics have been described as risk factors for child pedestrian and motor vehicle collision. Research results come mainly from developed countries, where family relationships could be different than in developing ones.
OBJECTIVE: To examine family characteristics as risk factors for pedestrian injury in children living in Guadalajara City, Mexico.
METHODS: Case-control study of injuries among children 1-14 years of age involved in pedestrian-motor vehicle collisions. Cases resulting in death or injuries that required hospitalization or medical attention were included and identified through police reports and/or emergency room registries. Two neighborhood matched controls were selected randomly and compared with cases to estimate odds ratios (OR) and 95% confidence intervals (CI).
FINDINGS: Significant risk factors were: male (OR 2.3, 95% CI 1.2 to 4.4), number of siblings in household (two siblings, OR 3.2, 95% CI 1.4 to 6.6; three siblings, OR 4.5,95% CI 1.9 to 11.0; four or more siblings, OR 3.7, 95% CI 1.1 to 12.9), and number of non-siblings/non-parents in household (four or more, OR 6.2, 95% CI 1.5 to 26.6). Children of a sole mother, working mother, or grandmother living in house did not show increased risk after adjusting for socioeconomic conditions.
DISCUSSION: Household size has implications for child pedestrian and motor vehicle collision prevention efforts and is relatively easy to identify. Also, the lack of risk association with working mothers may indicate that grandmothers are not part of the social support network that cares for children of working mothers.
Discrepancy between actual and estimated speeds of drivers in the presence of child pedestrians.
Correspondence: Niki Harr�, Department of Psychology, University of Auckland, Private Bag 92019, Auckland, NEW ZEALAND; (email: n.harre@auckland.ac.nz).
OBJECTIVES: First, to measure the speeds of vehicles with and without children on the footpath, and second to compare these with drivers' estimates of how fast they would go in these conditions.
DESIGN: The speeds of vehicles in three conditions: control (no children present), children playing with a ball on the footpath, and children waiting to cross the road, were measured using speed tubes during two 55 minute sessions. Drivers' estimates of their speeds were measured with a questionnaire.
SETTING: Speeds were measured on a main road in Auckland, New Zealand. The questionnaire was conducted at another time with drivers stopping for petrol approximately 500 metres from the measurement site.
SUBJECTS: A total of 1446 speed measurements were taken and 93 drivers' questionnaire responses were analysed.
FINDINGS: The mean free speed of vehicles in the control condition was 55.60 kph, with drivers' estimates being 56.37 kph. When children were playing with a ball the measured speed was 54.29 kph and the estimated speed 39.27 kph. When children were waiting to cross the measured speed was 52.78 kph, estimated speed 34.02 kph. Analyses indicated that there were significant differences between measured and estimated speeds.
DISCUSSION: New Zealand drivers make inadequate speed adjustments in the presence of children, despite probably believing they do so. Establishing specific rules about appropriate speeds around children and highlighting to drivers the discrepancy between their attitudes and behaviour are two intervention strategies suggested.
Factors influencing injury severity of motor vehicle-crossing pedestrian crashes in rural Connecticut.
Correspondence: John N. Ivan, Civil and Environmental Engineering, Connecticut Transportation Institute, University of Connecticut, U-37 Storrs, CT 06269-2037, USA; (email: johnivan@engr.uconn.edu).
The ordered probit model was used to evaluate the effect of roadway and area type features on injury severity of pedestrian crashes in rural Connecticut. Injury severity was coded on the KABCO scale and crashes were limited to those in which the pedestrians were attempting to cross two-lane highways that were controlled by neither stop signs nor traffic signals. Variables that significantly influenced pedestrian injury severity were clear roadway width (the distance across the road including lane widths and shoulders, but excluding the area occupied by on-street parking), vehicle type, driver alcohol involvement, pedestrian age 65 years or older, and pedestrian alcohol involvement. Seven area types were identified: downtown, compact residential, village, downtown fringe, medium-density commercial, low-density commercial, and low-density residential. Two groups of these area types were found to experience significantly different injury severities. Downtown, compact residential, and medium- and low-density commercial areas generally experienced lower pedestrian injury severity than village, downtown fringe, and low-density residential areas.
Injury prevention attitudes and awareness in New Zealand.
- Hooper R, Coggan CA, Adams B. Inj Prev 2003; 9(1): 42-47.
Correspondence: Carolyn Coggan, Injury Prevention Research Centre, University of Auckland, Private Bag 92019, Auckland, NEW ZEALAND; (email: c.coggan@auckland.ac.nz).
OBJECTIVES: This study was designed to obtain New Zealand data on beliefs related to a broad spectrum of injuries and their prevention.
METHODS: A cross sectional phone survey was conducted of approximately 400 randomly selected households from each of 13 territorial local authorities across New Zealand, giving a total of 5282. Respondents were asked questions on awareness and attitudes to injury prevention,ownership and use of safety equipment, safety behaviours, and incidence of self reported injury.
FINDINGS: 84% agreed with the statement that "Most injuries are preventable" and 91% rated their homes as "very safe" or "reasonably safe". A high proportion of homes had smoke alarms (81%) and first aid kits (81%), and more than half (56%) had turned down the temperature of their hot water to 55 degrees C or lower. However, less than half of the respondents said that they practised the other safety behaviors. Significant associations were found between the practise of safety behaviours and respondents' home safety ratings. There was a significant association between home safety ratings and the incidence of injury occurring in all settings (p <0.0001), however there was no discernable association between home safety ratings and injury occurring in the home.
DISCUSSION: Although this survey found that most respondents believed that injuries are preventable and considered their homes to be safe, the public need to be further encouraged to adopt common safety practices and behaviours in the home.
Correspondence: Barbara A. Elliot, Department of Family Medicine, School of Medicine Duluth, University of Minnesota, 1035 University Drive, Duluth, MN 55812-3031, USA; (email: unavailable).
