Correspondence: Michael Winkelman, Department of Anthropology, Arizona State University, Box 872402,
Tempe, AZ 85287-2402, USA; (email: michael.winkelman@asu.edu).
OBJECTIVES: This article examines drumming activities as complementary addiction treatments and discusses their reported effects.
METHODS: I observed drumming circles for substance abuse (as a participant), interviewed counselors and Internet mailing list participants, initiated a pilot program, and reviewed literature on the effects of drumming.
FINDINGS: Research reviews indicate that drumming enhances recovery through inducing relaxation and enhancing theta-wave production and brain-wave synchronization. Drumming produces pleasurable experiences, enhanced awareness of preconscious dynamics, release of emotional trauma, and reintegration of self. Drumming alleviates self-centeredness, isolation, and alienation, creating a sense of connectedness with self and others. Drumming provides a secular approach to accessing a higher power and applying spiritual perspectives.
DISCUSSION: Drumming circles have applications as complementary addiction therapy, particularly for repeated relapse and when other counseling modalities have failed.
Correspondence: John Pearn, Department of Paediatrics & Child Health, Royal Children's Hospital, Brisbane, Queensland, AUSTRALIA; (email: unavailable).
Children bear disproportionate consequences of armed conflict. The 21st century continues to see patterns of children enmeshed in international violence between opposing combatant forces, as victims of terrorist warfare, and, perhaps most tragically of all, as victims of civil wars. Innocent children so often are the victims of high-energy wounding from military ordinance. They sustain high-energy tissue damage and massive burns - injuries that are not commonly seen in civilian populations.
Children have also been deliberately targeted victims in genocidal civil wars in Africa in the past decade, and hundreds of thousands have been killed and maimed in the context of close-quarter, hand-to-hand assaults of great ferocity. Pediatricians serve as uniformed military surgeons and as civilian doctors in both international and civil wars, and have a significant strategic role to play as advocates for the rights and welfare of children in the context of the evolving 'Laws of War'.
One chronic legacy of contemporary warfare is blast injury to children from land mines. Such blasts leave children without feet or lower limbs, with genital injuries, blindness and deafness. This pattern of injury has become one of the post-civil war syndromes encountered by all intensivists and surgeons serving in four of the world's continents. The continued advocacy for the international ban on the manufacture, commerce and military use of antipersonnel land mines is a part of all pediatricians' obligation to promote the ethos of the Laws of War. Post-traumatic stress disorder remains an undertreated legacy of children who have been trapped in the shot and shell of battle as well as those displaced as refugees.
An urgent, unfocused and unmet challenge has been the increase in, and plight of, child soldiers themselves. A new class of combatant comprises these children, who also become enmeshed in the triad of anarchic civil war, light-weight weaponry and drug or alcohol addiction. The International Criminal Court has outlawed as a War Crime, the conscription of children under 15 years of age. Nevertheless, there remain more than 300,000 child soldiers active and enmeshed in psychopathic violence as part of both civil and international warfare. The typical profile of a child soldier is of a boy between the ages of 8 and 18 years, bonded into a group of armed peers, almost always an orphan, drug or alcohol addicted, amoral, merciless, illiterate and dangerous.
Pediatricians have much to do to protect such war-enmeshed children, irrespective of the accident of their place of birth. Only by such vigorous and maintained advocacy can the world's children be better protected from the scourge of future wars.
Correspondence: Susan Klitzman, Urban Public Health Program, School of Health Sciences, Hunter College, City University of New York, NY 10010, USA; (email: sklitzma@hunter.cuny.edu).
The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city's response to the public health, environmental/ occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city's health care and social service system. The authors suggest lessons that can inform the development of a post-September 11th agenda for strengthening urban health infrastructures.
OBJECTIVES: This study sought to characterize occupational injury and illness cases identified through 3 different sources of data on a population of immigrant workers.
METHODS: Participants were Cambodian and Lao workers living in Lowell, Mass. A household survey allowed comparisons between characteristics of work-related cases documented in workers' compensation wage replacement records and hospital records and characteristics of self-reported cases.
FINDINGS: The household survey captured types of cases missing from existing data, particularly illnesses self-reported to be associated with chemical exposures. Injuries and illnesses affecting the study population appeared to be significantly underrepresented in workers' compensation wage replacement data.
DISCUSSION: Community-based methods can supplement available occupational health data sources.
Occupational health nursing in Thailand. Insight into international occupational health.
Correspondence: Surintorn Kalampakorn, Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, THAILAND; (email: unavailable).