Objective: Project goals included creating a database for medical incidents at a Minnesota canoe and backpacking camp and identifying those most at risk within this population using one summer's experience.
Methods: YMCA Camp Widjiwagan employed a total of 123 staff and served 725 campersin summer 2000. This resulted in 9418 camper trail days (CTD), 2497 staff trail days (STD and 20,150 participant days (PD), the evaluation units for this study. Data were collected using routine documentation: treatment logs (TL) for any event that required care, and incident reports (IR) for more serious injuries and near misses. Information was entered into an Access database and analyzed using descriptive statistics and analysis of variance.
Findings: Canoe and backpack trips were compared using staff and camper days (CD). There were 582 TL and 59 IR, including 12 cases that resulted in evacuation to medical care (1/1000 PD). Canoe groups were no more at risk than backpack groups (P = .607), and campers reported more incidents than staff regardless of sex or location of injury (0.4/1000 CD compared with 0.1/1000 CD; P < .001). The camper groups most at risk were those beginning a series of advanced canoe trips (10 IR/1000 CTD; P < .001) and those on the longest, most advanced backpack trips (9 IR/1000 CTD; P < .001).
Discussion: Careful tracking of health incidents and near misses over time can reveal which campers and camper groups are at greatest risk for injuries and illnesses occurring during participation.
A retrospective case-control study of horse falls in the sport of horse trials and three-day eventing.
- Singer ER, Saxby F, French NP. Equine Vet J 2003; 35(2): 139-145.
Correspondence: E.R. Singer, Division of Equine Studies, University of Liverpool, Leahurst, Chester High Road, Neston, South Wirral CH64 7TE, UK; (email: unavailable).
OBJECTIVES: Serious injuries to horses and riders in horse trials (HT) and three-day events (3DE) are usually associated with falls of horses, which invariably involve falls of the riders. Many potential causes for these falls have been discussed. OBJECTIVES: The aim of this case-control study was to investigate the risk factors for horse falls on the cross-country phase of horse trials and three-day events.
METHODS: Using retrospective data, significant risk factors identified with unvariable analysis (P value <0.2) were entered into a multivariable logistic regression model. Significant risk factors (P value <0.05) were included in the final model.
FINDINGS: It was revealed that a number of course, obstacle and rider variables were significantly and independently associated with the risk of falling. Falling was associated with obstacles sited downhill (Odds ratio [OR] 8.41) and with obstacles with ditches in front (OR = 5.77).
DISCUSSION: The relationship between course variables and the risk of falling was characterised and showed a significantly increased risk with increasing numbers of jumps on the course and for jumping efforts later in the course. In contrast, after allowing for the total number of obstacles on the course, an increase in the total number of jumping efforts appeared to have a protective effect. A later cross-country start time was associated with a decreased risk of a horse fall. Amateur event riders were approximately 20 times more likely to fall than professional riders.
POTENTIAL CLINICAL RELEVANCE: This study has identified a number of risk factors associated with horse falls and highlights areas that can be altered to improve safety in cross-country competitions.
How much science is there in injury prevention and control?
- Smith CA, Shannon HS. Inj Prev
2003; 9(1): 89-90.
Correspondence: Harry S Shannon, Program in Occupational Health and Environmental Medicine, 1200 Main Street W, Room 3H50, McMaster University, Hamilton, Ontario, CANADA; (email: shannonh@mcmaster.ca).
OBJECTIVES: To determine what proportion of research papers at an injury prevention conference reported an evaluation.
METHODS: A random sample of 250 abstracts from the 6th World Conference on Injury Prevention and Control were classified by methodological type. Those that described any evaluation were further subdivided by whether the evaluation was of process or if it used an intermediate or "true" outcome.
FINDINGS: Of 250 abstracts, 20 (8%; 95% confidence interval 5.0% to 12.1%) showed evaluations with intermediate or true outcomes. Research designs were weak. Among the 20 reports, none was a randomized trial and only two conducted a before and after study with control group. The remaining 17 used before-after or "after only" designs.
DISCUSSION: The conference papers included few evaluations. To ensure that resources are best used, those in the injury prevention field must increase their use of rigorous evaluation.
Use of out of hours services: a comparison between two organisations.
- Van Uden CJ, Winkens RA, Wesseling GJ, Crebolder HF, Van Schayck CP. Emerg Med J 2003; 20(2): 184-187.
Correspondence: C J T van Uden, Department of Transmural Care, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, NETHERLANDS; (email: Caro.vanUden@hag.unimaas.nl).
OBJECTIVES: To investigate differences in numbers and characteristics of patients using primary or emergency care because of differences in organisation of out of hours care.
BACKGROUND: Increasing numbers of self referrals at the accident and emergency (A&E) department cause overcrowding, while a substantial number of these patients exhibit minor injuries that can be treated by a general practitioner (GP).
METHODS: Two different organizations of out of hours care in two Dutch cities (Heerlen and Maastricht) were investigated. Important differences between the two organisations are the accessibility and the location of primary care facility (GP cooperative). The Heerlen GP cooperative is situated in the center of the city and is respectively 5 km and 9 km away from the two A&E departments situated in the area of Heerlen. This GP cooperative can only be visited by appointment. The Maastricht GP cooperative has free access and is located within the local A&E department. During a three week period all registration forms of patient contacts with out of hours care (GP cooperative and A&E department) were collected and with respect to the primary care patients a random sample of one third was analysed.
DISCUSSION: The organization of out of hours care in Maastricht has optimised the GP's gatekeeper function and thereby led to fewer self referrals at the A&E department, compared with Heerlen.
Emergency nurse practitioners: a three part study in clinical and cost effectiveness.
- Sakr M, Kendall R, Angus J, Saunders A, Nicholl J, Wardrope J. Emerg Med J 2003; 20(2): 158-163.
Correspondence: Jim Wardrope, Accident and Emergency Department, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK; (email: Jim.Wardrope@sth.nhs.uk).
OBJECTIVE: To compare the clinical effectiveness and costs of minor injury services provided by nurse practitioners with minor injury care provided by an accident and emergency (A&E) department.
METHODS: A three part prospective study in a city where an A & E department was closing and being replaced by a nurse led minor injury unit (MIU). The first part of the study took a sample of patients attending the A & E department. The second part of the study was a sample of patients from a nurse led MIU that had replaced the A&E department. In each of these samples the clinical effectiveness was judged by comparing the "gold standard" of a research assessment with the clinical assessment. Primary outcome measures were the number of errors in clinical assessment, treatment, and disposal. The third part of the study used routine data whose collection had been prospectively configured to assess the costs and cost consequences of both models of care.
FINDINGS: The minor injury unit produced a safe service where the total package of care was equal to or in some cases better than the A & E care. Significant process errors were made in 191 of 1447 (13.2%) patients treated by medical staff in the A&E department and 126 of 1313 (9.6%) of patients treated by nurse practitioners in the MIU. Very significant errors were rare (one error). Waiting times were much better at the MIU (mean MIU 19 minutes, A & E department 56.4 minutes). The revenue costs were greater in the MIU (MIU pound 41.1, A&E department pound 40.01) and there was a great difference in the rates of follow up and with the nurses referring 47% of patients for follow up and the A&E department referring only 27%. Thus the costs and cost consequences were greater for MIU care compared with A&E care (MIU pound 12.7 per minor injury case, A & E department pound 9.66 per minor injury case).
DISCUSSION: A nurse practitioner minor injury service can provide a safe and effective service for the treatment of minor injury. However, the costs of such a service are greater and there seems to be an increased use of outpatient services.
Predictors and severity of injury in assaults with barglasses and bottles.
Correspondence: Jonathan Shepherd, Violence Research Group, Department of Oral Surgery,Medicine and Pathology, University Dental Hospital and School, Heath Park, Cardiff CF14 4XY, UK; (email: shepherdjp@cardiff.ac.uk).
BACKGROUND: Although glasses and bottles are frequently used as weapons in assaults,there is little knowledge on which prevention strategies can be based.
DESIGN: Scrutiny of a random sample of 1,288 criminal injury compensation applications.
OBJECTIVE: To identify predictors and relative severity of glass and bottle injury.
METHOD: Injury site, severity, treatment, and demographic characteristics of victims and assailants were studied with reference to awards from the UK national Criminal Injuries Compensation Authority (CICA).
MAIN OUTCOME MEASURES: Gender of victims and assailants, injury sites, treatment, and award (UK pounds) as indices of injury severity.
FINDINGS: Annual CICA awards to all victims of assaults in licensed premises during 1996-98 amounted to pound 4.08 million (for all glass/bottle assaults: pound 1.15 million = 28%). The mean cost of 746 glass assaults was pound 2347, compared with pound 2007 for 542 injuries from bottle assaults (mean difference pound 340; p<0.01). This difference largely reflected more eye injuries with glasses (26 cases: 3% of all glass assaults) than with bottles (eight cases: 1% of all bottle assaults). Bottle assault was significantly associated with unidentified assailants and scalp injuries; whereas glass injury was significantly linked to pub opening hours (midday to midnight), Thursdays, eye and face injuries, and treatment requiring sutures. Mean age of bottle assault victims (26.1 years) was lower than of glass victims (27.3 years; p<0.01), and same gender assaults were more frequent than between gender assaults for both bottle (p<0.001)and glass (p<0.001) assaults. Female victims were allocated to lower compensation awards more frequently than male victims; this was the case for both bottle (p<0.05) and glass (p<0.01) assaults.
DISCUSSION: Assaults with bottles caused less serious injury and resulted in lower compensation costs. Injury distribution was linked to victim gender and weapon choice, but not to assailant gender. Prevention strategies should focus on both bottle and glass assaults and should take account of the setting and time in which drinking occurs.
Socioeconomic variation in injury in children and older people: a population based study.
- Lyons RA, Jones SJ, Deacon T, Heaven M. Inj Prev 2003; 9(1): 33-37.
Correspondence: Ronan Lyons, Centre for Postgraduate Studies, Clinical School, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK; (email: r.a.lyons@swansea.ac.uk).
OBJECTIVES: To compare hospital admission rates for all causes and specific causes of injury in children and the elderly by a measure of economic deprivation.
STUDY DESIGN: All emergency admissions for Welsh residents from 1997-99 were located to one of 865 electoral tracts, which were grouped into fifths using a measure of socioeconomic deprivation. Standardised admission rates for all ages and 0-14, 15-75, and 75+ year groups for each quintile were calculated with 95% confidence intervals.
FINDINGS: There were 90,935 admissions in a population of 2.84 million yielding a crude admission rate of 1,601/100,000/year and a standardised rate of 1,493/100,000. The ratio of admissions in deprived and affluent areas varied with category of injury and age group. In general, socioeconomic variations in injury rates were much smaller in older people than in children with the exception of pedestrian related injuries where the rates were similar. The largest variations were for injuries sustained in assaults or self inflicted.
DISCUSSION: The relationship between socioeconomic position and injury varies by cause and age group. This should be considered when developing area based preventive interventions or monitoring the effectiveness of policies to reduce inequalities in injury occurrence.
Cause, type, and workers' compensation costs of injury to fire fighters.
- Walton SM, Conrad KM, Furner SE, Samo DG. Am J Ind Med 2003; 43(4): 454-458.
Correspondence: Surrey M. Walton, Department of Pharmacy Administration (M/C 871), College of Pharmacy, 833 South Wood St., Room 241, Chicago, IL, USA; (email:walton@uic.edu).
BACKGROUND: Work-related injury rates in the fire service industry exceed those for most other industries, however little is known about the cost of injury to firefighters.
METHODS: This is a preliminary investigation of detailed worker's compensation records of firefighter injuries, 1,343 claims in all, collected from 1992-1999. Summary statistics and regression analysis regarding the cause, nature, and cost of injury to firefighters are presented.