As a country that is both agricultural by nature, and moving toward new industrialization, Thailand is increasingly facing work related health problems. Major occupational illnesses are pesticide poisoning, silicosis, byssinosis, lead poisoning, and occupational injuries. Although the demand for occupational health services is high, occupational health services in Thailand are still not comprehensive. Because of the lack of role perception and inadequate preparation, Thai occupational health nurses have limited functions in providing occupational health services. The services are primarily directed at curative measures rather than prevention. Occupational health nursing in Thailand is currently undergoing intensive development in education, practice, research, and legislation.
This study examined parental perceptions of the benefits and barriers to bicycle helmet use and their level of knowledge about bicycle safety issues. A school-based bicycle safety education program was taught to first- and second-grade students in a rural/suburban school district by a graduate nursing student. Pender's Health Promotion Model was the theoretical framework used to guide this research study. A parent Bicycle Helmet Questionnaire (BHQ) developed by the author was the tool used to gather data. The study determined that parents of children in schools that received the educational intervention prior to completing the questionnaire had significantly higher knowledge level scores and that the majority of parents were in favor of bicycle helmet legislation for children. The implications from this research study include the importance of bicycle safety education interventions for students and parents and the need to implement bicycle helmet legislation.
Objectives: To examine risk factors associated with re-presentation (event rates) following an initial episode of hospital treated self-poisoning.
Method: A longitudinal cohort study using the Hunter Area Toxicology Service (HATS) database of all presentations to hospital of self-poisoned patients aged 10-19 in Newcastle and Lake Macquarie Regions of New South Wales from January 1991 to December 1995. The study factors were: age, gender, employment status, 'substance abuse' and psychiatric diagnosis at index (first documented episode during the study time-period) admission. The main outcome measure was re-presentations per unit time. Time-event analysis (multivariate) was used to compare re-presentation rates per person-year exposure to the study factors.
Findings: There were 450 patients who presented on a total of 551 occasions. The median and modal age at initial presentation was 17. Three hundred and nine (69%) were female and 141 (31%) were male. The probability (95% CI) of a patient re-presenting within one year of an index admission with self poisoning was 0.09 (0.07-0.12) and within 5 years was 0.16 (0.12-0.21). The adjusted rate ratios for episodes of re-presentation were: any 'substance abuse (ever)' 3.87 (2.08-7.21), 'alcohol abuse'2.32 (1.15-4.68),'benzodiazepine abuse' 4.89 (1.63-14.62), schizophrenia and other psychotic disorders (DSM-IV) 2.85 (1.2-6.79), and any personality disorder (DSM-IV) 2.68 (1.73-4.16).
Discussion: Interventions to decrease recurrence rates for adolescent self poisoning should be directed towards substance (particularly alcohol or benzodiazepine) abuse, non-affective psychoses and personality disorder.
Correspondence: Robert C. Cantu, Neurosurgery Service and Service of Sports Medicine, Emerson Hospital, Concord, Massachusetts; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill; and National Center for Catastrophic Sports Injury Research, Chapel Hill, North Carolina, USA; (email: unavailable).
OBJECTIVE: Brain injuries have been the most common direct cause of death among American football players since the annual recording of football-related deaths began in 1931. This study examines the 55-year experience with brain injury-related fatalities in American football from 1945 to 1999, including not only the incidence but also the cause of death in discrete 5-year spans to focus on the variables that have either increased or decreased fatalities. In addition, we describe the types of injuries that have occurred, the activities in which the players were engaged at the time of injury, the level of play involved, and whether the injuries occurred during games or in practice sessions.
METHODS: Data were collected nationwide regarding football fatalities in all organized football programs in public schools and in college, professional, and youth programs by conducting personal interviews and eliciting responses to questionnaires. The information collected included demographic data about the injured player, equipment data, injury type and body part involved, and pertinent information regarding the exact circumstances of the accident.
FINDINGS: We found that a total of 497 brain injury-related fatalities occurred among American football players during the period from 1945 through 1999. The causes of death were brain injuries in 69% of the cases, cervical spine injuries in 16%, and other injuries in 15%. Subdural hematoma was the type of injury associated with the majority (429, 86%) of brain injury-related fatalities. A majority (61%) of the brain injury-related fatalities occurred during participation in football games, and 75% of these were high school players. It should be noted that the number of high school football players is far greater (more than 1 million) than the number of either college (approximately 75,000) or professional (approximately 2000) players. The most frequent on-field activity involved when players sustained their fatal injuries was either tackling or being tackled (35%).