FINDINGS: Overexertion accounted for a significant portion (over 1/3) of injuries to firefighters, typically involved injuries to the back, and was associated with significantly higher costs than other types of injuries. The per-claim average worker's compensation cost of injury to firefighters was $5,168 and the average for injuries caused by overexertion was $9,715.
DISCUSSION: Overexertion is a costly source of injury to firefighters that can likely be reduced through policy intervention.
Modelling risk factors for injuries from dog bites in Greece: a case-only design and analysis.
Correspondence: Constantine E. Frangakis, Department of Biostatistics, Johns Hopkins University, 615 N. Wolfe Street, 21205, Baltimore, MD, USA; (email: cfrangak@jhsph.edu).
We conducted a study using a newly developed dataset based on Emergency Departments records of a network of hospitals from Greece on injuries from dog bites. Our goal is three-fold: (a) to investigate if surrogate factors of leisure time are associated with increased risk of injury from bites; (b) to address recently reported contradictory results on putative association of lunar periods and injuries from dog bites; and (c) to offer a general methodology for addressing similar case-only designs with combined factors of which some can exhibit cyclical patterns. To address these goals, we used a case-only design of our dataset, and conducted an analysis where we controlled simultaneously for weekday/weekend effects, season of year (winter, spring/fall, summer), and lunar periods, because any one of these factors can contribute to the degree of exposure to injuries from dog bites. We found that increased risk of injury from bites was associated with weekends versus weekdays (RR=1.19, 95% CI: 1.10-1.29), summer versus winter (RR=1.24, 95% CI: 1.11-1.39), and fall or spring versus winter (RR=1.31, 95% CI: 1.19-1.45). The results support the hypothesis that longer leisure time at these levels of factors does increase the risk of having a bite injury. Moreover, after controlling for these factors, risk of bite injury was not associated with moon periods, thereby also helping settle a longstanding argument.
OBJECTIVES: To characterize the events and examine suicide precursors among women and to examine gaps in surveillance.
SETTING: A statewide study in North Carolina.
METHODS: Suicides of women age 15 and older for the time period 1989-93, as identified from the Office of the Chief Medical Examiner, were included. All case files were reviewed by hand and telephone interviews were attempted with investigating law enforcement officials for every case in 1993.
FINDINGS: Altogether 882 suicides met the case definition, for an age adjusted rate that fluctuated between 5.53 and 7.26 per 100 000 women across the period. Interviews with law enforcement officials were completed for 135 of the 177 cases from 1993. White women had rates nearly three times those of racial minorities. Women under age 45 were proportionally more likely than older women to have recently experienced the breakup of an intimate relationship. Information about precursors was not as consistently reported as had been hoped. Medical examiner records were variable in completeness. Law enforcement interviews frequently did not yield information about the factors we had hoped to examine, probably because the investigations were conducted primarily to rule out homicide.
DISCUSSION: This study suggests somewhat different precursor patterns by age group. It also points to the need for reconsidering how suicide surveillance is accomplished as a strategy to guide intervention.
Prevalence of major depression in deliberate self-harm individuals in Harare, Zimbabwe.
- Chibanda D, Sebit MB, Acuda SW. East Afr Med J 2002; 79(5): 263-266.
Correspondence: D. Chibanda, Harare Central Hospital, P.O. Box St 1414 Southerton, Harare, ZIMBABWE;(email: unavailable).
OBJECTIVE: To investigate the prevalence of major depression in deliberate self-harm individuals.
DESIGN: A cross sectional descriptive study.
SETTING: Three tertiary health care centres in Harare, Zimbabwe.
SUBJECTS: Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited from July 1, 1997 to December 31, 1997 for this study. Diagnostic procedures included complete medical history, physical and neurological examinations. The DSM-IV criterion for major depression was used for the diagnostic purpose.
MAIN OUTCOME MEASURES: The prevalence of major depression, number of attempts and recent life events, methods used, feeling in deliberate self-harm individuals.
FINDINGS: The prevalence of major depression was 20.7% (n=80, 95% CI=16.7-24.2) according to the DSM-IV criterion. Sixty-two percent (95% CI=57.2-66.8) of the subjects with DSH were aged < or = 30 years. Significant differences (P<0.05) were found between DSH subjects with and without major depression related to age, education, life events and number of previous attempts.
DISCUSSION: The most predictive factors associated with DSH risks are age, depression, recent loss, divorced, loss of job and history of previous attempts. Further studies are needed to address some causes of DSH.
Effects of suicidal behavior on a psychiatric unit nursing team.
Correspondence: B. Joyce, Mental Health Program, M-4, McEwen Building, St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba, CANADA; (email:BJOYCE@sbgh.mb.ca).
1. Suicide of a psychiatric inpatient can have significant, although diverse, effects on the emotions and behavior of both individual nurses and team functioning. 2. The majority of participants in this study felt there was a need for formal debriefing or counseling for themselves and their colleagues after a critical incident, although there was less consensus about the timing and structure of such an intervention. 3. This research highlights the need for advanced training of critical incident stress management team members and for flexibility in the application of critical incident stress management techniques.
Suicide attempts in the United States: the role of physical illness.
- Goodwin RD, Marusic A, Hoven CW. Soc Sci Med 2003; 56(8): 1783-1788.
Correspondence: Renee D. Goodwin, Department of Epidemiology, Mailman School of Public Health, Columbia University, 1051 Riverside Drive, Unit 43, New York, NY 10032, USA; (email: rdg66@columbia.edu).