DISCUSSION: Brain injury-related fatalities accounted for 69% of all football fatalities from 1945 through 1999. The greatest number and percentage of brain injury-related fatalities occurred during the 5-year span from 1965 through 1969, and the smallest number and percentage occurred during the 2 decades from 1975 through 1994. Most brain injury-related fatalities involved a subdural hematoma sustained by high school football players while either tackling or being tackled in a game. In the 2 decades from 1975 through 1994, there was a dramatic reduction in these fatalities, and the preventive measures that have received most of the credit are 1) the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling and 2) the National Operating Committee on Standards for Athletic Equipment helmet standard, which went into effect in colleges in 1978 and in high schools in 1980.
Unpowered scooter injuries in children.
- Kubiak R, Slongo T. Acta Paediatr 2003; 92(1): 50-54.
Correspondence: Rainer Kubiak, Department of Pediatric Surgery, Children's Hospital Berne, Inselspital, Bern, SWITZERLAND; (email: rainerkubiak@hotmail.com).
OBJECTIVE: An increasing number of scooter-related injuries is being seen in emergency department. This study was initiated to establish the demographic profile and injury characteristics of the children involved, to examine the circumstances and to suggest preventive measures.
METHODS: During this descriptive cohort study, data from year 2000 were collected from all children below 16 y of age who were seen in the emergency department of a Swiss hospital following an accident with an unpowered scooter. Between January and September, information regarding age, gender, injury sustained and medical management was reviewed. From October to December, data were collected prospectively. A questionnaire was sent (January-September) or handed out personally (October-December) to the patients, to gather information on the circumstances surrounding the injury and the use of safety equipment.
FINDINGS: Thirty-six children (15M, 21F) were included in the study. The mean age was 8.8 y (range 3.0-15.8 y). The most common injuries involved the face (including six children with dental injuries) (44%) and the head (19%). Thirteen children (36%) (6M, 7F) sustained a fracture. The majority of injuries resulted from falls forward or to the side, caused by a loss of control or collision with an obstacle. Only one patient used any safety equipment.
DISCUSSION: Accidents with unpowered scooters can produce severe injuries in children. Although the majority of patients sustained minor injuries (e.g. lacerations, contusions), more serious injuries can occur. The head and face were the most vulnerable. The use of protective gear, especially helmets, may reduce the number and severity of injuries. Parents, doctors and healthcare workers should be aware of the causes and prevention of injuries caused by this rapidly growing recreational activity in childhood.
BACKGROUND: Children of adolescent mothers have higher rates of morbidity and unintentional injuries and hospitalizations during the first 5 years of life than do children of adult mothers.
OBJECTIVE: The purpose of this study was to evaluate the 2-year postbirth infant health and maternal outcomes of an early intervention program (EIP) of home visitation by public health nurses (PHNs).
METHODS: In a randomized controlled trial, a sample of predominantly Latina and African American adolescent mothers was followed from pregnancy through 2 years postpartum. The experimental group (EIP, n = 56) received preparation-for-motherhood classes plus intense home visitation by PHNs from pregnancy through 1 year postbirth; the control group (TPHNC, n = 45) received traditional public health nursing care (TPHNC). Health outcomes were determined based on medical record data; other measures evaluated selected maternal behaviors, social competence, and mother-child interactions.
FINDINGS:The total days of non-birth-related infant hospitalizations during the first 24 months was significantly lower in the EIP (143 days) than the TPHNC group (211 days) and episodes of hospitalization were fewer; more EIP than THHNC infants were never seen in the emergency room. The EIP mothers had 15% fewer repeat pregnancies in the first 2 years postbirth than TPHNC mothers. The TPHNC mothers significantly increased marijuana use over time, whereas EIP mothers did not.
DISCUSSION: The EIP improved in selected areas of infant and maternal health, and these improvements were sustained for a period of 1 year following program termination. These findings have important implications for healthcare services.
The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs.
- Cho SH, Ketefian S, Barkauskas VH, Smith DG. Nurs Res 2003; 52(2): 71-79.
Correspondence: Sung-Hyun Cho, Korea Institute for Health and Social Affairs, Department of Health Policy, San 42-14 Bulgwang-dong Eunpyeong-gu Seoul, KOREA; (email: shcho@kihasa.re.kr).
BACKGROUND: Nurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes.
OBJECTIVES: To examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs.
METHODS: Using two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes.
FINDINGS: Three statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization.
DISCUSSION: Patients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.
Acute Pesticide-Related Illnesses Among Working Youths, 1988-1999.
- Calvert GM, Mehler LN, Rosales R, Baum L, Thomsen C, Male D, Shafey O, Das R, Lackovic M, Arvizu E. Am J Public Health 2003; 93(4): 605-610.
Correspondence: Geoffrey M. Calvert, Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio 45226, USA; (email: jac6@cdc.gov).
OBJECTIVES: The goal of this study was to describe acute occupational pesticide-related illnesses among youths and to provide prevention recommendations.
METHODS: Survey data from 8 states and from poison control center data were analyzed. Illness incidence rates and incidence rate ratios were calculated.
FINDINGS: A total of 531 youths were identified with acute occupational pesticide-related illnesses. Insecticides were responsible for most of these illnesses (68%), most of which were of minor severity (79%). The average annual incidence rate among youths aged 15 to 17 years was 20.4 per billion hours worked, and the incidence rate ratio among youths vs adults was 1.71 (95% confidence interval = 1.53, 1.91).
DISCUSSION: The present findings suggest the need for greater efforts to prevent acute occupational pesticide-related illnesses among adolescents.
OBJECTIVE: To describe the epidemiology and outcomes of patients presenting after near-hanging to an emergency department in the Northern Territory of Australia.
METHODS: A descriptive retrospective review of hospital and retrieval records was made of all patients presenting to the Royal Darwin Hospital between January 1995 and August 2000 as a result of near-hanging.
FINDINGS: There were 72 patients who presented after near-hanging in the study period. The majority of patients were young adult males of Aboriginal descent living in the Tiwi Islands. Psychiatric and drug abuse histories were a prominent feature. No cervical spine injuries were detected and there were no neurological deficits in the survivors.
DISCUSSION: Near-hanging appears to be a significant problem among young indigenous males, especially those from the Tiwi Islands. Strategies to identify risk factors linked to suicide and to help empower families to reduce the incidence of self-harm are integral to addressing this problem.
Sexual orientation and suicide attempt: a longitudinal study of the general Norwegian adolescent population.
Correspondence: Lars Wichstrom, Department of Psychology, Norwegian University of Science and Technology, Trondheim, NORWAY; (email: lars.wichstrom@svt.ntnu.no).
Past and future suicide attempt rates among gay, lesbian, and bisexual (GLB) young people were compared with those of heterosexual young people. A sample of Norwegian students (N = 2.924; grades 7-12) was followed in 3 data collection waves. Risk factors included previous suicide attempt,depressed mood, eating problems, conduct problems, early sexual debut, number of sexual partners, pubertal timing, self-concept,alcohol and drug use, atypical gender roles, loneliness, peer relations, social support, parental attachment, parental monitoring, and suicidal behavior among family and friends. When homosexual attraction, homosexual identity, and same-sex sexual behavior were entered to predict suicide attempt, only same-sex sexual behavior was significantly predictive. The increased odds could not be attributed to GLB students' greater exposure to risk factors for suicide attempt.
A preliminary validation of the Positive and Negative Suicide Ideation (PANSI) inventory with normal adolescent samples.
Correspondence: Augustine Osman, Department of Psychology, The University of Northern Iowa, 334 Baker Hall, Cedar Falls, IA 50614-0505 USA; (email: augustine.osman@uni.edu).
The present study evaluated the factor structure, reliability, and validity of the Positive and Negative Suicide Ideation (PANSI; Osman, Gutierrez, Kopper, Barrios, & Chiros, 1998) inventory in a sample of high-school youths. The PANSI is designed as a measure of risk and protective factors related to suicidal behavior. Participants (114 boys and 103 girls) completed the PANSI and other self-report instruments. Results of the confirmatory factor analyses supported adequate fit of the 2-factor oblique model to the sample data. Both factor scales attained adequate levels of reliability. Boys and girls did not differ in their responses to the PANSI scales. The PANSI scale scores were associated with scores from related measures. Logistic-regression analyses were used to evaluate the contributions of the PANSI scale scores to differentiate between the study groups. Receiver Operating Characteristic (ROC) analyses, using data from the psychiatric suicide risk and high-school control youths, were used to identify cutoff scores of 1.63 and 3.33 for the PANSI-negative and PANSI-positive scales, respectively.
Association between the menses and suicide attempts: a replication study.
- Baca-Garcia E, Diaz-Sastre C, Ceverino A, Saiz-Ruiz J, Diaz FJ, De Leon J. Psychosom Med 2003; 65(2): 237-244.
Correspondence: Jose de Leon, Mental Health Research Center, Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA; (email: jdeleon@uky.ed).