The study aimed to determine the relationship between physical illness, mental disorder, and the likelihood of suicide attempt among adults aged 15-54 in the United States. Data were drawn from the National Comorbidity Survey (N=8,098), a national probability sample of adults in the United States. Multivariate logistic regression analyses were used to determine the relationship between self-reported physical illness and the likelihood of suicide attempt. Lung disease (OR=1.8 (1.1, 2.7)), ulcer (OR=2.1 (1.3, 3.4)), and AIDS (OR=44.1 (10.5, 185.6)) were each associated with a significantly increased likelihood of suicide attempt, independent of the effects of mental disorders. Consistent with previous studies, the number of physical illnesses was linearly related to an increased odds of suicide attempt (OR=1.3 (1.2, 1.5)). Possible mechanisms for these associations are discussed. These findings call for the inclusion of a range of physical health problems, especially chronic illnesses, in future research on suicide attempts in the population.
Correspondence: Pierre Thiffault, Laboratoire de Simulation de Conduite, Center de Recherche sur les Transports, Universite de Montreal, C.P. 6128, Succursale Centre-Ville, Que, H3C-3J7, Montreal, CANADA; (email: unavailable).
Studies have shown that drowsiness and hypovigilance frequently occur during highway driving and that they may have serious implications in terms of accident causation. This paper focuses on the task induced factors that are involved in the development of these phenomena. A driving simulator study was conducted in order to evaluate the impact of the monotony of roadside visual stimulation using a steering wheel movement (SWM) analysis procedure. Fifty-six male subjects each drove during two different 40-min periods. In one case, roadside visual stimuli were essentially repetitive and monotonous, while in the other one, the environment contained disparate visual elements aiming to disrupt monotony without changing road geometry. Subject's driving performance was compared across these conditions in order to determine whether disruptions of monotony can have a positive effect and help alleviate driver fatigue. Results reveal an early time-on-task effect on driving performance for both driving periods and more frequent large SWM when driving in the more monotonous road environment, which implies greater fatigue and vigilance decrements. Implications in terms of environmental countermeasures for driver fatigue are discussed.
The paradox of driving speed: two adverse effects on highway accident rate.
Whereas speeding is known to be a substantial risk factor in driving, there is no unequivocal evidence that accident rate on limited-access motor highways is considerably affected by average speed or by speed limits meant to regulate it. It is suggested here that the seeming puzzle actually may have a straightforward explanation: accident-prone interactions (APIs) between cars occur when they pass each other-mostly moving in the same directions or in opposite ones. Such interactions are shown here to happen more frequently, the lower average speed is. To the extent that high speed limits contribute to increase in average speed, they serve to reduce the number of such interactions, thereby to moderate at least part of the negative effect of speed on the driver's ability to avoid an impending accident.
Injuries and death of children in rollover motor vehicle crashes in the United States.
Correspondence: F P Rivara, Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Ave, Seattle, WA 91804, USA; (email: fpr@u.washington.edu).
BACKGROUND: There is an increased awareness of the problem of rollover crashes, but few data on children involved in rollover crashes in the United States.
OBJECTIVE: To determine: (1) the rates of rollover crashes involving children and the incidence of fatal injury; (2) the characteristics of crashes involving children; (3) the risk factors for children being in a rollover compared with a non-rollover crash; and (4) whether the risk of death is greater for children involved in crashes in sport utility vehicles (SUVs) or passenger cars.
METHODS: Retrospective cohort study. 1993 through 1998 crashes involving children younger than 16 years included in the Crashworthiness Data System or reported to the Fatality Analysis Reporting System.
FINDINGS: During the study period, 100.4 children per 100 000 person-years were involved in a rollover crash, accounting for 10% of all children involved in crashes. The incidence of fatal injuries in rollover crashes was 3.4 per 100 000 person-years. Sixty percent of children involved in rollovers were riding in SUVs. Among vehicles carrying children and involved in a crash, the adjusted relative risk of the crash being a rollover was 11.1 (95% confidence interval (CI) 9.3 to 13.3) for SUVs compared with passenger cars. The adjusted relative risk of death was 1.8 (95% CI 1.1 to 2.8) in a rollover crash and the relative risk of injury was 2.1 (95% CI 1.1 to 3.8) compared with non-rollover crashes. However, the relative risk of death for children in SUVs which crashed was 0.4 (95% CI 0.1 to 2.5) compared with passenger cars which crashed.
DISCUSSION: Crashes involving children in SUVs were more likely to be rollover crashes than those involving passenger cars, and rollover crashes were associated with an increased risk of death and injury. However, the overall risk of death for children in a crash was not higher for children who crashed in an SUV compared to children who crashed in a passenger vehicle. Whether children are safer overall in SUVs compared with other cars cannot be answered with the data used.
Seatbelt legislation in Japan: high risk driver mortality and seatbelt use.
- Nakahara S, Ichikawa M, Wakai S. Inj Prev 2003; 9(1): 29-32.
Correspondence: Shinji Nakahara, Department of International Community Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, JAPAN; (email: shinji@m.u-tokyo.ac.jp).
OBJECTIVES: To clarify why seatbelt legislation did not achieve the expected reduction in mortality in Japan. Location and background: Seatbelt legislation was enacted in Japan in September 1985 and penalties were introduced in November 1986.
METHODS: The driver deaths per vehicle km traveled (D/VKT) were calculated to adjust for changes in traffic volume. Decreases in D/VKT were compared with the reduction expected after legislation. The association between percentage changes of driver D/VKT, seatbelt use rate, and seatbelt non-use rate were explored. Deaths of passengers, pedestrians, and cyclists were also examined. Mortality data were obtained from vital statistics, traffic volume figures from the Ministry of Land, Infrastructure, and Transport, and seatbelt use rates from the National Police Agency.
FINDINGS: Although the decrease in D/VKT after the law was enforced was larger than the absolute number of deaths, it was far less than predicted. The percentage decrease in seatbelt non-use rate showed the strongest correlation with the percentage decrease in driver mortality. Mortality did not increase among other road users after the law was enacted.
DISCUSSION: Accurate evaluation of the effect of seatbelt legislation must take into account changes in traffic volume. The selective recruitment hypothesis-that high risk drivers were less responsive to seatbelt legislation-fits well with the findings. There was no conclusive evidence supporting risk compensation-that is, an increase in injuries among other road users.