OBJECTIVE: In our prior (first) study, suicide attempts were associated with the menses. The main hypothesis of this replication (second) study is that the proportion of suicide attempters during the menses is significantly higher than the expected probability in the general population.
METHODS: Using the same methodology and setting, this replication naturalistic study included 120 fertile female suicide attempters with regular menstrual cycles during a 1-year period in the emergency room of a general hospital in Madrid, Spain, serving a catchment area of 500,000 people.
FINDINGS: The significant increase in probability of attempting suicide during the menses for the first study was 1.61; for the second study, 1.72; and for both studies combined, 1.68 (95% confidence interval, 1.27-2.09). Thus, using the combined results, the probability of attempting suicide during the menses was 1.68 times higher than the overall probability of attempting suicide for any fertile women. In the catchment area, the population rate of fertile women arriving at the hospital after a suicide attempt was 166 per 100,000. The probability for women during the menses arriving at the hospital after a suicide attempt was significantly higher, 279 per 100,000 (1.68 x 166 per 100,000). The 95% confidence interval was 211 to 347 per 100,000.
DISCUSSION: Despite inherent limitations, this naturalistic study replicates a small but significant increase of suicide attempts during the menses.
Struggling against suicide: the need for an integrative approach.
Correspondence: Diego De Leo, Australian Institute for Suicide Research and Prevention, Griffith University, QLD, AUSTRALIA; (email: D.DeLeo@mailbox.gu.edu.au).
Transcultural comparisons would be beneficial for both our understanding of suicide phenomena and the setting up of preventative strategies. Changes in attitude throughout history, gender and age differences, socio-economic factors, influence of race and ethnicity, and the impact of religion are among the aspects mentioned in this article. All of them can actually have a considerable effect on suicide rates, and all of them should be taken into account when interpreting suicide trends and designing antisuicide strategies. In fact, both risk and protective factors may vary remarkably in different cultures. The need for an integrative approach is evident today more than ever, and this fact calls for more concerted and coordinated, multidisciplinary approaches to suicide prevention.
Suicide in the Ukraine.
- Kondrichin SV, Lester D. Crisis 2002; 23(1): 32-33.
Correspondence: Sergei V. Kondrichin, Institute of Sociology, National Academy of Sciences, Minsk, BELARUS; (email: unavailable).
The suicide rates of the 24 provinces (oblasts) of the Ukraine were found to be strongly associated with indices of social disintegration (such as divorce and illegitimacy rates), with the Western provinces incorporated in the USSR later than other Ukrainian territories having lower suicide rates and lower levels of social disintegration.
The protective role of parental involvement in adolescent suicide.
- Flouri E, Buchanan A. Crisis 2002; 23(1): 17-22.
Correspondence: Eirini Floouri, Department of Social Policy and Social Work, University of Oxford, UK; (email: eirini.flouri@socres.ox.ac.uk).
This study of 2,722 adolescents aged 14-18 years explored whether parental involvement can protect against adolescent suicide attempts. Compared to their counterparts suicide attempters were more likely to have been in trouble with the police, to report lower levels of parental interest and academic motivation, and to report suicidal ideation and using alcohol or an illegal drug when they feel stressed. They were also less likely to reside with both parents. The association between parental involvement and suicidal behavior was not stronger for sons than for daughters or for adolescents who had experienced family disruption than for those who grew up in two-parent families.
Suicide and suicide attempts in Ankara in 1998: results of the WHO/EURO Multicentre Study of Suicidal Behavior.
- Sayil I, Devrimci-Ozguven H; WHO/EURO Multicentre Study of Suicidal Behavior. Crisis 2002; 23(1): 11-16.
Correspondence: Isik Sayil, Psychiatry Department, Medical School of Ankara University, TURKEY; (email: ozguven@medicine.ankara.edu.tr).
BACKGROUND: The rates and associated basic demographic features of attempted and completed suicides in a catchment area in Turkey were investigated as part of the WHO/Euro Multicentre Study of Suicidal Behaviour.
METHOD: All hospitals in the catchment area were screened in order to identify attempted suicides. Statistics for completed suicides were obtained from the State Institute of Statistics (SIS).
FINDINGS: The rates of attempted and completed suicides per 100,000 inhabitants over 15 years of age were 31.9 for males and 85.6 for females, and 9.9 for males and 5.6 for females, respectively. The majority of attempted suicides were in the 15-24-year-old age group, as is the case in all other European countries. The majority of completed suicides were also in the 15-24-year-old age group, although in other European centers most completed suicides occur in the 40+ age group. The most frequent methods were overdose for attempted suicide and hanging for completed suicide. The rates of both attempted and completed suicides were lower than those of other participating centers in Europe.