Seatbelt use by high school students.
- Williams AF, McCartt AT, Geary L. Inj Prev 2003; 9(1): 25-28.
Correspondence: Allan F Williams, 1005 North Glebe Road, Arlington, VA 22201-4751, USA;(email: awilliams@iihs.org).
OBJECTIVE: To determine seatbelt use of teenage drivers arriving at high schools in the morning and at evening football games compared with belt use of adults driving teenage passengers to these events, and teenage passenger belt use depending on whether they were being driven by another teenager or an adult.
METHODS: Unobtrusive observations of belt use were made at 12 high schools in Connecticut and Massachusetts.
FINDINGS: Among males, teenage drivers had lower belt use than adults; differences between female teenage and female adult drivers were slight. Teenage passengers had lower belt use in vehicles driven by other teenagers than in cars driven by adults, but more than 40% of teenage passengers in vehicles driven by adults, presumed in most cases to be the teenager's parent, were not belted. Teenage passenger belt use was lower than teenage driver use regardless of gender. These differences were found both at morning arrivals and at football games, but teenage belt use was not much different in these two settings. Teenage passengers were belted more often if drivers were belted, whether the driver was another teenager or an adult,but a third of male passengers and 25%-30% of female passengers were unbelted even when drivers were belted.
DISCUSSION: Teenagers have high crash risk but low belt use, which adds to their injury problem. Avenues to address this include strong belt use laws and their enforcement, building belt use requirements into graduated licensing systems, keeping young beginners out of high risk driving situations, and finding ways to influence parents and other adults to ensure that their teenage passengers use seatbelts.
Race, Hispanic origin, and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults.
Correspondence: Elisa R. Braver, Insurance Institute for Highway Safety, 1005 North Glebe Road, 22201-4751, Arlington, VA, USA; (email: ebraver@iihs.org).
Black and Hispanic adults travel less in motor vehicles than whites but may be at greater risk when they do travel. Passenger vehicle occupant deaths per 10 million trips among persons ages 25-64 were computed by race, Hispanic origin, gender, and socioeconomic status (SES) using 1995 data from the Fatality Analysis Reporting System (FARS) and Nationwide Personal Transportation Survey. Educational level was used as the indicator of SES. Blacks, particularly black men, were at increased risk of dying relative to whites when traveling in motor vehicles (rate ratio (RR) for black men=1.48; 95% confidence interval (CI)=1.42-1.54). Hispanic men, but not Hispanic women, also had elevated occupant death rates, but their risk was less than that of black men (RR=1.26; 95% CI=1.20-1.31). SES was the strongest determinant of occupant deaths per unit of travel; RRs among those who had not completed high school were 3.52 (95% CI=3.39-3.65) for men and 2.79 (95% CI=2.69-2.91) for women, respectively. Whites without high school degrees had the highest death rates per 10 million trips. After adjustment for SES, the elevated risk of occupant fatalities persisted among black men and women, but not among Hispanic men.Seat belt use and alcohol-impaired driving were examined among fatally injured passenger vehicle drivers. Among those with no education beyond high school, higher percentages were reported as having high blood alcohol concentrations (BACs) or having not used belts. Reported belt use rates were lower among black men and women, even after controlling for SES, whereas Hispanic men and women had belt use rates similar to those of whites. High BACs were more common among Hispanic men, which appeared largely to be an effect of SES because most Hispanic men killed in crashes had not completed high school, the education level with the highest percentage that drove while impaired by alcohol. More effective public health efforts are needed to reduce occupant deaths among persons of lower SES, blacks, and Hispanics, including measures to increase use of seat belts and reduce alcohol-impaired driving.
An investigation of child restraint/seatbelt usage in motor vehicles by Maori in Northland New Zealand.
Correspondence: Marilyn Brewin, Injury Prevention Research Centre, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland, NEW ZEALAND; (email: m.brewin@auckland.ac.nz).
OBJECTIVE: To investigate child restraint/seatbelt use by the indigenous (Maori) population in Northland New Zealand.
METHOD: Observational surveys were conducted at the two main car parks (McDonald's and the largest supermarket) to determine the number of passengers restrained, the type of restraints, and correct use. Observations were restricted to those who were obviously Maori, based upon the local knowledge of the observer. In addition, face to face questionnaires were administered to Maori whanau/caregivers involved in the care of two or more children for more than three days a week.
FINDINGS: A total of 788 participants were observed. Babies were those most likely to have all occupants restrained correctly (97%), followed by toddlers (66%), adults (56%), and school age children (48%); 138 interviews were conducted. Females (86%) were significantly more likely to ensure that all passengers were restrained on short journeys compared to males (67%; p<0.05). Respondents under 45 (80%) were significantly less likely to restrain child passengers compared to people aged 45 or older (91%; p<0.05).
DISCUSSION: This study highlights the problem that larger families in this study had in providing correct child restraints for all their children.
Upper extremity interaction with a deploying side airbag: a characterization of elbow joint loading.
Computer simulations, dummy experiments with a new enhanced upper extremity and small female cadaver experiments were used to analyze the small female upper extremity response under side airbag loading. After establishing a worst case initial position, three tests were performed with the fifth percentile female hybrid III anthropometric test dummy and six experiments with small female cadaver subjects. A new fifth percentile female enhanced upper extremity was developed for the dummy experiments that included a two-axis wrist load cell in addition to the existing six-axis load cells in both the forearm and humerus. Forearm pronation was also included in the new dummy upper extremity to increase the biofidelity of the interaction with the handgrip. Instrumentation for both the cadaver and dummy tests included accelerometers and MHD angular rate sensors on the forearm, humerus, upper and lower spine. In order to quantify the applied loads to the cadaver hand and wrist from the door mounted handgrip, the handgrip was mounted to the door through a five-axis load cell and instrumented with accelerometers for inertial compensation. All six of the cadaver tests resulted in upper extremity injuries including comminuted mid-shaft humerus fractures, osteochondral fractures of the elbow joint surfaces, a transverse fracture of the distal radius and an osteochondral fracture of the lunate carpal bone. The results from the 6 cadaver tests presented in this study were combined with the results from 12 previous cadaver tests. A multivariate logistic regression analysis was performed to investigate the correlation between observed injuries and measured occupant response. Using inertially compensated force measurements from the dummy mid-shaft forearm load cell, the linear combination of elbow axial force and shear force was significantly (P=0.05) correlated to the observed elbow injuries.