DISCUSSION: Male sex is a risk factor for completed suicide and female sex is a risk factor for attempted suicide, while an age of 15-24 years may be a risk factor for both groups.
Incidence of completed and attempted suicide in Trabzon, Turkey.
- Bilici M, Bekaroglu M, Hocaoglu C, Gurpinar S, Soylu C, Uluutku N. Crisis 2002; 23(1): 3-10.
Correspondence: Mustafa Bilici, Karadeniz Technical University, School of Medicine, Department of Psychiatry, Trabzon,TURKEY; (email: mbilici@meds.ktu.edu.tr).
OBJECTIVE: Studies of completed and attempted suicide in Turkey are based on data of State Institute of Statistics (SIS) and emergency clinics of the large hospitals. This study seeks (1) to find, independent of the SIS and hospital data, the annual incidences of completed and attempted suicide in Trabzon, Turkey; (2) to examine the associated factors between the incidence of completed and attempted suicide.
METHOD: The data are derived by using a method specially designed for this study. Data sources include emergency clinics in all hospitals, village clinics, the Forensic Medical Center of Trabzon, the Governorship of Trabzon, "mukhtars" (local village representatives) of neighborhoods, the Office of the Public Prosecutor of Trabzon, the Police Headquarters and Gendarmerie, and the local press organs.
FINDINGS: The incidences of completed and attempted suicide per 100,000 inhabitants turned out to be 2.60 and 31.5, respectively, whereas the SIS reported the incidence of completed suicide to be 1.11 per 100,000 inhabitants in Trabzon in 1995.
DISCUSSION: Our results demonstrate that SIS data are inadequate for suicide research in Turkey. Our findings show that the risk of completed and attempted suicide is high in young, unmarried, and unemployed persons, and that these groups must be carefully evaluated for suicide risk. The study highlights the need for culture-specific research on suicidal behavior in Turkey.
Correspondence: Daniel R. Mayhew, Traffic Injury Research Foundation, Suite 200, 171 Nepean Street, Ont., K2P 0B4, Ottawa, CANADA; (email: danm@trafficinjuryresearch.com).
Since the mid-1980s there has been concern about the growing number of female drivers in the US involved in fatal motor vehicle crashes, and similar trends have been noted in other parts of the world. The present study examined whether this trend has continued into the 1990s and the reasons for it. Fatal crash data were obtained from the Fatality Analysis Reporting System (FARS), mileage data from the National Personal Transportation Survey, and licensure data from the Federal Highway Administration. Many more women were licensed to drive in 1998 than in 1975, and on average they drove more miles. When changes in total annual mileage were taken into account, per-mile crash rates decreased similarly for men and women (about 40%). An examination of the characteristics of their fatal crashes revealed that male and female drivers have seen similar reductions in single-vehicle, nighttime, and alcohol-related crashes. However, men continue to be involved more often in these types of crashes.
The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers.
Correspondence:Cynthia Owsley, Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham (UAB), 700 South 18th Street, Suite 609, Birmingham, AL 35294-0009, USA; (email: owsley@eyes.uab.edu).
Visual processing impairment increases crash risk among older drivers. Many older drivers meet the legal requirements for licensing despite having vision impairments that elevate crash risk. In this study, 365 older drivers who were licensed, visually-impaired, and crash-involved in the prior year were randomly assigned to an intervention group or usual-eye-care control group to evaluate the efficacy of an educational intervention that promoted the performance of self-regulatory practices. The educational curriculum was designed to change self-perceptions about vision impairment and how it can impact driver safety and to promote the avoidance of challenging driving situations through self-regulation, leading to reductions in driving exposure. Analyses compared the intervention and control groups at pre-test and 6 months post-test with respect to self-reported perceptions about vision and driving practices. At post-test, drivers who had received the educational intervention were more likely to acknowledge that the quality of their eyesight was less than excellent, report a higher frequency of avoiding challenging driving situations (e.g. left-turns) and report performing more self-regulatory practices (e.g. three right-turns) as compared to controls. Additionally, drivers in the educational intervention group reported significantly fewer days, fewer places and fewer trips made per week as compared to those not receiving the educational intervention. These findings imply that visually-impaired older drivers at higher risk for crash involvement may benefit from educational interventions by reducing their driving exposure and increasing their avoidance of visually challenging driving situations. A critical future step in this research program will be to examine whether this educational intervention has an impact on the safety of these high-risk older drivers by reducing their crash involvement in the years following the educational intervention.