Factors associated with fatal and injurious car crash among learner drivers in New South Wales, Australia.
This exploratory study investigated factors associated with car crash injury among learner drivers across difference ages by using data routinely collected by the NSW police. The results obtained indicated that some factors are commonly associated with car crash injury across nearly all ages. On the other hand, some others are more age specific. On the whole, female learner drivers were more at risk of being killed or injured as compared to males. The drivers of 16 years old had an increased risk of crash injury due to environmental factors, such as special road feature, and distraction outside the vehicle. The increased risk of crash injury for older drivers (>/=25 years) was associated with distractions from both inside and outside vehicle. Night time driving posed a special risk to learner drivers aged 20-24 years old, but not other age groups. Speeding was a common factor for the increased risk of crash injury across all age groups. The implication of the results and limitations of the study were discussed.
Correspondence: J.C. Stutts, Highway Safety Research Center, University of North Carolina, 730 Airport Road, Campus Box 3430, 27599-3430, Chapel Hill, NC, USA; (email: unavailable).
A population-based case-control study was carried out to examine driver risk factors for sleep-related motor vehicle crashes. Cases included 312 drivers involved in recent North Carolina crashes and identified on police reports as asleep at the time of the crash and 155 drivers identified as fatigued. Controls were 529 drivers also involved in recent crashes but not identified as asleep or fatigued, and 407 drivers not involved in recent crashes. All drivers were contacted for brief telephone interviews. Results showed that drivers in sleep-related crashes were more likely to work multiple jobs, night shifts, or other unusual work schedules. They averaged fewer hours sleep per night, reported poorer quality sleep, were less likely to feel they got enough sleep, were sleepier during the day, drove more often late at night, and had more prior instances of drowsy driving. Compared to drivers in non-sleep-related crashes, they had been driving for longer times, been awake more hours, slept fewer hours the night before, and were more likely to have used soporific medications. Knowledge of specific risk factors for sleep-related crashes is an important first step in reducing the thousands of deaths and injuries each year in the US attributed to drowsy driving.
Horizontal violence: experiences of Registered Nurses in their first year of practice.
- McKenna BG, Smith NA, Poole SJ, Coverdale JH. J Adv Nurs 2003; 42(1): 90-96.
Correspondence: Brian G. McKenna, Senior Lecturer, School of Nursing, University of Auckland; and Nurse Advisor, Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, NEW ZEALAND; (email: unavailable).
Background: Interpersonal conflict among nurses (traditionally called 'horizontal violence' or 'bullying') is a significant issue confronting the nursing profession. However, there is a dearth of research focusing on horizontal violence experienced by new graduate nurses.
OBJECTIVES: In order to assess the priority for preventive intervention programmes, the aims of this study were to determine the prevalence of horizontal violence experienced by nurses in their first year of practice; to describe the characteristics of the most distressing incidents experienced; to determine the consequences, and measure the psychological impact, of such events; and to determine the adequacy of training received to manage horizontal violence.
METHODS: An anonymous survey was mailed to nurses in New Zealand who had registered in the year prior to November 2000 (n = 1169) and 551 completed questionnaires were returned (response rate 47%). Information was requested on the type and frequency of interpersonal conflict; a description of the most distressing event experienced; the consequences of the behaviour; and training to manage such events. The Impact of Event Scale was used to measure the level of distress experienced.
FINDINGS: Many new graduates experienced horizontal violence across all clinical settings. Absenteeism from work, the high number of respondents who considered leaving nursing, and scores on the Impact of Event Scale all indicated the serious impact of interpersonal conflict. Nearly half of the events described were not reported, only 12% of those who described a distressing incident received formal debriefing, and the majority of respondents had no training to manage the behaviour. Conclusions. First year of practice is an important confidence-building phase for nurses and yet many new graduates are exposed to horizontal violence, which may negatively impact on this process. The findings underscore a priority for the development of effective prevention programmes. Adequate reporting mechanisms and supportive services should also be readily available for those exposed to the behavior.
Studying "exposure" to firearms: household ownership v access.
BACKGROUND: Firearm ownership has often been used to measure access to weapons. However, persons who own a firearm may not have access to it and conversely, persons who do not own a firearm may be able to access one quickly.
OBJECTIVES: To examine whether using firearm ownership is a reasonable proxy for access by describing the demographic characteristics associated with ownership and access.
METHODS: Data are from the 1994 Injury Control and Risk Survey, a national, random digit dial survey. Information about household firearm ownership and ready access to a loaded firearm were collected and weighted to provide national estimates. Adjusted odds ratios for three separate models were calculated using logistic regression.
FINDINGS: A total of 1353 (27.9%) respondents reported both having a firearm in the household and ready access to one. An additional 313 respondents (8.1%) reported having a firearm, but were not able to access these weapons. Another 421 respondents (7.2%) did not have a firearm in or around their home, yet reported being able to retrieve and fire one within 10 minutes. Based on the logistic regression findings, the demographic characteristics of this latter group are quite different from those who report ownership. Those who do not have a firearm, but report ready access to one, are more likely to be ethnic minorities, single, and living in attached homes.
DISCUSSION: Asking only about the presence of a firearm in a household may miss some respondents with ready access to a loaded firearm. More importantly, those who do not own a firearm, but report ready access to one, appear to be qualitatively different from those who report ownership. Caution should be exercised when using measures of ownership as a proxy for access.