Obstacles to implementing research outcomes in community settings.
- Ball K, Wadley V, Roenker D. Gerontologist 2003; 43(Spec No 1): 29-36.
Correspondence: Karlene K. Ball, Department of Psychology, University of Alabama at Birmingham, 35294-2100, USA; (email: kball@uab.edu).
In contrast to controlled laboratory- or clinic-based research that can fail to capture the real-world behaviors of older adults, field research offers the best opportunity for ecological validity. However, the tradeoff inherent in field studies is the potential sacrifice of scientific rigor. Applied research presents a unique set of challenges that vary with context. This article discusses these challenges along with possible solutions. Examples are drawn from an ongoing, longitudinal Roybal Center study of driving competence that is being conducted in Department of Motor Vehicles field sites. The challenges faced at each stage of the project are discussed. Methodological issues include identifying field collaborators, approaching administrators with the research proposal, producing a battery that is manageable and acceptable while maintaining scientific merit, training indigenous personnel to administer this battery, introducing the research and consenting potential participants, and managing large data sets offsite. Additional issues include quality control, the importance of distinguishing between individuals who consent and those who decline participation, and the collection of follow-up data via telephone. The use of field research in changing public perceptions, medical practice, and public policy is discussed.
Gender differences in the relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents.
Correspondence: Richard A. Bryant, School of Psychology, University of New South Wales,Sydney, New South Wales 2052, AUSTRALIA; (email: r.bryant@unsw.edu.au).
Objective: Acute stress disorder (ASD) describes initial posttraumatic stress reactions that purportedly predict subsequent posttraumatic stress disorder (PTSD). This study aimed to index the influence of gender on the relationship between ASD and PTSD.
Method: Motor vehicle accident survivors were assessed for ASD within 1-month posttrauma (n = 171) and were subsequently assessed for PTSD 6-months later (n = 134).
Findings: Acute stress disorder was diagnosed in 8% of males and 23% of females, and PTSD was diagnosed in 15% of males and 38% of females. In terms of patients followed up at 6 months, 57% and 92% of males and females, respectively, who met criteria for ASD were diagnosed with PTSD. Females displayed significantly more peritraumatic dissociation than males. Conclusion: Peritraumatic dissociation and ASD is a more accurate predictor of PTSD in females than males. This gender difference may be explained in terms of response bias or biological differences in trauma response between males and females.
Correspondence: Teresa L. Albright, MD, Corpus Christi Family Practice Residency Program, 2606 Hospital Blvd, Corpus Christi, TX 78405, USA; (email: albright@uthscsa.edu).
BACKGROUND: Firearm injury is the leading cause of injury-related death among youth and second leading cause of injury-related death overall in the United States.
OBJECTIVE: Our objective is to determine the impact of brief office counseling by family physicians on patients' firearm storage habits.
METHODS: Of the 1,233 patients who completed the enrollment questionnaire, 156 (13%) reported they had guns in their household and agreed to participate in the study. Postintervention survey instruments were completed by 127 (81%) of participants. Participants received either no counseling, verbal counseling alone, or counseling and a gun safety brochure from their physician. Firearm storage habits were measured at baseline and 60 to 90 days after intervention.
FINDINGS: At the postintervention interview, 64% of the group receiving verbal counseling and 58% of the group receiving verbal counseling plus written information made a safe change in gun storage compared with 33% of participants in the no-intervention group (P =. 02). A logistic regression model controlling for demographics and gun ownership showed that compared with the no-intervention group, intervention participants were three times more likely to make safe changes.
DISCUSSION: Family physicians' brief counseling efforts made a significant positive impact in the firearm storage habits of their patients. With a verbal or written recommendation, a significant improvement was observed in firearm storage.
Source of firearms used by students in school-associated violent deaths--United States, 1992-1999.
- Reza A, Modzeleski GW, Feucht T, Anderson M, Simon TR, Barrios L. MMWR 2003; 52(9): 169-172.
During July 1, 1992-June 30, 1999, a total of 323 school-associated violent death events occurred in the United States, resulting in 358 deaths. To guide prevention efforts, CDC examined school-associated firearm violent death events committed by students in elementary and secondary schools in the United States and determined the sources of the firearms used in these events. The findings indicate that, among the incidents for which data are available, the majority of the firearms used in these events were obtained from perpetrators' homes or from friends or relatives. The safe storage of firearms is critically important and should be continued. In addition, other strategies that might prevent firearm-related injuries and deaths among students, such as safety and design changes for firearms, should be evaluated.
Filicide: a review of eight years of clinical experience.
Correspondence: Rokeya Farooque, Department of Psychiatry, Neurology, and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee, USA; (email: unavailable).
Filicide is a form of family violence in which a child is killed by his or her own parent. Most of the literature on filicide addresses the association of mental illness, motivation, and other risk factors with the perpetration of filicide. However, almost no research has addressed the intellectual functioning of perpetrators. We investigated intellectual functioning in a collection of forensic cases seen by the first author over an eight-year period. Nineteen patients who underwent forensic psychiatric evaluation for filicide from August of 1993 to April of 2001 were studied using retrospective case review methodology. Data were obtained from medical and forensic records, reports of family members, legal documents, and other collateral sources. We found that mental illness is common among perpetrators, supporting other findings in the literature. In addition, we found a high frequency of substance abuse among parents who killed their children. However, we also found a significant frequency of intellectual impairment and argue that this factor may have been overlooked in the history of filicide investigations. Familial psychodynamics of filicide will be reviewed and discussed.
When is the personal professional in public child welfare practice?. The influence of intimate partner and child abuse histories on workers in domestic violence cases.
Correspondence: Meiko Yoshihama, University of Michigan School of Social Work, 1080 S. University, 48109-1106, Ann Arbor, MI, USA; (email: miekoy@umich.edu.
OBJECTIVE: The objective of this article is to examine children's services workers' (CSWs') personal histories of abuse and their influence on professional responses to allegations of domestic violence.
METHOD: Using an anonymous questionnaire, data were collected from CSWs in two large urban counties in Southern California who participated in a domestic violence training program (n=303). It was hypothesized that CSWs' responses to domestic violence cases would be affected by personal histories of abuse and the degree to which the CSWs identified with battered women.
RESULTS: Approximately one-half of the respondents reported experiencing physical and/or sexual violence by an intimate partner. One-third of respondents reported physical abuse, and 22%, sexual abuse during childhood. The experience of childhood sexual abuse, especially for female CSWs, was associated with increased support for removal of children whose mother is being abused. Those CSWs with a history of partner violence who identified with battered women were less likely to approve of removing children from the battered mother than were CSWs without partner abuse history or identification with battered women.
DISCUSSION: Our findings provide support for expanded training efforts that recognize the ongoing impact of victimization on CSWs' professional functioning.
Abusive head trauma in Maine infants: medical, child protective, and law enforcement analysis.
- Ricci L, Giantris A, Merriam P, Hodge S, Doyle T. Child Abuse Negl 2003; 27(3): 271-283.
Correspondence: Lawrence Ricci, The Spurwink Child Abuse Program, 17 Bishop Street, 04103, Portland, ME, USA; (email: unavailable).
OBJECTIVE: To collect and compare the results of medical, child protective, and law enforcement evaluation of a sample of Maine children who were victims of abusive head trauma (AHT) in order to describe the clinical and evaluative characteristics as they relate to victims, families and perpetrators of such trauma and to improve the professional response to AHT in Maine.
METHOD: Retrospective chart review of medical, child protective, and law enforcement records of all AHT victims admitted to two tertiary care hospitals in Maine or seen by the state medical examiner from 1991 to 1994.
FINDINGS: Nineteen children (age range 2 weeks to 17 months) were identified as victims of AHT (out of a total of 94 head trauma admissions) accounting for 20 hospitalizations during the study period. There was a history of prior injury in 30%, history of prior medical evaluations for possibly abuse related problems in 65%, while, on presentation, 75% had evidence or history of prior injury. The hospitals notified child protective services (CPS) in all 20 cases and correctly identified abuse in 18 (90%). Parental risk factors for abuse identified in CPS records included substance abuse (53%), domestic violence (42%), criminal history (32%), unrealistic expectations (42%), and attachment problems (32%). However, risk factors were inadequately assessed in 53% of homes. Law enforcement identified a likely perpetrator in 79% of cases and in the majority the identified suspect was the father. In the 15 cases where a perpetrator was identified by law enforcement, that person was alone with the child at symptom onset in 14 (93%).
DISCUSSION: The medical response, at least at the inpatient level, was generally well done with regard to suspicion and reporting. Cases are possibly being missed at the outpatient level. Child protective risk assessment was limited overall yet in a third of the homes where AHT occurred, few if any risk factors were present to aid in identification and prevention. Law enforcement results suggest that a primary suspect for AHT is the caretaker alone with the child at the time of symptom onset.