Association between handgun purchase and mortality from firearm injury.
Correspondence: Garen J Wintemute, Violence Prevention Research Program, UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA; (email: gjwintemute@ucdavis.edu).
OBJECTIVE: To determine the association between mortality from violent or firearm related injury and previous handgun purchase.
METHODS: Case-control study of 213,466 Californians ages 21 and older who died in 1998; cases were the 4728 violent or firearm related injury deaths, with subsets by specific cause and means of death, and controls were the 208 738 non-injury deaths. The exposure of interest was the purchase of a handgun during 1996-98. The main outcome measure was the odds ratio for handgun purchase, adjusted for age, sex, race, education, and marital status.
FINDINGS: Handgun purchase was more common among persons dying from suicide (odds ratio (OR) 6.8; 95% confidence interval (CI) 5.7 to 8.1) or homicide (OR 2.4, 95% CI 1.6 to 3.7), and particularly among those dying from gun suicide (OR 12.5; 95% CI 10.4 to 15.0) or gun homicide (OR 3.3; 95% CI 2.1 to 5.3), than among controls. No such differences were seen for non-gun suicide or homicide. Among women, those dying from gun suicide were much more likely than controls to have purchased a handgun (OR 109.8; 95% CI 61.6 to 195.7). Handgun purchasers accounted for less than 1% of the study population but 2.4% of gun homicides, 14.2% of gun suicides, and 16.7% of unintentional gun deaths. Gun suicide made up 18.9% of deaths among purchasers but only 0.6% of deaths among non-purchasers.
DISCUSSION: Among adults who died in California in 1998, those dying from violence were more likely than those dying from non-injury causes to have purchased a handgun.
Interpersonal violence issues in the nursing classroom.
Correspondence: M.J. Gagan, University of Arizona, College of Nursing, 1305 N. Martin, PO Box 210203, Tucson, AZ 85721-0203, USA; (email: mgagan@nursing.arizona.edu).
Interpersonal violence in the United States has been called a health issue of epidemic proportions (Rudman & Alpert, 2000). Reports of interpersonal violence appear daily in popular media, and specific cases have been sensationalized. The nursing profession traditionally has attempted to respond to major health issues through education, political activity, and direct patient care. So, what have nurse educators done to prepare nurses to address this issue in their clinical practices and communities?
Although the juvenile violent crime rate has decreased steadily during the past 5 years, the problem of violence and violence-related behaviors in the lives of our children and adolescents remains. The incidence of violent victimization against children and violence and violence-related behavior by today's youth is related to a variety of factors. Exposure to violence in the home, school, community, or video games and other entertainment significantly influences aggressive behaviors among children and adolescents. Other childhood violence predictors include alcohol and drug use, gender, and low self-esteem. The childhood violence risk indicators have implications for child and adolescent violence prevention and intervention programs. Nurses who recognize dangerous and potentially dangerous behavior in children and adolescents are better able to provide violence prevention and intervention services and referrals to children at risk or in danger. Because orthopaedic nurses often see adolescents who have already sustained injury from violence, identification of those at risk is particularly important.
Domestic violence in rural Uganda: evidence from a community-based study.
- Koenig MA, Lutalo T, Zhao F, Nalugoda F, Wabwire-Mangen F, Kiwanuka N, Wagman J, Serwadda D, Wawer M, Gray R. Bull World Health Organ 2003; 81(1): 53-60.
Correspondence: Michael A. Koenig, Department of Population and Family Health Sciences,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; (email:mkoenig@jhsph.edu).
Although domestic violence is an increasing public health concern in developing countries, evidence from representative, community-based studies is limited. In a survey of 5109 women of reproductive age in the Rakai District of Uganda, 30% of women had experienced physical threats or physical abuse from their current partner - 20% during the year before the survey. Three of five women who reported recent physical threats or abuse reported three or more specific acts of violence during the preceding year, and just under a half reported injuries as a result. Analysis of risk factors highlights the pivotal roles of the male partner's alcohol consumption and his perceived human immunodeficiency virus (HIV) risk in increasing the risk of male against female domestic violence. Most respondents - 70% of men and 90% of women - viewed beating of the wife or female partner as justifiable in some circumstances, posing a central challenge to preventing violence in such settings.
Violence against women increases the risk of infant and child mortality: a case-referent study in Nicaragua.
- Sling-Monemi K, Pe a R, Ellsberg MC, Persson Lk L. Bull World Health Organ 2003; 81(1): 10-16.
Correspondence: Kajsa �sling-Monemi, Division of Epidemiology, Department of Public Health and Clinical Medicine, Ume University, Ume , SWEDEN; (email: unavailable).
OBJECTIVE: To investigate the impact of violence against mothers on mortality risks for their offspring before 5 years of age in Nicaragua.
METHODS: From a demographic database covering a random sample of urban and rural households in Le n, Nicaragua, we identified all live births among women aged 15-49 years. Cases were defined as those who had died before the age of 5 years, between January 1993 and June 1996. For each case, two referents, matched for sex and age at death, were selected from the database. A total of 110 mothers of the cases and 203 mothers of the referents were interviewed using a standard questionnaire covering mothers' experience of physical and sexual violence. The data were analysed for the risk associated with maternal experience of violence of infant and under-5 mortality.
FINDINGS: A total of 61% of mothers of cases had a lifetime experience of physical and/or sexual violence compared with 37% of mothers of referents, with a significant association being found between such experiences and mortality among their offspring. Other factors associated with higher infant and under-5 mortality were mother's education (no formal education), age (older), and parity (multiparity).
DISCUSSION: The results suggest an association between physical and sexual violence against mothers, either before or during pregnancy, and an increased risk of under-5 mortality of their offspring. The type and severity of violence was probably more relevant to the risk than the timing, and violence may impact child health through maternal stress or care-giving behaviours rather than through direct trauma itself.
